Application Exercise STEP 1 Choose a community Community you are focusing on for this application exercise AIAN American Indian and Alaska Native STEP 2 Define the problems Level of SEM Social Determinants of Health affecting this community Public Policy The Indian Self Determination and Education Assistance Act and the Indian Child Welfare Act ICWA gave tribes control over their own educational systems and allowed Native American parents to keep their children from being sent to off reservation schools The clean water and food sources are impacted from the land and water rights The Indian Health Service has limited funding and it restricts the access to healthcare services The law enforcement and healthcare services are impacted negatively from the many different laws in federal state and tribal There is a lack of resources such as internet access and transportation It is difficult to travel and receive care on time due to the locations of the reservations There are limited economic opportunities and high poverty rates which can affect the access of social services and healthcare services A lack of preventative care programs limits education and contributes to higher rates of chronic illness Healthcare facilities frequently face issues of being understaffed and underfunded leading to restricted resources and a diminished quality of care There is a lack of individuals who are familiar with the culture which fosters mistrust between patients and providers Community Organizational Level of SEM Social Determinants of Health affecting this community Interpersonal Since some of these groups are in rural or geographically isolated areas their support networks are limited which can adversely affect mental well being Historical trauma and family separation weaken family bonds and strain community ties Intrapersonal Ongoing and historical trauma have led to a high prevalence of mental health issues such as depression and PTSD These communities have low health literacy which restricts their understanding of available healthcare options and other preventive measures Lifestyle factors and genetics contribute to a high incidence of diabetes and heart disease STEP 3 Brainstorm a solution Pick one level from above and describe a possible intervention to address the SEM at that level to promote health equity for this community For Intrapersonal there should be a resource where the AIAN people can seek resources for their mental health and historical trauma This would be able to help promote their health equity and have the percentage of the high prevalence of PTSD and depression decrease