High Alert Institute



Tribal, Cultural and Extended Family Factors as Determinants of Health – A Cautionary Tale

by | Nov 1, 2022

Co-Authors: Elizabeth M. Pepe, DO, FACOFP & Allison A. Sakara, NP, MSN, RN, PHRN 

“Nature was not dangerous but hospitable, not forbidding but friendly. Our faith sought the harmony of man with his surroundings. The other sought the dominance of surroundings. For us, the world was full of beauty. For the other, it was a place to be endured until he went to another world. But we were wise. We knew that man’s heart, away from nature, becomes hard.”
– Luther Standing Bear

In this series of Determinants of Health in a One Health/One Nature One Framework paradigm, we explored 4 of 5 important determinants of health topics that have not been consistently part of the Social Determinants of Health conversation. 

  • Non-human species (animals and plants)
  • Individual behaviors/choices
  • Shared environments
  • Regional environments
  • Mental health environments 

This final article explores the influence of tribal and extended families as a determinant of health. Studies show that, in cultures where the nuclear family is the norm to the exclusion of the extended or tribal family, health outcomes for the same illnesses are different than in cultures where these norms are reversed. This is similarly true for animals – the benefits and threats to health for animals in a group vs living in isolation are not the same. 

As the United States celebrates Indigenous Peoples past and present during Native American Heritage Month, we explore the impact of tribal and extended families through the lens of the experience of Indigenous Peoples. 

In the 2022 Proclamation on National Native American Heritage Month, the Whitehouse acknowledges that the United States has not always delivered on its promise of equal dignity and respect for Native Americans.  

“For centuries, broken treaties, dispossession of ancestral lands, and policies of assimilation and termination sought to decimate Native populations and their ways of life.  But despite this painful history, Indigenous peoples, their governments, and their communities have persevered and flourished.  As teachers and scholars, scientists and doctors, writers and artists, business leaders and elected officials, heroes in uniform, and so much more, they have made immeasurable contributions to our country’s progress.”

“We are also helping Native communities heal from intergenerational trauma caused by past policies.  Last year, the Department of the Interior launched the Federal Indian Boarding School Initiative to shed light on the harmful history of forced cultural assimilation at these academic institutions.  We are investing in Tribal language revitalization, protecting Tribal voting rights, and working with Tribal partners to tackle the crisis of missing or murdered Indigenous people.” 

Prior to the arrival of Europeans in North America, the Indigenous people led a simple life, they were North America’s first and most complete One Health/One Nature/One Medicine culture, treating and curing illness with herbal and traditional medicine, gathering season foods, harvesting animals for sustenance only, never taking more than what they needed. Food has always been a significant source of Native identity, cultural expression, and tribal participation. They foraged for fresh and healthy greens, fruits, and other unadulterated food items which were in-season at the time of need. Although smoking of meats was practiced, Indigenous Peoples obtained all the nutritional requirements needed from their traditional foods. They were true hunter-gatherers, lived in true communities, and children were taught how to live, survive, and thrive in the traditional “old ways”. Traditional food is associated with better health, staves off hunger longer than processed food, tastes better and is more nutritious than many of the foods introduced by the Europeans and later the American government. The Indigenous Peoples were generous with each other, respected other members of their tribes, took care of their elders, and balanced daily life with a spirituality involving the earth and all of its creatures. 

As more and more non-natives arrived, the indigenous people were forced into ever-shrinking areas and were forced to begin a new way of life. Changes in lifestyle were influenced by the many treaties with Native Tribes. In addition to the loss of the cultural relationship with the natural environment came changes in the regional environment as Tribal Nations were relocated and treaties broken. The lands upon which they depended for their food, shelter, clothing and medicine now had restricted access. As Indigenous Peoples were systematically “westernized” they lost the autonomy to make decisions regarding their determinants of health. They were also forced to gain employment, which further restricted their ability to obtain nutritious traditional food via their past hunter/gather activities or pursue their traditional cultural activities. This change in diet is thought to have been the catalyst for the unprecedented sudden rise in chronic diseases such as obesity, diabetes mellitus, hypertension, chronic kidney disease, and heart disease.

Due to the disruption of the traditional determinants of health associated with tribal and extended family influences, Indigenous Peoples now suffer overwhelming rates of obesity, diabetes, and heart disease. Many studies have been performed as to the possible causes and mitigations which could be performed. As a result, Indigenous People in the US now have access to impressive free medical clinics consisting of primary care, pediatrics, dental, optometry, on-site pharmacies, physical therapy, behavioral health, dietary and nutrition clinics, smoking cessation programs, and encourage exercise, some clinics even have exercise facilities. Some clinics in especially rural areas also have an emergency department and inpatient care as they are considered to be critical access facilities. These clinics are funded by the Indian Health Services (IHS), grants, and the federal government. These clinics utilize electronic health records (EHR) and “best practices” to promote routine and essential preventive medicine services. While the clinics now offer wonderful services, health care can still be considered inequitable due to the difficulty in reaching the tribal-approved clinic. 

Tribal, cultural and extended family factors are generally positive determinants of health. The experience of Indigenous Peoples is a cautionary tale for the negative impact of disrupting these traditional practices and imposing the practices of another cultural system.

Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.

Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.

The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). 

The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.

The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.

The High Alert Institute has partnered with Shutterstock to distribute stock images from the nature images donated by our supporters. For eligible stock images, Shutterstock will donate a portion of the royalty to the High Alert Institute. There is no cost to charitable organizations or to Shutterstock customers.

For eligible purchases through AmazonSmile, the AmazonSmile Foundation will donate 0.5% of the purchase price to the High Alert Institute. There is no cost to charitable organizations or to AmazonSmile customers. All you need to do is push the SMILE NOW button and select to support THE HIGH ALERT INSTITUTE on AmazonSmile.

Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.

Have you always wanted a Koi pond but don’t have the space one? Sponsor a Koi in our community shelter pond and we send you photos of your sponsored animal. Coming soon are live Koi Cameras above and below the water to enjoy your sponsored Koi anytime.

Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this  association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.

Want to share our cause with family, friends, and colleagues? Looking for a non-traditional way to celebrate a birthday or honor someone special? Support the Institute by starting your own Peer-to-Peer fundraising challenge! Let your contacts know why our mission is important to you and what they can do to support your cause. START YOUR OWN FUNDRAISER for the High Alert Institute.

From the staffing pool to the shelter ponds, from the boardroom to the classroom, and from reading the science to writing the analyses, High Alert Institute programs and services benefit from the experience, expertise, and generosity of our volunteers. Put your talents to use for good and to good use – VOLUNTEER TODAY.

Make your donation twice as nice by rehoming aquatic pets and providing a rehabilitation companion pet to a deserving person, family, or facility. Sponsor part or all of a Joy of Koi Program pond installation – complete with rehomed koi – and give the gifts of love and recovery.

Professional photographers, amateurs, and legal copywrite holders are all welcome to participate in the High Alert Institute Nature Photo Donation Program. Sales of the images benefit the Institute and donors are eligible for tax deductions equivalent to the fair market value of their photos. Landscapes, seascapes, animals, flowers – all may be accepted – whether new or vintage  images. People may be included in the photo but only if unidentifiable (i.e., blurred figures at a distance).

Did you know that unused patents and copyrights can be donated to charity? Intellectual Property (IP) just sitting on a shelf will lose value as it becomes obsolete. The High Alert Institute IP Donation Program seeks to rescue stranded, technology-related IP with the potential for development into marketable products. Once accepted by the program, the owner/inventor is eligible for a tax deduction equivalent to the fair market value of the IP. The Institute receives the patent licensing fees or revenue from the sale of the IP to businesses, helping us to fund our mission. In turn, businesses are able to advance their markets and create jobs for less money than starting a project from scratch.

Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.

Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.

Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.

Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.

We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.

The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.

When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.

Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency  plans for natural and manmade disasters.

Join the Institute
Stay informed and get updates.

*We do NOT share your information with any other sites or organizations.

High Alert Institute

4800 Ben Hill Trail
Lake Wales, FL 33898
Office: 863.696.8090
FAX: 407.434.0804


Privacy Policy

Cookie Policy

Terms of Use


Get Your Data

Shipping Policy

Message Us



Do Not Sell Info

Return Policy