Healing through language: Positive physical health effects of indigenous language use

Introduction

Indigenous communities have some of the worst health outcomes within their larger societies (Gracey & King, 2009). This is true across the world, for example, in Australia and New Zealand (Anderson et al., 2006), Latin America (Pan American Health Organization, 2001), Canada (Frohlich et al., 2006), and the United States (U.S. Commission on Civil Rights, 2004). Although many factors, such as location, poverty, and access to health facilities, contribute to this disparity, there is a growing recognition that historical trauma plays a role as well (Duran et al., 1998; Sotero, 2006). The present survey examines published studies that address one salient means of recovering from historical trauma, namely, maintenance and revitalization of indigenous language. These studies consistently find that there are physical health advantages to be gained from such efforts.

The ways in which languages emerge, evolve, and fall dormant have been increasingly discussed by linguists, biologists and cognitive scientists in the last two decades (Hale et al., 1992; Wang & Minett, 2005). However, health scientists have not largely embraced this discussion as relevant. Although native language is sometimes mentioned in "health literacy" (e.g. Berkman et al., 2011), health related outcomes as a result of language maintenance and revitalization efforts have not received much attention. Here, we explore the limited existing literature on health outcomes of indigenous language use and outline promising research avenues for the future.

Language is a uniquely efficient means of maintaining and passing on crucial cultural knowledge and thus promotes cultural diversity (McCarty & Zepeda, 2010). Although languages have come and gone throughout history, indigenous languages in a variety of post-colonial situations have been oppressed through official policies and social pressures (Dussias, 1999; Oster et al., 2014). These forced language shifts caused the loss of social and behavioral knowledge and understanding that was created over millennia, ultimately contributing to disastrous, endemic health deficits (Gracey & King, 2009; Hallett et al., 2007; King et al., 2009).

Emerging evidence (see “Existing studies” section below) ties individual and/or communal health to efforts that promote ancestral language and cultural fluency in a community-driven educational environment. Some of the literature addresses indigenous groups affected by the four settler states of the United States (US), Canada, New Zealand and Australia. The similarities in colonialism, history and outcomes for the original peoples outweigh the inevitable differences in specific situations. Further, the political boundaries between Canada and the US do not reflect original use and are often unrecognized by the first peoples. Here, indigenous people of North America (hereafter, called Native Americans or (NA)) will be an exemplar as we explore the ability to use one’s ancestral language as a knowledge-seeking catalyst to optimize health.

Health status

Native Americans suffer some of the poorest health statuses and health outcomes of any other racial group in the US (Indian Health Service, 2014). This includes shorter lifespans, higher death rates from a wide variety of causes, and more limited access to health services. According to the 2010 American Community Survey, NA have a higher rate of disability than any other single group at 15%, almost 25% higher than for whites. While some of this is due to rural poverty, disparities are profound even within urban areas (as reported for Canada) (Firestone et al., 2014).

Current, low socio-economic status clearly is a major factor for poor health outcomes in NAs, but NA health today also results from historical trauma and its inter-generational continuation. Federal Indian Policies from 200 years of removal, reservations, relocation/assimilation, termination, and language eradication have resulted in loss of identity, shame, guilt, unresolved grief and depression (Brave Heart & DeBruyn, 1998; Oster et al., 2014), key features of historical trauma. In today’s Native America, extreme poverty, poor health, and high homicide and suicide rates are tragic outcomes of this historical trauma (Brave Heart & DeBruyn, 1998; Sotero, 2006).

Indigenous language loss and language use

The loss of languages worldwide has been substantial over the past 200 years. Many linguists estimate that half to 90% of the world’s languages will be moribund by the end of this century (Grenoble & Whaley, 1998; Hale et al., 1992; Whalen & Simons, 2012). Even so, there was little concentrated effort to retain and revitalize language among NA communities until recently, aided by the passage of the Native American Languages Act of 1990. Despite subsequent progress, NA languages are still rapidly losing speakers and the knowledge residing in their languages.

Language and culture are intertwined, and neither completely determines the other (McCarty & Zepeda, 2010), but language use is a substantial indicator of cultural coherence. Many NA communities are engaged in the revival of language and culture (see examples Table 1), and raising the health of the community is often an explicit goal. For example, Stephanie Fielding (Mohegan Tribe, Council of Elders), states, “The Mohegan language program is more than a cultural effort, it is aimed at bringing our community together to improve its cohesion and health” (personal communication, 20 April 2016). There are indications that such efforts can be successful (e.g., Hinton, 2001:225), but the next section will survey published studies that more directly assess the effects of language maintenance (i.e., for first language (L1) speakers) and language revitalization (i.e., for second language (L2) learners).

Existing studies

Native health, from their own perspective, includes four domains: spiritual, mental, emotional and physical; a disruption in any part, is a loss in ‘health’ (Moss, 2015). More often there are several domains affected, so each must be considered in this discussion.

Spiritual life has always been key for American Indians. Intergenerational trauma or historical trauma has been termed as a ‘spiritual injury’, or ‘soul wound’. A large driver of this trauma was the taking away of language (Duran et al., 1998). Prayers and ‘medicine men’ have utilized indigenous languages traditionally (Moss, 2000). In many cases it is the spirit that is being healed.

While the present survey focuses on the physical effects, mental and emotional factors certainly play a role in suicide. Hallett et al. (2007) found the youth suicide rate for indigenous bands in British Columbia in which 50% of the community is conversationally fluent (L1) to be 1/6^th that of less fluent bands. The language factor was predictive even when other correlated cultural factors were subtracted from the analysis.

On the physical side, another study found that the percentage of smokers in US Southwestern tribes, where indigenous languages are widely spoken, was only 14 percent as compared to 50 percent among Northern Plains tribes, where language use is sparse (Nez Henderson et al., 2005). A survey study in California (Hodge & Nandy, 2011:797) found that those who could speak their ancestral language were more frequently classified in a (within-study defined) “good” wellness group (82.4%) than were those who could not speak it (70.1%). A survey of residents of the Hopi reservation found that language use was positively correlated with “practicing Hopi behaviors to keep healthy” (Coe et al., 2004:405). A recent study found that Canadian First Nations groups with greater cultural retention, as indexed by language use, had significantly lower rates of diabetes after factoring out socioeconomic factors (Oster et al., 2014). All of these studies combined L1 and L2 speakers.

In Australia, speaking an Aboriginal and/or Torres Strait Islander language was found to reduce several health risk factors such as excessive alcohol consumption (8% vs. 18% for English monolinguals), illicit drug use (16% vs. 26%), and violence victimization (25% vs. 37%) (Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS), 2005:3). Those who spoke their heritage language were also found to have half the rate of “poor health” as those who had switched to English (Trewin & Madden, 2005:95). Alcohol, violence and drug use (especially methamphetamines) are problematic in NA populations at rates exceeding the general US population (IHS, 2014:191).

One result based exclusively on L2 learners examined high school graduation rates, which are taken as a health indicator by the National Institutes of Health, in a Hawaiian language immersion school. The Nāwahī program in Hawaii has a 100% graduation rate (Wilson, 2012), compared to 70% for standard schools (Kamehameha Schools, 2009).

Why focus on language?

Language transmission is a particularly effective means of reinforcing culture and has the benefit of integrating most cultural and communal activities. Language is also an extremely efficient means of establishing membership or inclusion in a community. Studies that might disentangle language and culture are possible, but the approach argued for here takes it as a given that language is the most efficient means of transmitting, maintaining, and even reviving culture.

There are different kinds of environments and programs for language learning and use (Table 1). Evaluation can be a challenge, whether the study is retrospective or prospective, due to large differences in specifics and small numbers in many cases. Census data can, with limitations, add to the results. Prospective studies could compare such health measures as absentee rates from school or changes in the Youth Risk Behavior Surveillance System (YRBSS; Centers for Disease Control and Prevention, 2004). While indirect, these measures can be obtained for all children, allowing larger cohorts than would be possible if only eventual negative outcomes were measured.

The main recommendation suggested by these studies, then, is that language programs prospectively include assessment of health outcomes along with the core of the program (see also Marmion et al., 2014:46). In this way, samples across the wide variety of programs can be compared, with the expectation that those with the most positive health outcomes can be replicated in other programs. Comparisons, both in effectiveness and cost, to standard health programs are also needed, given that language programs are typically less expensive than many other types of programs.

Conclusion

Language programs in NA communities hold the promise of improving the mental and physical health of those who participate in them. All generations seem able to take advantage of this possibility. Data exist on palliative effects of use of a Native language and/or cultural practices on smoking (Nez Henderson et al., 2005), suicide rates (Hallett et al., 2007) and alcohol (Torres Stone et al., 2006; Whitbeck et al., 2004) and substance abuse (First Peoples’ Heritage Language and Culture Council, 2012:213), but many more issues are likely to be evident as more data are collected. A return to native spirituality has been shown to improve treatment results (Berry et al., 2012; Gone & Calf Looking, 2015), an effect that could be expected to increase with inclusion of the ancestral language. As Tulloch et al. (2013) point out, the many informal programs that have appeared recently are not well studied and may require novel methodologies.

The Endangered Language Fund has launched a program called Healing Through Language to facilitate the support and assessment of language programs throughout Native America (www.healingthroughlanguage.org). Communities throughout the US and elsewhere have started language programs with a wide range of models. Because this one type of program can, apparently, lead to positive outcomes in so many areas, we would expect to find a substantial return in health benefits on investment in language programs in Native America.

Speaking an indigenous language in and of itself may not be solely responsible for improved health status; rather, community validation of the indigenous knowledge system, community-driven tribal education, comprehending indigenous medicine, and youth empowerment through language and culture identity formation all play significant roles in the ability of a minority language to thrive and for the community to experience healthy outcomes from the collective effort.