Date of Award

Summer 8-9-2016

Level of Access Assigned by Author

Campus-Only Dissertation

Degree Name

Doctor of Philosophy (PhD)


Interdisciplinary Program


Darren Ranco

Second Committee Member

Gail Dana-Sacco

Third Committee Member

Lisa Neuman

Additional Committee Members

Linda Silka

Marcella Sorg




By Mary Jude

Dissertation Advisor: Dr. Darren J. Ranco, PhD

An Abstract of the Dissertation

Presented in Partial Fulfillment of the Requirements for the

Degree of Doctor of Philosophy

(Interdisciplinary in Anthropology, Public Health & Public Policy)

August 2016

Despite marked improvements in access to healthcare, researchers continue to report substantial health disparities among Indigenous people (Indian Health Services Fact Sheet, October 2009; Roubideaux, 2013). This study examines the relationship of history, culture and policy to the health of Maine’s Native American population.

Identification of the upstream causes that result in poor health outcomes for Native Americans is fundamental to finding workable solutions, yet the underlying causes remain largely undefined. After considering these issues for some time, my research question became: Why do tribal health disparities persist, despite advances in modern medicine and increased access to care?

Initial research efforts identified the negative influences of historical trauma (HT) on today’s health outcomes (Brave Heart, 1998). Interviews with tribal members and both Native and non-Native policy members described historically oppressive colonization policies at both the state and federal level, with community resiliency emerging as a positive protective factor.

This process caused me to re-consider the concept of health disparities and in doing so, to begin to understand that not only was I observing the issues through a Western, medicalized lens, but that most attempts at addressing poor health outcomes are also directed through the Western evidence base. Although colonization practices and the resultant historical trauma response are of foundational importance, the lack of an Indigenous evidence base may be the critical reason that health outcomes for Native Americans have not shown marked improvements over time.

Future efforts to address tribal health will require a community-based approach tailored to the culture and health practices of Native populations, using Indigenous research methods to further the development of an Indigenous evidence base. It will be the obligation of the Academy to provide the support needed to help Native Mainers re- define health and appropriate interventions on their own terms.

Key Words: health disparities, Native Americans, colonizing behaviors, Indigenous, resiliency, historical trauma, historical trauma response, evidence base, Indigenous evidence base, Indigenous research methods.