Introduction

Alaska Native (AN) peoples have resided in rural, collectivist systems of being for time immemorial (Napoleon, 2013; Oleksa, 2005). However, AN history has been punctuated by manifold and often generational changes to these systems; family structures, expressions of culture, land-based identities and AN cosmology and ontology are directly impinged upon by colonisation. Evidence of change exists in outward migration, climate change, health disparities and Western systems of health, learning and knowledge (Napoleon, 2013; Oré et al., 2016). Resilience, success and quality of life are evident in community resources, inward migration and the cultural and contextual factors that comprise tribal group identity (Crouch et al., 2020; Rountree & Smith, 2016). All are firmly grounded within place, community strengths and cultural revitalisation, and are embedded in land and nature.

The Norton Sound, a sea inlet dividing the Bering Strait region from the Yukon-Kuskokwin region, is composed of fifteen villages outlying the hub city of Nome. While outlying villages have more homogeneity, Nome reflects more demographic diversity, given its centrality within the region, economic strength and abundance of resources in contrast to more remote locations. A little over half the population of Nome is of AN heritage (58 per cent), and Nome is a seventy-five-minute plane ride from Anchorage, the largest city in Alaska, as there are no roads or trains connecting the two locations (Alaska Department of Community and Regional Affairs [ADCRA], 2017). Within the Bering Strait region, one can only travel by road between Nome and Teller or St Michael and Stebbins, as no other roads or road systems exist. The present between-city road system is not maintained in winter, and between-city travel is typically accomplished through planes from airlines located in Nome, or snowmachines. Flights in or out of Nome are offered once or twice per day and are contingent on weather conditions. While all cities are accessible by plane, Little Diomede is only accessible by helicopter once a week or every other week. The region varies from rural to highly rural and remote, and this fact has allowed for many aspects of AN ways of life to continue.

Alaska Native peoples have inhabited the Norton Sound region for time immemorial (Norton Sound Health Corporation [NSHC], 2021). They were and are a thriving culture who flourished within the climate and adapted to the climate to successfully subsist off the land and develop family and community infrastructure. Precolonial and contemporary Norton Sound is home to three distinctly cultural and linguistically diverse AN groups: (1) Inupiaq; (2) Central Yup’ik; and (3) Siberian Yup’ik. While Nome is home to three distinct AN groups, the cultures come together to engage in community events and shared traditions. Activities include beading, dancing, ivory carvings, sewing (for example, skin, fabric, fur) and traditional drumming and singing. However, with the arrival of European and religious settlers with the intent of colonisation, the tribal ways of life in Nome and the region became irreversibly disrupted. Like most if not all other places across Alaska, the Norton Sound region was greatly impacted, with some places being decimated by disease, and others being generationally wounded by traumas. Economic, communal, familial and spiritual structures were changed, and people were expected to assimilate. Nome, known by the Indigenous residents in the Inupiaq language as Sitŋasuaq/Sitnasuak, was ‘established’ on 9 April 1901 (ADCRA, 2017; NSHC, 2021). Settler-colonial establishment was a direct result of westward expansion spurred by the finding of gold within the Sound by Scandinavian travellers. With them came thousands of other people seeking the fortunes of the touted next Eldorado. One million dollars of gold was mined in the first two months. The population of Nome dropped drastically by 1910 due to resources being depleted, and decreased further during the flu epidemic in 1918. Relatedly, the catalyst for what is known today as the Iditarod Trail Sled Dog Race was a diphtheria outbreak requiring life-saving anti-toxin. Since 1974 the race has been a mainstay of Alaskan culture and an economic wellspring for Nome. However, while tourism boosts the economy, outsiders fill up all the hotels and are known to drink heavily during this time. This perpetuates old historical wounds, has put vulnerable women at an increased risk of assault and creates a period of time when AN people from outlying villages have little ability to access Nome or the integrative medical system.

Nevertheless, the AN people in the Norton Sound region are persistent and resilient. The warm summers and fertile soil are optimal for harvesting traditional foods from the land (NSHC, 2021). Subsistence has been a way of life for inhabitants of the Norton Sound region from before colonisation to the present day. The land provides a variety of plant and animal species to utilise for food, clothing, revenue and more. Subsistence is part of daily life across the region but is contingent on location and availability. People who live inland have a diet rich in caribou, bear, moose and fish. Coastal diets include sea mammals like walrus and seal in addition to caribou and fish. Those who live on the islands have diets high in foods from the sea like crab and fish along with seasonal foods like fowl, berries and plants. The people of Nome subsist on hunting, crabbing, fishing, berry picking, gathering traditional greens and trading of foods. Nome provides seal, caribou, moose, musk ox, ptarmigan, duck, geese and brown bears. The tasty salmon and plethora of berries including blue, black, salmon and cranberries provide valuable items of trade to people of the region who have whale and other foods not available. This has been and continues to be a function of rural living and a tool for increasing nutrition and diversifying the diet of AN peoples. However, it is estimated most inhabitants in the region are at or below poverty level. Resident income is comprised of both money and subsistence. Many AN peoples throughout the region supplement their income by making and selling art to people in other regions, the local gift shop in Nome, at craft fairs or community events, and even by selling their art online to people in other parts of the state, the nation and the world.

Alaska Native historical context

Alaska Native peoples and Tribes have rich cultures signified by strength, resilience and growth in the face of historical and contemporary traumas (Peter, 2008). Alaska Native culture has been rooted in the natural environment and within rural communities. Notably, there existed precolonial ontology, pedagogy and epistemology for all aspects of life, such as medicine, surgery, diet, meteorology and astronomy, to name but a few (John, 2010; Napoleon, 2013). Tribe and community thrived in regional communication and cooperation and intertribal modes of trade for knowledge, culture, art and goods that sustained the fabric of daily life (Napoleon, 2013; Peter, 2008). While intertribal tension existed and strife was inevitable, these were dealt with through intertribal spiritual and cultural norms and rules predicated on Elder wisdom and tradition. The AN timeline occurred naturally and organically through adaptation, change and the normative process of personal, communal and regional evolution and growth. Moreover, land and nature, which are inseparable from Tribe or body, were also integral aspects that facilitated community as much as the people themselves. However, the interconnected, dynamic and viable process of the AN way of life was permanently altered by the arrival of European settlers to rural Alaska.

The AN community has undoubtedly been disrupted by forces of colonisation and trauma (Gone, 2007; Yellow Horse Brave Heart & DeBruyn, 1998; Yurkovich & Lattergrass, 2008). Theses traumas to person, group and land have been a stark reality for AN peoples, with the influx of Russian colonisers in the 1700s and the colonial migration of European settlers and churches in the 1800s and beyond. Western domination was an act of denigrating the AN culture, while simultaneously promulgating and proselytising Western culture and norms. These include, but are not limited to, fossil fuels, urbanisation, Christianity, the English language and small nuclear family systems that viewed land as separate and ownable, arguably also people as separate and ownable. While AN peoples are widely diverse in culture, values, traditions and regions, all share a common experience of separation and destruction to family and community through forced boarding schools, religious indoctrination, cultural and dietary changes and mass death due to diseases (Bassett et al., 2014). Religious sects organised and settled in different parts of Alaska. Families, communities and tribal healers and leaders were separated as a tool to dismantle AN culture for generations. Through an ongoing process of assimilation, colonisation threatened to rip AN peoples from their communal and natural roots and replace the fabric of society with systems, practices and values that were foreign and incongruent to sustain rural AN life. However, these historical facts are not confined to history, as historical traumas have informed and manipulated contemporary contexts (for example, discrimination, racism, marginalisation, health disparities; Gone, 2007; Lewis et al., 2014).

Western frameworks of quality of life, successful ageing and well-being could not then nor can now provide a full view of what it means to be an AN person, often referred to as the human beings or the real humans. Alaska Native culture is understood through the lens of connections and linkages that transcend time, space and dimension (Lewis et al., 2014). Some legends, stories and histories are literal and some are figurative, but they are all pathways to understanding greater truths for daily living. In AN culture there is the belief that there are those who are going through the motions of life, do not know who they truly are and are asleep (for example, those who experience substance abuse; John, 2010). On the other hand, there are those who are fully awake/aware/becoming aware to who they are, to their spirituality (the spirituality of the multiverse), and who live cognisant of what was before, what is now and what is after. This is a direct expression of one’s culture and a contextual understanding is integral to fully realising the intersection of person and place as a construction of worldview. Moreover, AN culture is a function of rurality, inasmuch as tribal people belong to the land on which they originate and have strong value systems rooted in a mutual and beneficial connection and caregiving relationship.

Cultural trauma

Cultural trauma is a salient historical and contemporary reality for people the world over, and for the first time this century in a shared global context, given the current and changing nature of the coronavirus disease 2019 (COVID-19) pandemic. Cultural trauma broadly occurs when a community/group has had collective experiences/events that are damaging to identity and quality of life (Alexander et al., 2004). Insomuch as the trauma is a wound on the person(s), it is also an internalisation of responsibility that can both perpetuate and/or alleviate the hurt. For example, Indigenous Tribes in the United States have long recognised postcolonial distress and strived to find culturally grounded and derived means for collective healing (Kirmayer et al., 2014), whereas many outside entities often do not consider fully or acknowledge the historical traumas that cultures have incurred (for example, slavery, holocaust, internment) to the detriment of these communities’ emancipatory sovereignty. Trauma is situated in culture as much as healing, however; there are gravitational forces greater than them both in the way of sociopolitical structures, laws and systems that are beyond the scope of this discussion but are imperative to note. As sources of trauma(s) become artefacts, ‘collective identity will be rooted in sacred places and structured in ritual routines’ (Alexander et al., 2004, p. 23). Collectivist communities, within both the AN context and culture, are predominantly rural in nature, and within the US rurality provides some protective factors towards one’s quality of life and against traumas that could otherwise be identity-intrusive, collective, cumulative and/or intergenerational (Kirmayer et al., 2014; Suarez, 2016).

Given that data has shown that there are myriad factors associated with differences in quality of life across rural and urban contexts, a recent study (Oh et al., 2021) analysed data from the RAND American Life Panel of 2,554 participants, which reflected a representative sample of the US population aged 17 years and older. The researchers looked at how birthplace (that is, large urban, small urban, suburban, rural) was associated with mental health issues, such as anxiety disorder, post-traumatic stress disorder (PTSD) and mood disorders. They found that overall urbanicity was significantly associated with greater odds of developing a psychiatric disorder than being born in a rural environment. Prior research, global and the US alone, found urban environments have an associative link between environment and poor mental health outcomes (Krabbendam et al., 2021; Zeng et al., 2019). Contributing factors of psychiatric disorders/distress within urban environments include environmental pollution, overcrowding and population density, social distress (for example, social isolation, lack of free time, exposure to violence) and lack of access to natural environment (for example, trees, grass, open water). Even AN Elder research has found that moving to an urban environment and the lack of traditional resources such as plants, food, running water, fresh air and space to be on the land and practice cultural activities (for example, hunting, fishing, gathering) is deleterious to AN quality of life and successful ageing (Lewis, 2010). Further, while suicide risk is often a salient associative risk and concern for rural residents, research (Thorne et al., 2017) suggests that PTSD symptomology that leads to taking one’s life is more likely to be associated with being raised in an urban environment as opposed to a rural environment. While the complexities of urban and rural life are not easily summed as either-or, good versus bad, protective versus harmful, it is important to both acknowledge the disparities that exists for those in rural environments (for example, lack of resources, healthcare inequity) and to recognise the innate and generative quality of life that is embedded in rurality. To further understand culture, cultural trauma and resilience, central to and inseparable from the context of rurality, AN quality of life and an AN framework is used.

Quality of life and rurality

In order to understand AN quality of life from the ground up, a sample of AN adults (N=15) within rural Alaska was recruited to share their collective and lived realities related to their quality of life (Crouch et al., 2020). Participants engaged in a community-based participatory process from recruitment through dissemination. Focus groups consisted of interactive tasks and thematic analyses. Through the Goodness of Life for Every Alaska Native (GLEAN) Study, nine salient themes were revealed: (1) Family represented connections and systems of support; (2) Subsistence emphasised the importance of traditions and land-based survival; (3) Access to Resources focused on community resilience in the face of adversity and change; (4) Health and Happiness reflected the holistic, contextual and intersectional dimensions of living well; (5) Traditional Knowledge and Values was comprised of identity, beliefs and practices that reinforce culture; (6) Acts of Self is focused on sovereignty and interdependence; (7) Providing included reciprocity, self-determination and prosperity; (8) Sobriety was focused on a holistic balance and temperance; (9) Healing emphasised the cyclical and grounded nature of collective resilience and reclamation of Indigenous ways. To fully understand the salience of the themes, one must first consider the place-based culture, knowing and natural environment of the study location: The Norton Sound region of Alaska.

Thus, the GLEAN Study explored the rich and robust AN cultural practice of daily rural life in the Norton Sound region of Alaska (Crouch et al., 2020). This research resulted in nine AN quality of life themes, the first of which was Family. Participants described it as representing all of one’s connections to plant, animal and person and the intersections therein. One person stated that ‘you’re alive when you’re with your family’. Another said that family is the context and those that comprise it, calling it ‘the family community’. Participants endorsed family as an expression of AN traditional values, saying, ‘Basically, the tradition of helping others, and if we see people who need, just give, don’t ask. Well, you know, give it back. What we gave them [will] be up to them, but don’t go after them for what you gave them.’ A reciprocity, sharing and value of taking care of self, others and the land were integral aspects of what it means to be a family member and to maintain the family and thus the community. Family is also closely tied to place and nature. One participant said, ‘Family always goes camping together and do stuff together. Or the whole village always gets together.’ Another shared, ‘My family loves to go out in the country and I teach them what’s edible from what’s washed ashore from the sea and what’s on the land.’ Further, a participant stated, ‘[Family] is healthy food. Native food is healthier than store-bought food. I want to teach my child how to smoke salmon like I did … build a smokehouse and all that stuff. The last couple of years I’ve tried to teach my cousin’s kids how to make a stove out of a drum.’ Other participants discussed the impacts to rural AN life and family sustained through urbanisation and reliance on Western goods and ways of life, stating ‘Seems like if we’re not teaching our kids, seems like the value of trying to teach them what things are and what to get from the country. They probably don’t know how to look for even mussels, or, you know, things like that.’ Another said ‘When I had my own kids, I never bought those instant things, or those Hot Pockets and anything like that, or even canned things. I never went for those, but nowadays it’s the canned vegetables or the frozen one, but I can’t get used to buying those stuff yet.’ Climate change, Westernisation and outward migration all were noted as playing a part in changing and threatening AN culture, which has been supported by rural living, nutrition, animal and land.

The theme of Subsistence was integral and viewed as maintaining and facilitating AN quality of life. One participant equated subsistence and natural health to that of their own bodily health: ‘Our good health would be more like trying to find good food when you’re at camp, fishing, hunting, that kind of stuff.’ Subsistence was not only comprised of nature, exercise and food, it also represented clothing, luxury and necessity; one participant shared, ‘[The Elders] always have something useful, and they would make beaver hats or mittens, seal-skin mittens, seal-skin hats.’ Conversely, poor quality of life was viewed as lack of access to nature, land and traditional ways of life; a participant added, ‘like your sadness might be you did poor hunting, poor camping’. Quality of life is inherent in cultural practices and particularly food, a spiritual and symbolic act of ingesting one’s traditional knowledge and of successful ageing. One participant said, ‘My mom lived to be 93 because she was mostly eating Native food. She couldn’t stand eating a store-bought one. One of my nephews, when they put him in the hospital [in Anchorage, the big city] he started puking because he can’t stand eating that food.’ Another woman talked about the impacts of industrialisation on the climate and ecosystems of her rural village:

The theme of Access to Resources represented the disconnection from traditional rural life and the reliance on Western systems for healthcare, food, clothes, economic stability, transportation, clean water, energy, heat and housing, to name a few. One participant observed, ‘it seems like it’s a struggle to survive’. Another said, ‘as I got older it seemed like everything is out of struggle now’. Many talked about Western responses to trauma that are not part of AN traditional ways, such as alcohol and tobacco. One participant shared about the intergenerational deficits created by colonisation and the outward migration of youth and adults alike: ‘[Elders] they can’t hunt and fish for themselves anymore, so I just try to help them get whatever they need, like fish and things.’ Another said, ‘Our Elders used to always say life is going to be harder after we live our lives, and we get older. They said we better get back to our older ways.’ Participants also talked about the Western barriers imposed on natural resources that exists within the rural environment:

One participant defined the theme of Health and Happiness as ‘Stay out of trouble, be strong in situations, or try to be. Be happy, have a good attitude towards others, be kind, have fun … going to camp, walking on the beach … be honest, be helpful to others and yourself. Be yourself.’ Another viewed the theme as intergenerational sharing and spirituality stating, ‘My husband’s grandma and his Uncle Joe, they were very spiritual and traditional. His great-uncle used to let me sit down at the table [and] … just teach me stuff.’ Many viewed health and happiness as ‘creature comforts’, leisure activities, exercise, having fun with others (for example, playing, laughing), expressions of love and taking a perspective of positivity, all of which were a function of being within community and sharing with one another. Moreover, one’s health and happiness were contingent on the overall health and happiness of the community.

The theme of Traditional Knowledge and Values was closely aligned with Health and Happiness, as it is AN knowledge and values that are the blueprint of how and why one is to be healthy and happy. Traditional knowledge and values are the basis for quality of life, reflect community-held beliefs and wisdom and stand as a guidepost for AN lifestyle and lifecycle. One participant said that traditional knowledge and values have ‘got to be something within yourself’, and another stated that they have the power to ‘change the younger generation [for the better]’. Others shared their explicit traditional teachings: ‘Help an Elder, always help an Elder, always’; teach the children ‘to cut fish and how to hang fish’; and ‘you need to save for the winter … because winters are hard sometimes and you just need to try and, at least, think about winter when you’re hunting and fishing’. Traditional knowledge and values was inextricably linked to AN Elder wisdom about how to live well, long and successfully. One participant who was himself an Elder shared, ‘I learn a lot from the Elders, too. I still learn a lot from them.’

Acts of Self was a theme that reflected intra- and interdependence and tribal sovereignty. It was closely associated with Sobriety, which was a theme named by the participants but was used to reflect a harm-reduction approach, balance, temperance and holistic health. Participants defined Acts of Self as ‘keeping control of your own actions’; goal setting and ‘setting good goals’; to ‘think about the future’; and ‘enjoying the benefits’ of one’s positive choices. Another participant said that it’s ‘to be honest. You have to be honest to yourself before you can be honest to somebody else.’ Participants declared that both acts of self and sobriety were to ‘avoid self-indulgence on alcohol and drugs’. Speaking to their own sobriety a participant said,

Another participant shared,

Many acknowledge that drugs and alcohol were not a traditional way of life and not a legacy they wanted to pass down to younger generations; rather, they wanted to teach the youth how to subsist from the land, use traditional practices to stay healthy and to foster a strong sense of cultural self.

The theme of Providing represented taking care of family/community, self-determination and AN advancement. Participants viewed providing in terms of financial and job security, a positive attitude and mentality, and securing traditional plants, medicines and foods. Speaking to this, one participant said,

Another stated, ‘It makes me feel good to take care of my family and knowing that I’m there to cook for them and do their laundry.’ Participants discussed the importance of providing a traditional way of life. They endorsed hunting and gathering from the land to provide for spring/summer/fall and for the longer winter months in order to take care of both family and community.

The last theme, Healing, was used by one focus group to represent an overarching theme for all other themes. It reflects the importance of safety, cultural revitalisation and reclamation, and AN resilience and healing from past traumas. Specifically, participants discussed AN spirituality, religion and/or church as sources of hope and strength. A participant stated, ‘Yeah, faith. Yeah, pray, because that’s what keeps me going. Praying … because I know I’ll feel better.’ Another shared, ‘I learned something not too long ago from my oldest daughter. She said don’t worry about things because there’s somebody that can do your worrying. I asked her, who? She said, the [Creator] will take care of you. You don’t have to worry and make yourself sick.’ The last focus group said that healing was ‘knowing that everything is safe. We know that our family is safe. We know that our bills [are paid] and there’s food on the table. And we know that other people care for us.’ Additionally, healing also exemplified a spirit of community sharing and helping; AN people were regarded as being responsible for their own and community needs. A participant said, ‘Help others like people who don’t do subsistence or don’t have the care to do their subsistence. I offered them to help me so that they can get their share. Or when someone is depressed, you talk to them to bring their spirits up.’

Culture, community and rurality

Culture is everything; it is the construction of who one is, becoming and how they came to be. The relational self, which is oneself within a particular context, speaks to the broader concepts of independence and interdependence (Fiske & Taylor, 2013). These two concepts are themselves interconnected, on a continuum, and can be expressed within one’s culture. Consider the following postulation: people in any cultural context gradually develop through socialisation a set of cognitive, emotional and motivational processes that enable them to function well – naturally, flexibly and adaptively – in the types of situations that are common and recurrent in the cultural context (Kitayama et al., 1997, p. 1245). This is to say that culture facilitates the construction of self and self in relation to others. For example, a person from a predominantly interdependent cultural context (a rural environment) who lives in a predominantly independent cultural context (an urban environment) has a unique set of values, skills and social conceptualisations that may not translate. Therefore, the culture of rurality is inextricably linked to that of AN peoples.

Culture and community are inherent protective factors, and strengths are embedded in traditional knowledge and values (Burack et al., 2007; MacDonald et al., 2013; Tafoya, 2014). Culture is expressed through community and exists within interpersonal relationships, family and nature. These collective pathways increase holistic health and quality of life; ‘health is not only an outcome in and of itself, but also a determinant for overall community health and cohesion and is directly and intimately tied to other aspects of community health and wellbeing’ (MacDonald et al., 2013, p. 12). In other words, the quality of one’s life is inseparable from the health and success of one’s Tribe, community, culture and land, and it is a direct expression of who one is and from whom and where they have come. Quality of life is in many ways maintained by people fully being themselves as human beings in spite of and even because of adversities (Napoleon, 2013). Thus, Indigenous quality of life is an expression of resilience, as it demonstrates holistic health and healing in the face of adversity by engagement and reclamation through cultural practices and strengths as follows: sharing or learning one’s Native language, intergenerational learning, peer support, storytelling, parenting children through traditional ways and being involved in tribal and community activities. Moreover, shared ‘cultural values, beliefs, and practices are a source of strength, power, medicine, and healing’ (Oré et al., 2016, p. 148).

Notably, resilience does not mean quality of life alone (Burack et al., 2007). While one might be successful in the Western world, one may still be experiencing deficits within and across indices of AN quality of life. Rather, AN quality of life may involve achieving balance across both Western domains and the often marginalised AN domains, such as traditional knowledge, practices and spirituality (Crouch et al., 2020; John, 2010). When quality of life is viewed as reclamation and enculturation, it can be both a measurement tool and a device for awakening one’s culture (Garrett & Garrett, 1994; Goodkind et al., 2015; John, 2010). Counter to the common belief that Indigenous traditions are a hindrance to Western success, research has demonstrated that Indigenous culture strengthens and facilitates success and well-being within both a Western industrialised context and a non-Western more rural context (Dockery, 2010). Further, AN culture is the cornerstone to AN quality of life and cannot be separated from place. A paucity of AN quality of life measures and conceptualisation exists in the literature (Crouch et al., 2020; Sharma et al., 2013; Wolsko et al., 2006); however, an enormity of data exists as traditional knowledge and values, shared stories and wisdom-based worldviews, lifestyles and practices. Critically, AN peoples are the cultural bearers of their knowledge and they themselves are the storehouses of their own histories. Therefore, it is imperative AN quality of life, central to rural being, be examined with these in mind.

Successful ageing in a rural context

Just as climates alter community, the topography of land shifts and culture expands to accommodate change, AN quality of life is not constrained by the lifecycle. Rather, quality of life is nuanced and amplified by AN values, knowledge, practices and Elder wisdom. Research (Hopkins et al., 2016; Lewis, 2011, 2016; Lewis et al., 2020) demonstrates how AN Elder knowledge, intergenerational connection and generativity and indigenised tenets of successful ageing exemplify how rural AN communities become and stay well, and pass on healing and wellness to future generations. The lens of Indigenous ageing is a view into the barriers that exist in living rurally and the dire need to continue a rural, AN way of life. In order to examine successful ageing in AN populations, research relied upon surveys and interviews with a purposive sample of fifteen AN adults ranging in age from 26 to 84 and representing six different AN tribal groups (Lewis, 2010). Half of the participants were from an urban environment (n=8) and the other from a rural (n=8) environment. The researcher found that there were notable differences between environments, with rural participants reporting traditional living, staying in balance with nature and an active lifestyle as an integral part of successful ageing. Urban participants reported access to healthy foods, time with friends and exercise as parts of successful ageing. While both are similar, each highlights the adaptation to new environments (for example, rural to urban) and the intersectionality of place and expression of Indigenous ways of knowing. Comparatively, while rural participants reported their access to land and traditional practices as their biggest advantages, the urban participants listed those very facets of Indigenous life as lacking within their environment. All participants viewed Elders as the source of knowledge and wisdom within the community and entrusted them with the task of teaching the community how to age successfully.

Overall, participants reported the integral parts of successful ageing to be the sharing of knowledge between generations, staying holistically active and the connection to others, land and the rural community. It was noted that there was ‘hardly any mention of health care’ or basing successful ageing on ‘health status’ (Lewis, 2010, p. 392). These results suggest that AN peoples require culturally competent and contextualised treatment and caregiving regardless of Western conceptualisations of disease; over-pathologising of AN peoples could potentially be counterproductive to long-term healthcare utilisation and outcomes. In addition, the findings posit that globalisation, urbanisation and acculturation are sources of breakages in the traditional AN ways of life (Lewis, 2010; Lewis et al., 2020). In other words, while AN culture is persistent, resilient and powerful, it has been threatened by the overt efforts of historical and contemporary oppression and the persistent push to modernise and move from traditional, rural life. Through the process of colonisation there has been a disruption in the natural order of life, and through improving eldership, revitalising cultural practices and restoring traditional ways of being and living, one has the opportunity to undo past hurts, promote healing and make space for success as one moves towards holistic well-being among the nine culturally grounded domains of AN quality of life (Crouch et al., 2020).

While rural Alaska continues to undergo rapid sociocultural changes, the land and its people continue to thrive, reminding us of the resilience within AN peoples. As AN peoples continue to experience inward and outward migration, the quality of life in rural Alaska is higher given the strong connection to land, which gives AN peoples their identity, spirit, nourishment and well-being. Through this analysis of the historical and contemporary impacts and changes within the AN cultural system of being and functioning, a holistic framework of understanding the meaning and embeddedness of quality of life in a rural AN context can be fully realised.

Acknowledgements

National Heart, Lung, and Blood Institute, Diversity Award Supplement, award number: R01HL117736. Alaska Native Community Advancement in Psychology Graduate Research Grant. Norton Sound Health Corporation’s Research Ethics Review Board. Alaska Area Institutional Review Board, reference number: 2015–02–014.