The Work of Nations: Cultivating Wealth and Health in Indian Country


Editor's Note:
This week, we continue our Special Series on Addiction and Recovery among Tribal Communities with an Op-Ed/Editorial by Katherine Spilde, Ph.D.  Dr. Spilde is an Associate Professor at San Diego State University and the Endowed Chair of the Sycuan Institute on Tribal Gaming. Here, she shares her experiences witnessing, and helping to document, the benefits of tribal economic development for tribal wealth and health. Like last week's guest contributor, Dr. Anne Helene Skinstad, Dr. Spilde has learned that it is essential for researchers interested in tribal communities to approach their research questions with cultural sensitivity, a genuine desire to learn from those they are studying, and a focus on positive as well as negative processes. 

Introduction: Tribal Wealth Development

Tribal government gaming is best framed as a form of tribal economic development rather than a commercial enterprise for profit. Unlike other governments that rely on a tax base to fund programs and provide services, tribal governments must operate successful businesses like casinos in order to create a steady revenue stream to support tribal budgets and operate tribal programs. Since tribal gaming is the largest and most successful form of economic development across Indian Country, it is often evaluated against a long history of less successful development attempts by tribal governments in order to determine what features set it apart from other ventures. The Harvard Project on American Indian Economic Development (HPAIED) has produced more than twenty years of academic research on tribal economic development that attempts to identify, simply, “what works, where and why?”

To summarize, the HPAIED’s body of research finds that, generally,

“When Native nations make their own decisions about what development approaches to take, they consistently out-perform external decision makers—on matters as diverse as governmental form, natural resource management, economic development, health care and social service provision.” (See here for examples.)

What the HPAIED research suggests is that when tribal leaders and community members create their own agenda based on a deep local knowledge, the economic outcomes surpass those of projects imposed by well-intentioned outsiders who lack a connection to both the context and the outcomes. After decades of unsolicited business advice from outsiders (including individual investors, federal agencies and financial institutions, to name a few), tribal government gaming was ultimately successful because it was truly a tribally-driven enterprise that grew to serve tribal priorities. Tribal leaders and citizens themselves decided where, when and how to seize the opportunity to exercise their civil regulatory authority for offering permitted forms of gaming on tribal lands and invest in their own infrastructure development. Nearly 30 years later, tribal government gaming generates over $27 billion in gross gaming revenues annually and has resulted in vast improvements in both social and economic indicators. (See here for revenue figures and  for here for social and economic impact research.)

Tribal Health Development

In spite of the robust lessons from tribal economic development, there is still a tendency among public health officials, public policy makers and others to believe that they “know what is best” in the area of tribal health and wellness initiatives. However, given the diversity of tribal cultures, tribal gaming and tribal government, it seems clear that the important decisions of how to direct tribal resources towards health and wellness would also be better left to those with deep local knowledge.

It seems that the same questions about “what works, where and why” can be applied to social change and improved health outcomes (some, but not all, related to gaming) across Indian Country. As with economic development work, there are myriad outside experts on social change and recovery who have shown a commitment to working with tribal communities on social change and recovery. Perhaps the most commonly stated interest seems to be from public policy makers or those in the recovery community who are concerned about the possible (or sometimes assumed) effects of gaming in tribal communities, possibly in the form of disordered gambling. As a regular attendee at conferences that address substance abuse and gambling addiction, I have attended many discussions related to the “best ways” to work with tribal communities on supporting culturally-appropriate health and wellness outcomes.

These discussions, like the ones I used to hear related to tribal economic development, seem to share some of the same characteristics. For example, attempts to “help” tribal communities recover from gambling addiction or other health problems assume that strategies and behaviors that work in other communities will find similar success in tribal communities. When tribal communities fail to embrace these borrowed “best practices” they are sometimes seen as resistant or in denial. Even when cultural factors are acknowledged, there is an assumption that outside practices can be “translated” in ways that will make them meaningful to tribal people, perhaps with the idea that “importing” solutions will save time and money and might “speed up” the social and health recovery in places that are assumed to be suffering.

As a non-native cultural anthropologist who has helped document the benefits of tribal economic development for native and non-native communities, I understand the strong desire to “share” good ideas and solutions across Indian Country. As tribal governments began to expand gaming, diversify their economies, re-design their government institutions and invest their gaming revenues, I was eager to document, evaluate and promote tribes’ incredible nation building efforts. What is most difficult to get across, however, is the important point that these successes are theirs alone and arise out of Indian Country from a place of deep understanding, collective action and cultural process. Rather than try to influence them, I have accepted with great honor the opportunity to simply witness them.

When looking for an appropriate lens for understanding tribal government economic and social recovery, I have been inspired by the respectful lens utilized by those who conduct global research on the phenomenon known as positive deviance (PD). A framework that emerged in the context of international work on child nutrition, positive deviance is an incredibly respectful approach to working in other cultures on sensitive issues. Rather than assume that there are universally identifiable problems in a community that must be addressed or solved, PD acknowledges that the community itself holds the wisdom to develop special practices to addresses current or future needs, if indeed there are any.

Linking the history of economic development to that of wellness and health is not meant to discourage partnerships or cross-cultural engagement. Rather, like many others across disciplines, I continue to be impressed with the work of tribal nations and simply want to be mindful in balancing my urge to “get involved” with the more patient approach wherein I allow Indian Country to show me how people and communities heal, where and when.


Katherine A. Spilde, Ph.D, is an Associate Professor at San Diego State University and the Endowed Chair of the Sycuan Institute on Tribal Gaming.

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