Transcript No Slide Title

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 Chairmen’s Health Board
1770 Rand Road
Rapid City, South Dakota 57702
[email protected]
website: www.aatchb.org
Compelling evidence that race and ethnicity
correlate with persistent, and often increasing
health disparities among the U.S populations
demands national attention.
DHHS
The Causes of Health Disparities:
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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
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 Man’s Indian,” 1996
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
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.
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 %
Health Issues
Behavioral 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
60.0
50.0
48.7
40.0
30.0
20.0
20.0
15.0
10.4
10.0
7.3
6.7
0.0
Alcoholism
Suicides
Homicides
Chart indicates deaths per 1000 people.
Blue = AI, Burgundy = U.S. Average
“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
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.
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 Whiteman’s Indian, Fergus
Bordewich,1996
12 Areas of IHS
Barriers to Healthcare Local Level
• Lack of Funding leading to weak infrastructure
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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 doesn’t understand rural
Cultural misunderstanding
Racism, prejudice, discrimination
AATCHB Role and Activities
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Advocacy
Policy Analysis
Legislative Updates
Information dissemination to Tribes
Networking
Monitoring Legislative process
Creating Congressional support
Increasing Funding Base for Operations
Involving the Community
The True Founding Fathers
CIRCLE OF HEALTH
HEALTH
DIRECTORS
PHS
NURSES
NPHS
SOCIAL
SERVICES
ALCOHOL
AATCHB
EMS
CHR
MENTAL
HEALTH
GPTCHB SPOT MATRIX
+ Strong leadership
+ Responsiveness to
+ Growth, progressive, track
community
record
+ Unity of Aberdeen
+ EPI Center
area tribes
+ Collaboration - tribes, fed., + HB ability to advocate
state govts & universities
for AA tribes in
+ Diversity of membership
Washington.
+ Focus on health
+ HB relationship w/ nat’l orgs.
+ Grants & ear-marked funding
PROBLEMS
- Lack of effective communications -internal & external
- Lack of adequate $$
- Too many priorities/lack of focus
- Vast distances--travel, costs,
communications, coordination
- Poor attendance/quorums/
changing delegates
– Lack of training/orientation of Board
members
- Don’t get our message out
- Integrating diversity of members
- Health not a priority of tribal
chairmen.
- Technology -- inadequate and
lack of staff training or
willingness to use.
– Weak or inadequate
partnerships
–- Lack of sustainable funding
- Lack of focus on unmet
needs
–- Lack of sustainable funding
–- Advocacy - not fairly
integrating all the needs of
tribes
- Lack of org. infrastructure
(operational, personnel,
mgt. systems
OPPORTUNITIES
Start with the
end in
mind-have
a prioritized
plan
•Commitment
Corporate &
Mandate
other sponsors
for Board
for less
Members
restricted $$
Focus
groups for
larger
meetings
• Find new ways to
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deal w/ major
decision making
& resolutions
between mtgs.
Use Technology
to plan & meet
+Conf. Calls
+Video conf.
Orientation
Program for
Strengthen Refine
Tribal councils,
PartnerBylaws
local & area HBs
ships
• Set up tribal
e-mail system
4Tribal HD’s
Tribal Chairs
&Councils
• Public Relations
Program
“Our” Chairman’s
Health Board
THREATS
Disunity of chairman
Lack of ability to change quickly
Treaty opposition
Substandard services-diminished health status
Page 4
FUTURE/EXTERNAL
CURRENT/INTERNAL
STRENGTHS
October 28, 2004
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)
Barriers to Health Care National Level
 Trust responsibility functions have not kept pace with
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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
IHS Appropriations Per Capita Compared to Other Federal Health Expenditure
Benchmarks
$7,000
5,915
5,214
$6,000
$5,000
1999
5,065
Forecast
to 2003 3,879
2001
$4,000
3,803
3,725
1999
1999
$3,000
1998
IHS
1999
1,914
Year
of Last
Published
Data
$2,000
$1,000
2002
Medical
Care
619
NonMedical
$0
Medicare
Expenditures per
Enrollee
Medical Care for
Veterans
Administration Users
US Per Capita
Expenditures for
Personal Medical
Services
Acute Medical Care
for Medicaid
Enrollees
March 2003
Medical Care for
Federal Prison
Inmates
FEHB Medical Care
Benchmark per IHS
User
IHS Appropriations &
Collections Per User
COMMUNITY ORIENTED HEALTH POLICY
PREVENTION
RESEARCH
HEALTH PROGRAMS
ORGANIZATIONAL
CAPACITY
CLINICAL SERVICES
WORKFORCE
CAPACITY &
COMPETENCY
INFORMATION &
DATA SYSTEMS
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.
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.
“For AI/AN people, the federal responsibility
to provide health services represents a “prepaid”entitlement, 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
“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
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
(1911–78)
“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