Indian health researchers identify challenges for region’s reservations

• American Indian health disparities

American Indian health disparities
• Donald Warne

Donald Warne

Talk about it

American Indians die from such preventable diseases as diabetes at far higher rates than other Americans, especially in North Dakota and other states in the region, and a leading Indian health authority says more tribally driven research is needed to reduce such disparities.

Also, “chronic under-funding of the Indian Health Service (IHS) has more impact on Indian health than any disease,” Dr. Donald Warne told participants in a UND-sponsored conference on Indian health research.

He said diabetes, depression and alcoholism — a “triad” of debilitating conditions common in Indian communities — each aggravates the others and hampers treatment.

“We don’t address this holistically,” as cultural traditions would suggest, Warne said. “Instead, we cut treatment in half; the medical side isn’t integrated with the behavioral side. I think we’ve proven this is not working.

“Our traditional healers would find this (divided approach) ridiculous.”

Warne, a member of the Oglala Lakota tribe from Pine Ridge, S.D., spoke Friday at the eighth annual American Indian Health Research Conference at the Alerus Center.

Recently appointed director of Sanford Health’s new Office of Native American Health, he will coordinate activities involving the hospital system, the IHS and the 28 tribes within Sanford’s coverage area in Minnesota, North Dakota, South Dakota, Iowa and Nebraska.

A key part of that will involve “working with the tribes to help them build their own research agendas” so research results may lead to improved health and health services, he said.

“We know we have a significant problem with alcoholism and substance abuse,” Warne said, but researchers unfamiliar with Indian culture and history aren’t likely to find appropriate remedies.

“I don’t know that we’ve ever done adequate research on the effects of historical trauma,” the collective memory of defeat and subjugation, he said.

“If you live in an impoverished society and you tell your kids, ‘You can be a doctor,’ are they going to believe you? Does it seem doable?”

Sacred pipe OK, but not cigarettes

Inadequate funding of health and other services contributes to the prevalence of type-2 diabetes in Indian communities by cutting into physical education and nutrition programs in tribal schools, Warne said.

And while rates of colon cancer are declining in every other segment of the population, thanks to greater reliance on screening, that’s not the case among Indians, he said, because the IHS doesn’t pay for screening.

Indian communities themselves could do more to reduce cigarette smoking and cancer deaths, Warne said. It doesn’t help that many elected tribal officials, traditional healers and other role models continue to smoke.

“We need to be respectful of traditional tobacco” as it is used in many ceremonies, he said, “but we also need to acknowledge that cigarette smoking is killing us.

“Did we chain-smoke the sacred pipe? No, we did not.”

Phyllis Johnson, UND vice president for research and economic development, opened the conference Friday, noting that the university’s new strategic plan for research will include a focus on indigenous art, culture, history and language.

Johnson also noted that about 20 percent of American Indian physicians working today were trained at UND, as well as professionals in psychiatry, nutrition and other health fields.

Several current research projects undertaken by UND faculty and students were highlighted in displays at the one-day conference, with topics ranging from the role of spirituality in mental illness in Northern Plains Native Americans to youth suicide prevention, college students’ health risks and “pre- and post-colonial diet analysis of the Northern Plains tribes.”

Guinea pigs or research partners?

For too long, most research institutions and funding agencies treated Indian communities as laboratories — guinea pigs — rather than as partners, Warne said.

“We’ve made tremendous strides in the last decade,” he said, but Indian communities “still aren’t setting the research agenda.”

Health researchers looking at conditions on reservations need a better understanding of Indian country, Warne said. A diabetes researcher, for example, must take into account the influences of poverty, reliance on the government’s commodity foods program, even the “lack of safe places to exercise” on some reservations, and not simply ask, “Why don’t those people eat better and exercise more?”

Also, health professionals and researchers accustomed to communicating “assertively” need to understand that a core value in Lakota and other Indian cultures is humility, which may color how Indian patients or survey respondents communicate.

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com.

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