Reclaiming Native Health

Nov 15th, 2003 | By | Category: 15-2: Reclaiming Native Health, Editor's Essay
By Marjane Ambler

BOY WITH ELDERThere was a time when we all lived off the land. We used our muscles and ate whole grains, wild game, roots, natural sugars from raw fruit, and unprocessed vegetables. For American Indian people, these traditions are fairly recent. When Columbus arrived in the Western Hemisphere, he found “clean, good looking people without apparent illness.” Although life expectancy was not any higher than Europeans at the time, the people were fit.

Something that was very right has gone very wrong, according to Stacy Bohlen (Ojibwa), director of federal relations at the American Indian Higher Education Consortium. Today American Indians have a higher disease occurrence than other racial/ethnic groups; and some of these diseases, such as AIDS and diabetes, have become common only in the last generation. The disparity in death rates between whites and American Indians, blacks, and Hispanics is widely recognized. The federal government has created whole agencies whose names and missions are “health disparities.” Even within these minority groups, American Indians rank at the bottom. Native Americans are 650 % more likely to die from tuberculosis than other Americans, 318 % more likely to die from diabetes, 670 % more likely to die from alcoholism, and 204 % more likely to suffer accidental death when compared with other groups, according to a recent report by the U.S. Civil Rights Commission. That report did not refer to HIV/AIDS, but recent research indicates this is a growing epidemic among American Indian people.

To people who live in such communities, these are not just numbers but the constant realities of sirens and phones calling them to hospitals and funerals. They must witness their favorite grandmother going blind or having her foot amputated because of diabetes or the high school basketball star moving to the city for diagnosis and treatment of AIDS because no one has the resources to deal with her.

Not Inevitable

Educators in tribal college communities on reservations and in urban areas know many of these diseases and problems are not inevitable, and they are beginning to see evidence that they are not impossible to overcome. American Indian people are not inherently weak or sick people; their cultural background does not make them more prone to problems. The Lummi Indian people, for example, have a proud tradition at sea, and Lummi canoeists still work hard to keep fit for competitions, swearing off alcohol and cigarettes. Lakota hoop dancers, who whirl and spin as they climb through hoops, must run many miles a day to maintain their aerobic condition. In the communities, the fat melts away when tribal members learn the benefits of power walking and avoiding fry bread. Thus while they know it is important to address the national, systemic problems, they also are beginning to learn about working models that can be utilized at the community level.

Since generic approaches imposed from Washington cannot take into consideration the individual characteristics of various tribes, communities must play a key role in leading the way back to health. Tribal colleges and universities are intimately familiar with the good leaders and agonizingly familiar with the problems. They understand best the culture, the values, and the natural support systems. They know what works with their people, and with the right partners and the right resources they can begin. The articles in this issue describe some of the ways in which tribal colleges and universities are doing this.

Tribal colleges combine specific cultural practices with Western knowledge and approach problems holistically. For example, Danny Lopez at Tohono O’odham Community College leads a nutritional program in a community known for a high incidence of diabetes. He is convinced that the Tohono O’odham culture can not only reduce diabetes but also help the people deal with the pressures of modern life. Because of the many nutrition related diseases, several of the colleges are returning to traditional foods.

While sexual practices are never a comfortable subject, tribal college AIDS educators argue that it is even more difficult in their communities. By enlisting the help of traditional cultural leaders, tribal colleges in Montana and New Mexico are addressing these subjects and helping prevent a new pandemic that some fear could be as destructive as smallpox to Indian populations.

People respond to a physician or nurse who looks more like them and who understands them better than an outsider might. By educating Indian health professionals – doctors, nurses, and nutritionists – communities will become healthier. Several tribal colleges have nursing programs, and Salish Kootenai College trains dental assistant technicians.

To prepare for health professions, students need to become excited about science at an earlier age. Most tribal colleges provide programs involving the K-12 schools in their communities. For example, Keweenaw Bay Ojibwa Community College (Baraga, MI) has a summer science camp that educates young children about diabetes and science careers in a setting so enjoyable that the children want to attend even on weekends. As a result, long before they enter college, some of these students may choose to become veterinarians or wildlife biologists.

Although many illnesses could be addressed by proper nutrition, reservations lack trained nutritionists. Fond du Lac Tribal and Community College in Cloquet, MN, now has a two-year associate degree in nutrition. Fitness facilities are rare in rural communities, especially reservations, but Turtle Mountain Community College in North Dakota has built a gymnasium, and Fort Peck Community College in Montana has a model wellness center.

Tribal colleges are also conducting research. For example, United Tribes Technical College in Bismarck, ND, is collecting and analyzing data about student health and tailoring programs specifically to their needs. Diné College in Shiprock, NM, is teaching students from tribal colleges across the country how to study their communities’ diabetes problems. Others, such as Fort Berthold Community College, are interviewing elders and other experts about traditional foods.

Obstacles

Indian communities cannot solve these problems alone. The report on federal funding in Indian Country published by the Civil Rights Commission in July says the health disparities exist because of “disproportionate poverty, poor education, cultural differences, and the absence of adequate health service delivery in most Native communities.” There simply is not access to adequate health care for Native Americans. The Indian Health Service spends 50% less per person ($1,600 per year) for comprehensive health services in its hospitals and health clinics compared with public and private health insurance plans, according to the report. .As of 2001, there was a $900 million backlog in unmet needs for health facilities.

Poor health correlates with poverty rates nationwide, and Indian people are statistically the poorest of the poor. More than 30% live below the poverty level, compared to 13% of the general population, and they are more than twice as likely to be unemployed, according to the Indian Health Service. In some tribal college communities the unemployment rate is as high as 60 or 70%. Recent research indicates that intergenerational grief also contributes to chronic health problems.

Although tribal colleges and universities play an important role in addressing the underlying social and economic problems, they are chronically under funded. At a meeting with the Office of Minority Health in July, one tribal college president said that her college had only one science lab. Another president from a small tribal college said they lost their drug and alcohol counseling department because they could not provide competitive salaries for the instructors.

The presidents told the OMH their students arrived on their campuses without the proper science and math courses. Summer camps won’t suffice for preparing students for careers in science.

Although many federal grant programs have been created to address health disparities with Hispanics and blacks, sometimes American Indians are omitted and told they are “statistically insignificant.” The federal grant process tends to reward the best grant writers, not the best programs, and many tribal colleges lack the personnel to study the Federal Register for opportunities and to prepare the grant applications.

For too many years, American Indian communities have been the subjects of research by outsiders who documented their problems without contributing to the solutions. Today there is growing awareness that the tribal colleges and universities can provide the leadership in partnerships involving the federal government, mainstream university experts, and others. Such partnerships can help reclaim Native health.

Marjane Ambler has been editor of the Tribal College Journal since 1995. For more information, see The Quiet Crisis: Federal Funding and Unmet Needs in Indian Country published by the U.S. Commission on Civil Rights July 2003 and available on the website, www.usccr.gov.

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