Fieland, K. C., Walters, K. L., & Simoni, J. M. (2007). Determinants of health among two-spirit American Indians and Alaska Natives.

Introduction

In comparison to other racial/ethnic groups, American Indians and Alaska Natives (AIANs or “Natives”) suffer from glaring disparities in health-related resources and outcomes. Specifically, morbidity due to violence and substance use is higher and overall mortality is greater (Indian Health Service [IHS], 2001). AIANs who identify as gay, lesbian, bisexual, or transgender (GLBT) or with the modern roughly equiva- lent Native term “two-spirit” (hereafter collectively referred to as “two- spirits”) face additional stressors associated with negotiating their dual oppressed statuses. They often confront heterosexism from Natives and racism from GLBTs. Not surprisingly, two-spirits are thought to be at even greater risk for adverse health outcomes than other Natives (Walters, 1997; Walters et al., 2001). Preliminary empirical evidence supports the notion that two-spirits experience disproportionately greater anti-gay as well as anti-Native violence, including sexual and physical assault during childhood and adulthood (Walters et al., 2001; Simoni et al., 2004a) and historical trauma (Balsam et al., 2004)—expe- riences that are typically linked to adverse health and psychosocial functioning. Despite the considerable heterogeneity both within and across the more than 562 federally recognized tribes in the United States, the universal experience of colonization has created a shared history for two-spirit people, shaping distinctive conditions of health risk and resilience.

The health problems of AIANs in general and two-spirits in partic- ular are not simply an artifact of Native genetics, culture, or way of life.

Rather, historical and contemporary trauma in concert with sociode- mographic vulnerabilities have interacted to undermine the physical and mental health of indigenous populations (Walters & Simoni, 2002). Precisely how these factors affect the health of two-spirits has yet to be empirically evaluated. Indeed, public health research and practice has given scant attention to AIAN populations and has virtually ignored two-spirits: There are no comprehensive reviews of two-spirit health or health-related issues and few empirical studies of even modest scope.

The major aim of this chapter is to stimulate work in the area of two- spirit health by providing a foundation for the conceptualization of two-spirit health risks and resilience. We review the available litera- ture, highlight major gaps in the knowledge base, and provide directions for future research. We first provide an overview of the his- torical experience of two-spirit people and of the literature on Native health, including morbidity and mortality statistics. We then present the “indigenist” stress-coping model of Walters et al. (2002) as a framework by which to conceptualize how historical, structural, inter- personal, and cultural factors affect two-spirit health outcomes. Research related to some of these health-determining factors is then reviewed. Given the dearth of studies focusing on two-spirits, we refer mainly to studies of AIANs and other people of color as well as GLBT populations, which are almost exclusively non-Native. We conclude with a list of “decolonizing” strategies for future research on two-spirit health.