Traditional Perspectives on American Indian Public Health

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1 Traditional Perspectives on American Indian Public Health NB3 Foundation Grantee Conference Albuquerque, NM April 30, 2015 Donald Warne, MD, MPH Oglala Lakota Chair, Department of Public Health Mary J. Berg Distinguished Professor of Women s Health

2 Traditional View of Public Health

3 Pine Ridge Indian Reservation

4 Pine Ridge Indian Reservation

5 Pine Ridge Indian Reservation

6 Pine Ridge Indian Reservation

7

8

9

10 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

11 What is health? More than simply the absence of disease Minimization of the effects of disease The ability to function well in the physical, mental, social, and emotional realms Social class and income are associated with health status and health outcomes

12 What is Public Health? The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort. the fulfillment of society s interest in assuring the conditions in which people can be healthy Institute of Medicine, 1988

13 Ten Essential Services

14 Top Ten Achievements PH

15 Benefits of Public Health An increase in life expectancy from 45 to 75 years for individuals living in the U. S. occurred during the twentieth century. 25 of the 30 years increase is attributable to public health. Changes in Life Expectancy Through Time

16 Indian Health Service Areas Portland Billings Great Plains Bemidji California Phoenix Nashville Tucson Navajo Oklahoma Alaska Albuquerque

17 American Indian Health Disparities Death rates from preventable causes 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

18 American Indian Health Disparities Average Age at Death in ND ( ): 75.7 years in the White population 54.7 years in the American Indian population

19 Prevention Cornerstone of Public Health Prevention of: Infectious Disease Immunizations Sanitation Chronic Disease Tobacco Control Obesity Lifestyle / Diet / Exercise Injuries Car seats / Seat belts Workplace safety / wellness

20 Diabetes Life Line Gestational Diabetes Birth Obesity IGT Diabetes Complications Death Prevention Resources Primary Secondary Tertiary $ $$ $$$ Model Public Health Medical

21 Determinants of Health Physical Environment Social Environment Genetic Inheritance Health Behavior Health Care Services

22 2.5 Times as Many AI/ANs as Whites Live Below Poverty Line Adults 18 years who live below federal poverty level 25% 23% 20% 21% 21% 20% 18% 19% 15% 10% 8% 8% 10% 11% % 0% White Black Asian/Pacific Islander AI/AN Hispanic Source: CDC Health Disparities and Inequities Report 2011, MMWR, Vo. 60

23 Determinants of Health Health Behavior Smoking, alcohol, substance abuse, seat belts, diet, physical activity, sexual activity, etc.

24 What Works in Public Health? Evidence Based Practice using the best available evidence to make informed public health practice decisions. Best Practice PH programs, interventions, and policies that have been evaluated, shown to be successful, and have the potential to be adapted and transformed by others working in the same field.

25 What Works in Public Health? Emerging Practice Incorporates the philosophy, values, characteristics, and indicators of other positive/effective public health interventions. Promising Practice Has strong data showing positive outcomes, but does not yet have enough research or replication to support generalizable positive public health outcomes.

26 Need for AI PH Evidence-Based Practices Whose evidence is it?

27 Need for AI PH Evidence-Based Practices Whose evidence is it? Do current EBPs work in tribal communities?

28 Need for AI PH Evidence-Based Practices Whose evidence is it? Do current EBPs work in tribal communities? Examples from Indian Country!

29 Public Health in a Cultural Context Evaluation helps us to understand the relationship & effectiveness of public health programs

30 MEDICINE WHEEL NORTH WEST EAST SOUTH

31 MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL

32 MEDICINE WHEEL & Determinants of Public Health EDUCATIONAL ENVIRONMENTAL CULTURAL SOCIAL

33 MEDICINE WHEEL DECISIONS ACTIONS VALUES REACTIONS 33

34 MEDICINE WHEEL & Public Health Programming PLAN IMPLEMENT ENVISION EVALUATE

35 NDSU MPH Program Mission The program s mission is to promote health and well-being in diverse populations with an emphasis on American Indian and other underserved populations by providing educational, practical, and research opportunities for public health professionals.

36 Specializations/Tracks NDSU MPH Program o Health Promotion (CHES) o Management of Infectious Diseases o Public Health in Clinical Systems o American Indian Public Health

37 Specializations/Tracks American Indian Public Health Required Courses American Indian Health Policy American Indian Health Disparities Cultural Competence in Indian Health Research Issues in Tribal Communities Case Studies in Indian Health

38 AIPH Competencies 1. Analyze key comparative health indicators for American Indians. 2. Describe American Indian health in historical context and analyze the impact of colonial processes on health outcomes. 3. Describe the unique challenges in implementing the Ten Essential Public Health Services in Tribal communities. 4. Critically evaluate public health policy, research, and programs for their impact on AI populations.

39 Donald Warne Chair, Department of Public Health NDSU

Best and Promising Practices in American Indian Public Health Notah Begay, III Foundation North Dakota State University National Indian Health Board

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