Impact of Unresolved Trauma on American Indian Health. Avera Health Sioux Falls, SD May 7, 2018
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1 Impact of Unresolved Trauma on American Indian Health Avera Health Sioux Falls, SD May 7, 2018 Donald Warne, MD, MPH Oglala Lakota Associate Dean, Diversity, Equity and Inclusion Director, INMED UND School of Medicine and Health Sciences
2 Objectives 1. Describe patterns of historical trauma and its potential impact on health disparities 2. Explain the connection between historical trauma and epigenetics
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4 Traditional View of Public Health
5 IHS Areas Portland Billings Great Plains Bemidji California Phoenix Nashville Tucson Navajo Alaska Albuquerque Oklahoma
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7 Historical Context
8 Historical Context
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11 You will do well to try to inoculate the Indians by means of Blanketts, as well as to try every other method that can serve to Extirpate this Execrable Race. I should be very glad your Scheme for hunting them Down by Dogs could take effect
12 Historical Context
13
14 Historical Context
15 Dakota War of 1862
16 Dakota War of 1862 The Daily Republican Winona, MN 1863
17 AI/AN Population by County
18 AI/AN Population Decline and Recovery,
19 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Chronic Disease Disparities Genocide Warne & Lajimodiere 2012
20 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Gestational Stressors Birth Chronic Disease Disparities Genocide Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012
21 Historical trauma is the collective emotional wounding across generations that results from massive cataclysmic events Historically Traumatic Events (HTE)* The trauma is held personally and transmitted over generations. Thus, even family members who have not directly experienced the trauma can feel the effects of the event generations later
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23 Epigenetics Epigenetics refers to the study of changes in the regulation of gene activity and expression that are not dependent on DNA sequence.
24 Epigenetics
25 Epigenetics
26 Epigenetics
27 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Gestational Stressors Birth Childhood Stressors Chronic Disease Disparities Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012
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29 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Gestational Stressors Birth Childhood Stressors Chronic Disease Disparities Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012 Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison
30 Impact of ACEs on Health
31 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Gestational Stressors Birth Childhood Stressors Adulthood Stressors Chronic Disease Disparities Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012 Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison Adverse Adulthood Experiences Alcoholism & SA Suicide rates / death rates Poverty / Poor nutrition Racism / Toxic Stress Role models Few positive Many negative Parenting
32 Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives Historical Trauma Gestational Stressors Birth Childhood Stressors Adulthood Stressors Chronic Disease Disparities Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison Adverse Adulthood Experiences Alcoholism & SA Suicide rates / death rates Poverty / Poor nutrition Racism / Toxic Stress Role models Few positive Many negative Parenting Warne & Lajimodiere 2012 Next generation
33 AI/AN Health Disparities Death rates from preventable diseases among AI/ANs 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
34 White, Espey, Swan, et al. AJPH Supplement 3, 2014, (104): S377-S387 Cancer Death Rates (Rate per 100,000 population) NORTHERN PLAINS SOUTHERN PLAINS ALASKA PACIFIC COAST EAST SOUTWEST ALL US AI/AN White
35 Smoking Disparities by State
36 Traditional Tobacco Commercial Tobacco Traditional Tobacco Commercial Tobacco
37 MEDICINE WHEEL NORTH WEST EAST SOUTH
38 MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL
39 MEDICINE WHEEL DECISIONS ACTIONS VALUES REACTIONS
40 MEDICINE WHEEL DECISIONS SELF- MEDICATION NEGATIVE EMOTIONS
41 MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL
42 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
43 Medicine Wheel & Intergenerational Trauma mrna AMINO ACIDS DNA PROTEINS
44 Medicine Wheel & Intergenerational Trauma mrna AMINO ACIDS DNA GAMETE Next Generation
45 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
46 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
47 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
48 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
49 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL
50 Medicine Wheel & Intergenerational Trauma MENTAL PHYSICAL SPIRITUAL EMOTIONAL Connectedness to both ancestry and to future generations (7 th Generation)
51
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