It Takes a Whole Indian Village . . .

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It Takes a Whole Indian Village . . . Steps to
Decreasing Health Disparities 11th Annual
Summer Public Health Research Video Conference
on Minority Health Chapel Hill, North
Carolina June 20-21
Presented by Carole Anne Heart, Executive
Director Aberdeen Area Tribal Chairmens Health
Board 1770 Rand Road Rapid City, South Dakota
57702 execdir_at_aatchb.org website www.aatchb.org
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Compelling evidence that race and
ethnicitycorrelate with persistent, and often
increasinghealth disparities among the U.S
populationsdemands national attention.
DHHS

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• The Causes of Health Disparities
• health care access
• resources
• treatment
• outcomes
• patient beliefs
• provider biases
• stereotyping
• health status for racial and ethnic patients
• patient-physician relationship
• healthcare delivery system
• language problems
• understanding culture

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Impact of Epidemics For relatively self
contained communities, the consequences of such
catastrophes can scarcely be imagined. It meant
devastation far worse than that wrought by
warfare. Epidemics meant not only the sudden
loss of parents, children and beloved friends but
the destruction of entire cultures and economies.
When warriers died, the entire nation became
more vulnerable to predatory neighbors. When
hunters died, the food supply shrank. When
medicine men died, the spiritual world
disintegrated. When young women died in large
numbers, the community lost its capacity to
reproduce. When the elderly died, collective
memory went with them. Fergus Bordewich,
Killing the White Mans Indian, 1996
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• The Facts
• The unemployment rate on the Pine Ridge is 80
  compared
• to 42 on Spirit Lake reservation. It is
  only 4.6 for the
• entire U.S. population.
• The median income is 6,700 compared to
  national
• median income of 30,056.00.
• In the American Indian population, 43.1 are
  under the age
• of five years lives below the poverty line
  compared to 20.1
• of the white population.
• In the age group of 18-64, 27 live below the
  poverty line
• compared to 11.0 of the white population.
• Trends in Indian Health, 1999

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• More Facts
• Unintentional injuries is the second leading
  cause of death
• for all ages, the foremost is motor vehicle
  accidents. It is
• fourth leading cause of death for U.S.
  males.
• Aberdeen has the highest rate of death by
  alcoholism
• 108.7, of all the 12 regions, the lowest is
  OK at 21.7.
• 14.1 have attained less than 9th grade
  education compared
• to 8.9 of the white population.

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• Trends in Indian Health Stats
• Cardiovascular disease is now the leading cause
  of
• mortality among AI/AN people.
• AI/AN have the highest prevalence of type 2
• diabetes in the world, 2.6X the national
  average.
• Rates of substance abuse among 12 year olds and
  
• older is highest among AI/AN, 14.
• AI/AN die at higher rates than other Americans
• alcoholism 0- 770
• tuberculosis 750
• diabetes 420
• accidents 280
• homicide 210
• suicide 190

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Health IssuesBehavioral Health

• Alcoholism
• 6 out of 10 leading causes of death of children
  are alcohol related
• Suicides
• 72 higher than All Races
• Domestic Violence
• In New Mexico Indian women make up 3 of
  population yet are 14 of shelter population

Chart indicates deaths per 1000 people. Blue
AI, Burgundy U.S. Average
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The disease of alcoholism now constitutes an
epidemic on the reservation. The effects
of this disease have been devastating,
widespread and pervasive, and have very nearly
destroyed the basic structure of the family as a
viable unit of tribal society and it has become
evident with the passage of time and futility of
effort that no meaningful lasting progress can
ever be realized by the Tribe until this disease
is brought under some degree of control Gregg
Bourland, Past Chairman, Cheyenne River Sioux
Tribe, 1991
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• More Stats from Trends
• AI/AN life expectancy is almost 6 years less
  than the general
• population.
• Other estimates put the rate for Oglala male
  at 55 years
• Infants die at a rate of 8/1,000 live births,
  compared to
• 7.2/ 1000 for US
• Injuries cause 75 of all deaths among AI/AN
  from age 19
• and younger.
• Injuries are the leading cause of death for
  AI/AN ages 1-44.
• Deaths from car crashes, pedestrian
  accidents, fir and
• drowning have decreased but overall death
  rate from
• preventable injuries is 2X as high.

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WHAT IS AN INDIAN? Indians who did not conform
to white expectations were harder to define. In
1869, the Supreme Court of New Mexico Territory
declared that the Pueblos were not actually
Indians, since they were honest, industrious,
and law-abiding citizens and exhibited virtue,
honesty and industry to their more civilized
neighbors. However, after receiving agents
reports of drunkenness, dancing, and debauchery,
the Court reversed itself and declared that the
Pueblos were Indians after all Taken from
Killing the Whitemans Indian, Fergus
Bordewich,1996
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12 Areas of IHS
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Barriers to Healthcare Local Level

• Lack of Funding leading to weak infrastructure
• Communication between Tribes
• Communication between AATCHB/IHS
• Severe under funding of IHS programs
• Lack of Grant writers/professional staff
• Territoriality or turf issues
• Fuzzy Personal/Professional boundaries
• Metro doesnt understand rural
• Cultural misunderstanding
• Racism, prejudice, discrimination

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• AATCHB Role and Activities
• Advocacy
• Policy Analysis
• Legislative Updates
• Information dissemination to Tribes
• Networking
• Monitoring Legislative process
• Creating Congressional support
• Increasing Funding Base for Operations
• Involving the Community

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The True Founding Fathers
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CIRCLE OF HEALTH
HEALTH DIRECTORS
PHS NURSES
NPHS
SOCIAL SERVICES
ALCOHOL
AATCHB
EMS
CHR
MENTAL HEALTH
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GPTCHB SPOT MATRIX
October 28, 2004
OPPORTUNITIES
Find new ways todeal w/ majordecision making
resolutions between mtgs.
STRENGTHS

Strong leadership Growth, progressive, track
record EPI Center Collaboration - tribes,
fed., state govts universities Diversity of
membership Focus on health HB relationship w/
natl orgs. Grants ear-marked funding
CommitmentMandatefor BoardMembers
Responsiveness to community Unity of Aberdeen
area tribes HB ability to advocate for AA
tribes in Washington.
Corporate other sponsorsfor less restricted
Start with theend in mind-have a prioritizedplan
Set up tribale-mail system 4Tribal HDsTribal
ChairsCouncils
Focus groups forlarger meetings
Use Technologyto plan meetConf.
CallsVideo conf.
OrientationProgram for Tribal councils, local
area HBs
Public RelationsProgram Our
ChairmansHealth Board
RefineBylaws
Strengthen Partner-ships
PROBLEMS
CURRENT/INTERNAL
FUTURE/EXTERNAL
- Health not a priority of tribal chairmen. -
Technology -- inadequate and lack of staff
training or willingness to use. Weak or
inadequate partnerships - Lack of sustainable
funding - Lack of focus on unmet needs - Lack of
sustainable funding - Advocacy - not fairly
integrating all the needs of tribes - Lack of
org. infrastructure (operational, personnel, mgt.
systems
THREATS
- Lack of effective communications --internal
external - Lack of adequate - Too many
priorities/lack of focus - Vast
distances--travel, costs, communications,
coordination - Poor attendance/quorums/changing
delegates Lack of training/orientation of Board
members - Dont get our message out - Integrating
diversity of members
Disunity of chairman
Lack of ability to change quickly
Treaty opposition
Substandard services-diminished health status
Page 4
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• How is AATCHB responding?
• Creating a stable, credible organization
• Establishing a Strategic Long Range Plan
• Creation of the Northern Plains Tribal Epi
• NARCH, MCH, Academic Liaison, Injury
  Prevention
• Supporting the Northern Plains Healthy Start
• SIDS/FAS Prevention Video
• Rites of Passage Program
• Breastfeeding Conference
• Finding Partners
• Sponsoring Conference/Seminars
• First Cancer Conference
• IRB Trainings (3)
• Grant Writing
• First Ever Tobacco Training
• First Asthma Conference (July)

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Barriers to Health Care National Level

• Trust responsibility functions have not kept
  pace with
• the demands of a growing population,
  inflation or
• disease burden.
• Communications between tribes/AATCHB/IHS/Feds
  and
• States needs greater attention
• National Politics Indian Issues are not a
  priority
• Treaty obligations have been diluted
• Rural isolation, poverty and cultural
  differences
• AA tribes are predominantly non-self governance
• Facilities, healthcare professionals and
  specialized
• care is not on same level as facilities off
  reservation
• Tribal infrastructure needs strengthening

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COMMUNITY ORIENTED HEALTH POLICY
PREVENTION
RESEARCH
HEALTH PROGRAMS
CLINICAL SERVICES
ORGANIZATIONAL CAPACITY
WORKFORCE CAPACITY COMPETENCY
INFORMATION DATA SYSTEMS
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• Doctrine of Discovery
• Gave the discovering power or party, the
• first right of occupation if there were no
• previous inhabitants.
• IF there were inhabitants, the discovering
• power had the first right to trade with, and
• to negotiate with, the newly discovered
• people issues of allegiance, sovereignty,
• and land sharing.

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• Trust
• assured reliance on the character, ability,
• strength, or truth of someone or something,
• one in which confidence is placed,
• reliance on future payment for property or
• merchandise as delivered,
• Something committed or entrusted to one to
• be use or cared for in interest or another.

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For AI/AN people, the federal responsibility to
provide health services represents a
pre- paidentitlement, paid for by the cession
of over 400 million acres of land to the U.S. In
many of the treaties negotiated between Tribes
and US, specific provisions for
basic healthcare, such as the services of a
physician and the construction and maintenance
of hospitals and schools were included. Sally
Smith, before the Senate Select Committee on
Indian Affairs

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Sadly, our national honor has been repeatedly
blemished by our failure to Live up to our word
and to extend a fragment of the human respect
that first greeted visitors to these shores. The
Tribal structures have, however, survived, and
sovereignty, in a real, although diminished form,
has continually been acknowledged by the courts.
Such sovereignty must be encouraged for it is
by the strengthening of tribal bonds and culture
that not only Indian people will be served, but
our national honor as well. Larry B.
Levanthal, Quare, University of Minnesota Law
School, 1977
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Children can change the World Each child is an
adventure into a better life an opportunity to
change the old pattern and make it new.
Hubert H. Humphrey (191178)
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The world is an evil place, not because of
evil people but because of those who sit back
and do nothing about it. Albert Einstein
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