Editor's Commentary and Acknowledgments

The year 2001 brings with it new challenges, new technologies, and new insights. The challenges we face are enormous. They include combating new and old diseases, as well as dealing with ongoing social and political concerns. In American Indian and Alaska Native communities, these challenges are compounded by cultural issues, including language, illness beliefs, and a value system that is all too often at odds with the larger society.

Health educators and health care practitioners are particularly challenged to design culturally sensitive and appropriate interventions and activities that promote health and combat illness and disease. As health educators and practitioners, we acknowledge the enormity and severity of the diseases in Native communities. The approach to ameliorate these health problems is conditioned largely by cultural issues. This special issue of Wicazo Sa Review is centered on such ongoing health concerns as diabetes, heart disease, HIV/AIDS, and cancer. Additionally, issues such as managed care, the conduct of research in a culturally sensitive manner, and methodological issues are presented and discussed.

Diabetes has become one of the leading epidemics facing Native peoples. Type II diabetes is more than double and in some cases three and four times the rate of the general population. Lorelei De Cora powerfully portrays the diabetes epidemic among the Winnebago tribe of Nebraska and calls much-needed attention to this disease. Betty Geishirt Cantrell describes a large-scale study funded by the National Institute of Nursing Research that tests a community-based intervention called Talking Circles designed to motivate diabetics and those at risk of diabetes to control and prevent the onset of the disease.

Cancer is the third leading cause of morbidity among Indian groups. Cervical cancer, discussed by Teshia Solomon and Nell Gottlieb, provides an excellent opportunity for educators and researchers to gain a better understanding of the cancer threat. C. June Strickland presents a most thoughtful and eloquent paper on pain management in a tribal group in the Northwest. The presentation of pain and the treatment and control of pain are important aspects of culturally relevant research. Additionally, the contribution of Irene Vernon and Roe Bubar in the area of HIV/AIDS on Native peoples provides a thoughtful examination for health care providers and researchers alike.

Research in Hawaii, Los Angeles, and Alaska provides the reader and researcher with important data. John Casken offers valuable understanding of the cultural issues and health issues surrounding the term "native Hawaiian." The findings of Mary Kay Duffié's pilot project in Los Angeles are an important contribution. Designing and implementing a pilot project are significant steps in research, as Duffié successfully demonstrates. Barbara Stillwater presents alarming statistics regarding the health problems facing Alaska Native women. Her work is a significant contribution that brings urgent issues of cultural adaptation to the forefront and indicates considerations for researchers and health care providers.

Roxanne Struthers shares her views on conducting research among Native peoples as a sacred and trust-invoking process. Her experience provides valuable insight for researchers and educators alike. Conducting research in Indian communities is not to be taken lightly; serious breaches in conduct have littered the path before us, and misinterpretation is a great danger. Hers is a thoughtful and important contribution to research methods and approaches to collaborative partnering.

Carol Marquez presents a thoughtful piece on the challenges of Medicaid managed care for Native Americans. The future of managed care, with cost containment issues, scheduling and processing problems, and denial of health care services is a real dilemma for health care providers. Bureaucratic problems abound and Indian clinics and hospitals now have an added layer of bureaucracy with which to contend.

David Barney brings significant findings on American Indian youth. Attention to our youth--as the future generation--is an important area that begs our attention. Our Native children are our future, and what better future can we offer the next generation than a wealth of knowledge about the health and welfare...