This health disparities framework emphasizes the genetic, biological, environmental, social, political, and cultural influences on the health of individuals and populations. It highlights multiple points of intersection and their iterative effects. All elements operate in the context of the birth status of people in the target population, such as genetics, race, ethnicity, age, sex, and tribal affiliation, as well as ascribed status deriving from education, income, and occupation.
It offers a systematic approach by which to identify and locate influences that may be especially relevant to understanding the health and well being of American Indians and Alaska Natives. This is particularly true in regard to determinants thought to be salient for this population, but which are often not considered by conventional research because they reside outside of the normal experience of non-Native groups. Examples include spirituality, collective resilience, historical trauma, non-biomedical constructions of illness, traditional healing resources, boarding school education, alternate financing and structure of healthcare, tribal sovereignty, major federal Indian policies, and the like. As depicted in the above table, such determinants fall naturally within these dimensions of influence, and can be readily operationalized, measured, and analyzed in ways analogous to their conceptual counterparts for other populations.
