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
Traditional View of Public Health
Pine Ridge Indian Reservation
Pine Ridge Indian Reservation
Pine Ridge Indian Reservation
Pine Ridge Indian Reservation
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
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
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
Ten Essential Services
Top Ten Achievements PH
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
Indian Health Service Areas Portland Billings Great Plains Bemidji California Phoenix Nashville Tucson Navajo Oklahoma Alaska Albuquerque
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 2002-2003
American Indian Health Disparities Average Age at Death in ND (2005-2010): 75.7 years in the White population 54.7 years in the American Indian population
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
Diabetes Life Line Gestational Diabetes Birth Obesity IGT Diabetes Complications Death Prevention Resources Primary Secondary Tertiary $ $$ $$$ Model Public Health Medical
Determinants of Health Physical Environment Social Environment Genetic Inheritance Health Behavior Health Care Services
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% 2005 2009 5% 0% White Black Asian/Pacific Islander AI/AN Hispanic Source: CDC Health Disparities and Inequities Report 2011, MMWR, Vo. 60
Determinants of Health Health Behavior Smoking, alcohol, substance abuse, seat belts, diet, physical activity, sexual activity, etc.
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.
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.
Need for AI PH Evidence-Based Practices Whose evidence is it?
Need for AI PH Evidence-Based Practices Whose evidence is it? Do current EBPs work in tribal communities?
Need for AI PH Evidence-Based Practices Whose evidence is it? Do current EBPs work in tribal communities? Examples from Indian Country!
Public Health in a Cultural Context Evaluation helps us to understand the relationship & effectiveness of public health programs
MEDICINE WHEEL NORTH WEST EAST SOUTH
MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL
MEDICINE WHEEL & Determinants of Public Health EDUCATIONAL ENVIRONMENTAL CULTURAL SOCIAL
MEDICINE WHEEL DECISIONS ACTIONS VALUES REACTIONS 33
MEDICINE WHEEL & Public Health Programming PLAN IMPLEMENT ENVISION EVALUATE
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.
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
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
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.
Donald Warne Chair, Department of Public Health NDSU donald.warne@ndsu.edu