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Impact of Social Determinants of Health on Tribal Communities Montana Cancer Coalition
Helena, MT May 7, 2019 Donald Warne, MD, MPH Oglala Lakota Associate Dean of Diversity, Equity and Inclusion Director, INMED & MPH Programs School of Medicine and Health Sciences University of North Dakota
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Indigenous Peoples
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Lakota North America
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Sami Norway – Europe
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Nenets Siberia
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NAKOTA DAKOTA
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ND MN SD
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Helena
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Traditional View of Public Health
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IHS Areas Albuquerque Portland Billings California Phoenix Oklahoma
Nashville Navajo Tucson Alaska Great Plains Bemidji
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Historical Context
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Historical Context
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You will do well to try to inoculate the Indians by means of Blanketts, as well as to try every other method that can serve to Extirpate this Execrable Race. I should be very glad your Scheme for hunting them Down by Dogs could take effect…
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Historical Context
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Historical Context
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Dakota War of 1862
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Dakota War of 1862 The Daily Republican Winona, MN—1863
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AI/AN Population by County
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AI/AN Population Decline and Recovery, 1492 – 2010
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Historical Trauma Genocide Warne & Lajimodiere 2012
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Gestational Stressors Chronic Disease Disparities Historical Trauma Birth Genocide Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012
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Historical trauma is the collective emotional wounding across generations that results from massive cataclysmic events – Historically Traumatic Events (HTE)* The trauma is held personally and transmitted over generations. Thus, even family members who have not directly experienced the trauma can feel the effects of the event generations later Intergenerational transmission of trauma is a relatively recent focus of mental health. First observed in by clinicians alarmed by the number of children of survivors of the Nazi Holocaust seeking treatment The multigenerational aspects of trauma continue to be treated as secondary and, consequently, the behavior of many children of survivors of massive trauma is misunderstood and not treated appropriately The historical unresolved grief is a part of the trauma being experienced.
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Epigenetics Epigenetics refers to the study of changes in the regulation of gene activity and expression that are not dependent on DNA sequence.
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Gestational Stressors Childhood Stressors Chronic Disease Disparities Historical Trauma Birth Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Warne & Lajimodiere 2012
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Gestational Stressors Childhood Stressors Chronic Disease Disparities Historical Trauma Birth Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison Warne & Lajimodiere 2012
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ACE Study Pyramid
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Impact of ACEs on Health
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Impact of ACEs on Cancer
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Impact of ACEs on Cancer
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Impact of ACEs on Cancer
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Impact of ACEs on Cancer
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Gestational Stressors Childhood Stressors Adulthood Stressors Chronic Disease Disparities Historical Trauma Birth Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison Adverse Adulthood Experiences Alcoholism & SA Suicide rates / death rates Poverty / Poor nutrition Racism / Toxic Stress Role models Few positive Many negative Parenting Warne & Lajimodiere 2012
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Inter-Generational Basis for Chronic Disease Disparities Among American Indians and Alaska Natives
Gestational Stressors Childhood Stressors Adulthood Stressors Chronic Disease Disparities Historical Trauma Birth Genocide WIC FDPIR Boarding School Experiences Abuse (physical, sexual) Neglect Abandonment Forced Removal Loss of culture & language Forced Christianity Lost traditional parenting & family structure Adverse Childhood Experiences Abuse (physical, sexual) Neglect Substance Abuse in home Mental Health Dx in home Witnessing violence Divorce Food insecurity Family member in prison Adverse Adulthood Experiences Alcoholism & SA Suicide rates / death rates Poverty / Poor nutrition Racism / Toxic Stress Role models Few positive Many negative Parenting Warne & Lajimodiere 2012 Next generation
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South Dakota Health Survey
The survey included questions on: Basic information, including age, sex, race; Self-reported health status, including chronic diseases, depression, and other health issues; Mental Health Screening; Access to services, including cost, distance, and other access issues; and Adverse Childhood Experiences.
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Prevalence: Mental Health Screens
Participants who screened positive for a condition using standardized mental health screening tools
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AI ACE Disparities in South Dakota
AI Non-AI p-value
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Adverse Childhood Experiences Domains
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Equality, Equity, Systemic Barriers
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Significant Challenges
Social Determinants Poverty Trauma Politics Inattention/Neglect Racism Inequity Outcomes Health Disparities Education Inequality Generational Poverty Ongoing Racism Worsening Inequity Suffering and Death
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Significant Challenges
Social Determinants Poverty Trauma Politics Inattention/Neglect Racism Inequity Outcomes Health Disparities Education Inequality Generational Poverty Ongoing Racism Worsening Inequity Suffering and Death Need to address issues in a comprehensive manner—medical, behavioral, public health…
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Next Steps Indigenous Health MPH—UND Online, Fall 2019
Indigenous Health PhD—UND Fall 2020 Build competencies in: Research Methods Evaluation Frameworks Policy Development and Analysis Leadership
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Indigenous Health PhD 60 Credits, post-Masters 3-Years, full-time
42 credits—coursework 6 credits—Indigenous Health Seminar Series 12 credits—Dissertation / Portfolio Dissertation— “Academic Track” Portfolio— “Applied Track” Community Health Assessment, Grant Proposal, Published Manuscript, Strategic Plan, Policy Brief, etc.
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Indigenous Health PhD Principles of Indigenous Health—1 & 2
Applied Biostatistics Applied Epidemiology Quantitative Methods Qualitative Methods Mixed Methods CBPR & Tribally-Driven Research Frameworks Indigenous Research Methods American Indian Health Policy—1 & 2 Public Health Program Evaluation Indigenous Evaluation Frameworks Indigenous Leadership
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Blackfeet A child is sacred. And when that child comes into the home, the family must welcome it. And if the child is happy and feels the want, he will come into this world very, very strong. And not to know this is to know nothing.
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