Traditional Approaches to Modern Health Disparities. Donald Warne, MD, MPH

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1 Traditional Approaches to Modern Health Disparities Donald Warne, MD, MPH Oglala Lakota Director, Master of Public Health Program North Dakota State University Association of American Indian Physicians September 14, 2012 Oklahoma City, OK

2 Overview Overview of AI/AN Health Disparities Cultural Competence in AI Healthcare Medicine Wheel in Practice Traditional Strategies to reduce Disparities

3 IHS Areas Portland Billings Aberdeen Bemidji California Phoenix Nashville Tucson Navajo Alaska Albuquerque Oklahoma

4 AAIHS / AATCHB

5 AI Health Disparities Life Expectancy in Years: Men Women Total U.S AAIHS Disparity: Median age at death in SD (2009): 81 Years in the General Population 58 Years in the AI Population

6 National Survey on Drug Use & Health AI/AN Substance Use Disorders In , AI/ANs were more likely than other racial groups to have a past year alcohol use disorder (10.7 v 7.6 percent) In , AI/ANs were more likely than other racial groups to have a past year illicit drug use disorder (5.0 v 2.9 percent)

7 AI Health Disparities Death rates from preventable diseases among AIs are significantly higher than among non- Indians: Diabetes 208% greater Alcoholism 526% greater Accidents 150% greater Suicide 60% greater Indian Health Service. Regional Differences in Indian Health

8 State Suicide Mortality rates by Race, State Rate North Dakota White 11.3 American Indian 26.0 South Dakota White 12.8 American Indian 27.0 Underlying mortality data provided by NCHS ( Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups, Census P ) standard

9 Diabetes Death Rates (Rate/Per 100,000 Population)

10 Alcohol Related Death Rates (Rate/Per 100,000 Population)

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12 Medical Behavioral

13 State of South Dakota Medicaid BH Carveout Alcohol & SA Mental Health

14 AI/AN Cancer Disparities IHS total: 184.1

15 Smoking Disparities by State

16 Traditional Tobacco Commercial Tobacco Traditional Tobacco Commercial Tobacco

17 A BRIEF HISTORY OF MEDICINE 2000BC Here, eat this root 1000AD That root is heathen, here say this prayer 1800AD That prayer is superstition, here drink this potion 1900AD That potion is snake oil, here swallow this pill 1950AD That pill is ineffective, here take this antibiotic 2000AD That antibiotic is artificial, here eat this root

18 MODERN TRADITIONAL Model Allopathic Holistic

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20 MODERN TRADITIONAL Medicine Physical Spiritual

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22 MODERN TRADITIONAL Communication Linear Circular

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24 MODERN TRADITIONAL Provider Physician Healer

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26 MODERN TRADITIONAL Symbol Serpent & Staff Medicine Wheel

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29 MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL

30 Traditional Systems of Diagnosis MEDITATION HERBS PRAYER COUNSELING Key Components: Ceremony, Family & Community Participation

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32 MEDICINE WHEEL DECISIONS ACTIONS VALUES REACTIONS

33 MEDICINE WHEEL & Traditional Values WISDOM COURAGE FORTITUDE GENEROSITY UP HONOR DOWN RESPECT WITHIN HUMILITY

34 MEDICINE WHEEL ATTITUDES ACTIVITIES BELIEFS FEELINGS

35 MEDICINE WHEEL & Public Health EDUCATIONAL ENVIRONMENTAL CULTURAL SOCIAL

36 Ed McGaa, Eagle Man Native American Indians learned how to live with the earth on a deeply spiritual plane. The plight of the non-indian world is that it has lost respect for Mother Earth, from whom and where we all come. Mother Earth Spirituality, 1990

37 Ed McGaa, Eagle Man We all start out in this world as tiny seeds no different from our animal brothers and sisters, the deer, the bear, the buffalo, or the trees, the flowers, the winged people. Mother Earth is our real mother, because every bit of us truly comes from her, and daily she takes care of us. Mother Earth Spirituality, 1990

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39 Rick Two Dogs We need to understand that the primary reason our people are so afflicted with addiction, poverty, abuse and strife, is that our way of life was taken from us. Everything was taken. And nothing was replaced. Wounded Warriors: A Time For Healing, 1995

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46 Substance Abuse and the Medicine Wheel What greater grief than the loss of one s native land Euripides B.C.

47 Alcohol Related Death Rates (Rate/Per 100,000 Population)

48 Suicide Death Rates (Rate/Per 100,000 Population)

49 MEDICINE WHEEL and Substance Abuse DECISIONS ACTIONS VALUES REACTIONS

50 MEDICINE WHEEL and Substance Abuse SUBSTANCE ABUSE DECISIONS NEGATIVE EMOTIONS

51 MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL

52 Medicine Wheel Assessment Interpersonal Relationships Surface Interactions Professional Relationships, Acquaintances, etc.

53 Medicine Wheel Assessment Interpersonal Relationships

54 Medicine Wheel Assessment Interpersonal Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL Core Interactions Encompass all Four Directions Family, Close Friends

55 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL

56 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL

57 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL

58 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL

59 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL

60 Medicine Wheel Assessment Family Relationships MENTAL PHYSICAL SPIRITUAL EMOTIONAL Connectedness to both ancestry and to future generations (7 th Generation)

61 Child Abuse Any willful act or threatened act that results in any physical, mental, or sexual injury or harm that causes or is likely to cause the child s physical, mental, or emotional (or spiritual) health to be significantly impaired.

62 The ACE Study (Adverse Childhood Experiences) Adverse Childhood Experiences and their relationship to Adult Health and Well-Being A collaboration between the CDC & Kaiser Permanente s Health Appraisal Clinic in San Diego

63 ACE Study - continued Examined the health, social and economic effects of adverse childhood experiences across the lifespan 18,000 participants

64 ACE Study - continued What is an adverse childhood experience? Child abuse and neglect Growing up with domestic violence, substance abuse or mental illness in the home, parental loss, or crime

65 Long Term Health Effects of Child Abuse Significant Risk For: Smoking Severe Obesity Physical Inactivity Depression Suicide Attempt Alcoholism Illicit Drug Use Injected Drug Use 50+ Sexual Partners History of Sexually Transmitted Disease

66 ACE Pyramid Early Death Disease, Disability & Social Problems Life Span Adoption of Health-risk Behaviors Social, Emotional & Cognitive Impairment Disrupted Neurodevelopment Childhood Maltreatment/Trauma

67 Long Term Health Effects of Child Abuse 103% more likely to smoke. 43% more likely to become suicidal 103% more likely to become alcoholics 192% more likely to develop a drug addiction Need AI ACE Study!

68 Blackfeet Saying A child is sacred. And when that child comes into the home, the family must welcome it. And if the child is happy and feels the want, he will come into this world very, very strong. And not to know this is to know nothing.

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70 Traditional Medicine Services Talking Circles Healing Ceremonies Herbal Remedies Smudging Sweat Lodge Counseling Regionally Specific Remedies 70% of urban & 90% of reservation AI people use traditional medicine

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72 Sample Programs PIMC Traditional Cultural Advocacy Committee Sweat Lodge on Hospital Grounds Intake Form Urban Issues

73 Sample Programs Winslow Hospital Medicine Man on Staff Hogan on Hospital Grounds Medicine Man s Association

74 Sample Programs Hu Hu Kam Memorial Hospital Traditional Healers on Staff BHC RBHA DEC PL

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76 BLACK ELK Of course it was not I who cured. It was the power from the outer world, and the visions and ceremonies had only made me like a hole through which the power could come to the two leggeds. If I thought that I was doing it myself, the hole would close up and no power could come through.

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