American Indian Culture and Research Journal

In the past five years, there has been a surge in the attention shown to community and community-based health programs among Native Americans, particularly for chronic health problems such as diabetes. New Mexico’s Native American Diabetes Project, a diabetes education and gardening project in the American Northwest, and the Daya Tibi health center in Poplar, Montana are just a few of the programs to report outcome success using a community-based model. What do these projects have in common, and to what does community-based refer? Is community participation, as Bell and Franceys declare, just a euphemism for unpaid labor? Community participation in health programming—from the efforts of community health workers (CHWs), to participatory research, to the impact of politics on community health programs—has been a popular approach in anthropology and public health since the late 1970s and is now a hackneyed expression in health programming. As part of a comprehensive edited volume on the subject, Barbara Israel et al. declare community participation to be not a method but an orientation based upon nine principles such as the facilitation of collaborative, equitable partnerships in all phases of the work; promotion of colearning and capacity building among partners; and the involvement of systems development through a cyclical and iterative process. This discussion offers a view of community participation from Indian country. One major impetus behind this resurgence of “community”-developed programs for Native Americans is the momentum of self-determination. The era of tribal self-determination, stemming from the 1975 Self-Determination Act among other pieces of legislation, is nascent in its capacity to produce novel, culturally relevant, and community-minded programs in health. Tribal councils and other governing bodies have increasingly demanded participatory methods of research, health care, and education from both Native and non-Native professionals. It is little wonder, then, that these terms fill the titles of public health, medical anthropology, and even diabetes care literature on tribes. Tribes have motivated this transformation.