Health Justice Begins with ACKNOWLEDGMENT

Written by Timian Godfrey, DNP, MSN, APRN, FNP-BC

It is imperative to begin by acknowledging the homelands of the Piscataway Conoy Tribe, on which Johns Hopkins University and the School of Nursing is built. I honor and give respect to my Indigenous brothers and sisters who are the traditional owners of land of the Chesapeake Bay region.

Acknowledgment… this word stimulates so many thoughts and feelings.

Throughout the COVID-19 pandemic, I have repeatedly heard the phrase, “Native American communities are disproportionately affected by the coronavirus pandemic.” However, this statement is not new to me. Even before the pandemic, throughout my nursing education, similar phrases like, “Native Americans have a life expectancy lower than the general U.S. population” or “American Indian and Alaska Native people suffer disproportionately from diabetes, chronic kidney disease, heart disease, cancer, chronic liver disease, suicide, assault, substance use…” occurred regularly in the literature and classroom.

Now, once again, my people are disproportionately affected.

Upon reflection of this disturbing trend, it is impossible to ignore the social determinants of health when examining the health disparities existing in Native communities. We must further acknowledge distinctive factors directly impacting the continual disparities of chronic disease, violence, poverty and now the effects of the pandemic. Prolonged racism, colonialism, loss of traditional lands, boarding schools, commodity food programs, food insecurity, tribal/government relations, genocide, historical trauma, adverse childhood experiences, and intergenerational trauma are all examples of the Indigenous Social Determinants of Health significantly contributing to the egregious inequities we see today.

Full acknowledgement of the societal treatment of marginalized people in creating existing conditions is necessary to adopting and integrating cultural humility into our clinical, research and pedagogical practices as nurses.

In addition to cultural humility, cultural rigor needs to be taken as seriously as scientific rigor.

Especially now that the pandemic has accelerated health practice innovation at a rapid pace, cultural rigor is of utmost importance. Science must acknowledge that the expertise resides within the tribal communities when developing relief efforts and community health programs. Without full collaboration with Indigenous communities, success is not likely, and the disparities will persist. In fact, as we have seen in history, harm often occurs when scientific activities are conducted without cultural humility and cultural rigor. As nurses, we are uniquely positioned to greatly impact the lives and well-being of our patients, their families and communities in a meaningful way. We must acknowledge the powerful effect cultural reverence has on health outcomes. Displaying the moral courage to ensure cultural rigor is upheld supports our commitment to ethical practice and social justice.

As an Indigenous nurse, I am honored to have held the hands of, and advocated for those suffering from some the greatest health inequities and social injustices. When I look into the eyes of the Native people I care for, the Native students I teach, and my family, I see generations of resiliency and strength. Empowering the people and communities of our Indigenous Nations through culture and traditional practices is the answer to addressing the health disparities described in scientific literature. Fostering symbiotic partnerships with Native communities by acknowledging and utilizing a strengths-based approach to develop education, health, and socioeconomic policies designed to promote to the traditional values of these sovereign Nations is the way towards health equity.

Only when we as a society acknowledge the injustice that has been inflicted upon Indigenous Peoples in this country, and strive to rectify centuries of wrongdoing, then will we start to progress towards health justice.

Especially during the Year of the Nurse, we are morally obligated to employ cultural reverence in our practice to achieve optimal outcomes for our Native students, patients and communities by creating environments respecting traditions and culture. Further, we must prepare nurses who are ready to stand for social justice and the values that the profession clearly embraces.  

My ancestors fought tirelessly to break down many barriers that have allowed me to become a nurse. To answer the call of my ancestors and to honor them, I have the bestowed responsibility to do the same and pave the way for future generations. As a nurse in academia, I have made a commitment to increasing diversity in the nursing workforce and create organizational structures to support students differently prepared/advantaged in attaining a nursing education. These students will then return and significantly impact the health of their communities.

We must acknowledge that our actions and how we treat one another have a ripple effect on the health of populations.

I want my two young daughters to grow up learning from Native nurses, educators, and scientists who have changed the world. I want them to grow up acknowledging their sacred culture as a strength. I want them to be proud of their heritage and proud of who they are. These wishes are possible through concerted effort to practice cultural reverence and move beyond acknowledgement to no longer tolerating systemic discrimination.

Ahéhee’ (with gratitude in Navajo)

This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.

Read more:

• Get to Know Timian Godfrey, DNP, APRN, FNP-BC, CPH
• Faced with a Pandemic, “Little Holy One” is Guided by Indigenous Values
• Indigenous communities are resilient, but stretched too thin, in the face of COVID-19
• A Q&A with Natalie Nicholson and Amanda Wyatt, Native Nurses and DNP Executive Track Students
• Fort Peck Indian Reservation: The Healthy People Factory
• Acknowledging the Land on Which we Build
• Center for American Indian Health

ABOUT THE AUTHOR: TIMIAN GODFREY

Dr. Timian Godfrey is a member of the Navajo Nation and belongs to the Red Bottom clan with her maternal grandfather being from the Salt clan. Dr. Godfrey graduated from the Johns Hopkins University School of Nursing DNP Executive Track in 2019, and simultaneously attained certification in American Indian Health from the Center for American Indian Health at the Bloomberg School of Public Health. Currently, she is a Clinical Assistant Professor at the University of Arizona College of Nursing in the FNP-DNP program. Dr. Godfrey has more than 17 years of health care experience working in the capacities of a certified nursing assistant, emergency medical technician, registered nurse, and now as a nurse practitioner. Dr. Godfrey also works as an advanced practice clinician with TribalEM, an emergency medicine leadership company that works exclusively with government and tribal health programs. A primary motivation to pursue a nursing career is her personal conviction in Hózhó , a Navajo holistic belief that health and well-being for all living things results in physical and spiritual beauty, harmony and goodness. It is often said that one must “walk in beauty.” Dr. Godfrey believes this statement aligns with the mission of nursing.