Nályééh (pronounced Nah ahl yeh) = Navajo word meaning 'giving back' in the form of a pay back to a due owed.

In the summer of 2007, a cadre of hundreds of volunteers worked tirelessly in the American Indian communities of North Carolina to fulfill nályééh.

Native Health Initiative volunteers

Without speaking to the individual projects that transpired, the process behind this summer and the Native Health Initiative’s work over the past three years is worth exploring, hoping that what we have learned can be transferred to programs in other populations and communities. We will look at three unique aspects of this program – ownership, framework and coalition-building.

Ownership

“What we’ve seen in the past is that when outsiders come in they want to force changes”

        -  Mark Deese (Tuscarora), NHI Mentor

When volunteers arrive in North Carolina, their questions as to what exactly they will be doing are answered by the NHI coordinators with, “Not quite sure.” Indeed, the locus of control within NHI’s projects rests in the hands of community leaders, known as NHI Mentors. These Mentors develop projects based on the areas of highest need in their Tribes, along with consideration of which projects will be most sustainable given the community’s resources. This has been a priority for NHI since its inception, which took place, not on a college campus, but in a meeting of community and health leaders in a Pembroke church. (Pembroke is the center of the Lumbee Tribe’s community, and is the largest American Indian community in the Eastern United States). At this meeting, the name of the project, along with its core principles, were decided.

Though there are challenges that arise with this approach, we have seen an unprecedented amount of community support for NHI because of the Tribal ownership of the project. NHI has taken further steps to ensure this, such as mandating that at least 50 percent of any grant won by NHI will be directed to our community partners.    

Framework

“The fact that American Indians live sicker and die younger is an injustice, and we must call it for what it is. Period.”

        - Shannon Fleg (Navajo), NHI co-coordinator

NHI operates on a unique conceptual framework that leads to concrete outcomes. First, we use health equity, the absence of systematic differences in health across population groups[i], as our gold standard for our work, believing that (1) the majority of disparities in health in the United States are unjust, unfair and preventable, and should therefore be called as such – health inequties, and (2) that health equity is a needed gold standard, reminding us that nothing short of the elimination of inequities in health is ethically acceptable.

Secondly, NHI operates under the model of loving service as our guide in this work. Taken largely from the example lived out in indigenous culture, loving service reminds us that our ultimate goal in this work is to give from our hearts, to share our cultures and lives with one another, and to never forget the value of the people we are working alongside. The aspect of nályééh is central to this work, as NHI’s students and community members work with a sense of humble indebtedness, espousing the “savior ethic” only insofar as promising to save (and change) ourselves.

This framework has tangible results. For instance, the spirit of loving service has allowed NHI to build genuine relationships and trust that allowed us to carry out a summer program in 2007 for $4,000 that would otherwise have cost more than $50,000; In other words, in-kind donations, based simply on the human-to-human connections fostered by NHI, are our primary funding source! While it is more difficult to see a change in the way of health statistics regarding health equity, we do know that NHI has become an educator of thousands of health professionals of tomorrow on this subject, through our various projects, lectures, workshops, and most recently, through the creation of a course in American Indian health at the UNC School of Medicine.

Coalition-building

“It is amazing how much gets done when no one cares who gets the credit”

        - NHI mantra  

Initially, NHI’s partners included the American Indian tribes of North Carolina, organizations within these Tribal communities, and the N.C. Commission of Indian Affairs. The hesitation to partner with a university or university-affiliated programs was well-founded initially considering the history of exploitative research in American Indian communities by such institutions.

However, as NHI gained the trust of the American Indian community, many benefits arose to partnering with organizations beyond the indigenous community, including the chance to put American Indian health on the agenda of minority health and service-learning groups that had never before worked with this population. “I think one of the most important aspects of building partnerships in our work is the ability, in a non-confrontational way, to remind people that American Indians are often the forgotten minority, relegated to long-ago history, left to suffer in obscurity,” says NHI co-coordinator Shannon Fleg.

What has emerged from NHI’s partnerships is a growing attention to American Indians within the UNC campus community, along with a larger sense of the common struggles and injustices facing communities of color throughout the state and country.

We hope that our fellow APHA members will find this description of the Native Health Initiative’s approach insightful, and useful to your specific programs and communities. The issues of ownership, framework and coalition-building are essential for our collective work in empowering communities to better health, and moving away from the ivory tower approach to “doing public health.” Moreover, we hope that NHI turns our collective energies to seek the Navajo principle of nályééh as our guide, replacing NIH funding and publications as our measure for our work.  

Please read more about our project and contact us with questions or opportunities for partnerships at www.unc.edu/~flega.