\f\f\f\fChapter 8 American Indians and Alaska Natives Populations Overview of Chapter Topics Chapter Introduction American Indians Alaska Natives Considerations for Health Promotion and Program Planning for American Indians and Alaska Natives Chapter Summary and review questions Case Study: American Indian veteran's struggle with PTSD Model Program: The American Indian Life Skills Development Curriculum Introduction Terms American Indian and Alaska Native - Refer to people descended from any of the original peoples of North and South America (including Central America) who maintain tribal affiliation or community attachment - Terminology reflects that of 2000 U.S. Census General characteristics of these groups - Diverse, geographically dispersed, and economically disadvantaged - Disease patterns reflect poverty, limited access to health care, inadequate education, high unemployment, discrimination, and cultural dislocation American Indians History of American Indians - Descended from first humans to migrate into North America - Arrival of Europeans brought violence and wars against American Indians, and new diseases to which American Indians had no immunity were introduced (i.e., small pox) - Europeans' attitudes toward American Indians were characterized by ethnocentrism and racism - American Indians were viewed as a problem with the solution being to eradicate them American Indians History of American Indians (continued) - In U.S., Indians were often seen as impediments to European settlement, with eradication and/or westward removal typically deemed the proper solutions - Lead to the Indian Removal Act of 1830 which pushed Indians westward - Some steps taken to \"civilize\" the Indians i.e., not permitting them to speak native language, boarding schools - Indians granted U.S. citizenship in 1924 American Indians in the U.S. 561 Federally recognized tribes and tribes recognized in certain states in U.S. Importance of Federal recognition as a tribe - Gives them the right to govern themselves - Creates relationship of government-to-government relationship - Limitations same as state government i.e., cannot engage in war, coin money etc. Demographic patterns - 43% in West, 31% in South, 17% in Midwest, 9% in Northeast American Indians in the U.S. American Indians in the U.S. Educational and occupational achievement - 76% aged 25+ have at least high-school diploma, 14% have at least bachelor's degree - 26% 16+ work in management and professional occupations - 25% live in poverty Access to health care services - - - - 45% have private health insurance 21.3% have Medicaid 31% do not have insurance Indian Health Service provides federal health services to American Indians and Alaska Natives American Indians in the U.S. Many American Indian and Alaska Native languages have become extinct General features of religious/spiritual beliefs - Most tribes believe in Supreme Creator and lesser deities - Try to maintain daily harmony - Treat all life with respect American Indians in the U.S. Social patterns - Family-based people - Respect elders and obey their orders - Men are considered leaders of the house after elders - Community is important - Storytelling, songs, music, and dance are important rituals American Indians in the U.S. Food - Some foods are sacred, i.e., corn - Dietary food practices have changed drastically - Current dietary patterns similar to rest of U.S. population American Indians in the U.S. Source: CANFIT, Berkerly, CA. Used with permission . American Indian Beliefs About Health and Illness Health seen as a process of staying spiritually, mentally, and physically strong Harmony with oneself, other people, natural environment, and Creator are considered essential Does not believe in biomedicine or germ theoryillness is caused by personal responsibility, qualities, and spirits American Indian Beliefs About Health and Illness Violation of traditional beliefs/codes seen as leading to physical/mental illness, disability, bad luck, or trauma Illness seen as linked to past or future behavior Healing Traditions Among American Indians Traditional healing practices: General cultural values - Restoration of individual, tribal, and spiritual harmony is emphasized - Practices tend to be holistic, addressing the totality of the individual rather than specific symptoms - Widespread openness to use of traditional healers Healing Traditions Among American Indians Traditional healing: Specific Practices - Sweat lodges Used for healing and balancing Good way to clean body and sweat out illness or disease Stones covered in water are used to create steam bath Building of the sweat lodge is sacred and symbolic i.e., four sides represent four sacred directions, 28 poles that may represent ribs of a woman - Talking circles Reflect circle of life i.e., changing of the seasons, phases of the moon Group gathers in a circle and feather is passed aroundperson holding feather speaks Healing Traditions Among American Indians Traditional healing: Specific Practices - Plants and herbs Used to purify the spirit and bring balance Wide variety used i.e., sage Tobacco is sacred plant, smoke pure Peyote, hallucinogenic drug, it is a dome-shaped cactus, legal only on Indian reservations because of its healing and spiritual properties - Healing ceremonies Used to help groups of people return to harmony Sand paintings Medicine wheel Healing Traditions Among American Indians Healers - \"Medicine men\" (man or woman) Prominent healers Are in turn with the way that humans interact with the world Takes many years of training May specialize in such areas as herbal medicine, bone setting, midwifery, or counseling Healing may involve use of tobacco or herbs, vision quests, sweat lodges, contacting animal spirits Some medicine men also are shaman Healing Traditions Among American Indians Healers - Shaman Has special powers of communication with the spirit world Goes on soul journey to spirit world aided by drums, songs, rattles, and other objects to communicate with spirits before healing ceremony Behavioral Risk Factors and Common Health Problems Among American Indians Major behavioral risk factors - Nonuse of automotive seatbelts - Cigarette smoking - Abuse of alcohol - Sedentary lifestyles - Excessive body weight/obesity - Lack of preventive behaviors (e.g., health screenings) Behavioral Risk Factors and Common Health Problems Among American Indians Leading causes of death (2003) - Heart diseases - Malignant neoplasms - Unintentional injuries - Diabetes - Chronic liver disease and cirrhosis - Cerebrovascular diseases - Chronic lower respiratory disease - Suicide - Influenza and pneumonia Behavioral Risk Factors and Common Health Problems Among American Indians Cancer: American Indian and Alaska Native men have stomach and liver cancer rates twice that of white men Diabetes: American Indian and Alaska Native adults 2.3 times as likely as white adults to have diabetes Behavioral Risk Factors and Common Health Problems Among American Indians Behavioral Risk Factors and Common Health Problems Among American Indians HIV/AIDS rates - For American Indian/Alaska Natives overall, HIV/AIDS rates are 40% higher than those of nonHispanic whites - For American Indian/Alaska Native men, HIV/AIDS rates are only 10% higher than those of non-Hispanic white men - For American Indian/Alaska Native women, HIV/AIDS rates are three times higher than those of nonHispanic white women Behavioral Risk Factors and Common Health Problems Among American Indians Infant mortality - General infant mortality rates are 1.5 times that of non-Hispanic whites - American Indian/Alaska Native babies are 2.2 times more likely to die of SIDS than white babies Behavioral Risk Factors and Common Health Problems Among American Indians Stroke - American Indian and Alaska Native adults are 60% more likely to have a stroke than white adults - American Indian and Alaska Native women have twice as many strokes as white women Alaska Natives History of Alaska Natives - Numerous historical conflicts regarding land possession and redistribution - Discrimination and segregation long practiced upon Alaska Natives by Whites, Russians, and Americans 1945 Alaska state law marked the beginning of the end of legal segregation Native Alaskans in the U.S Tribal affiliations and lifestyle/cultural changes - Alaska Natives include tribes such as the Aleut, Inupiat, Yupic, Eskimo, and Athabascans - Many forced by lack of resources to live outside their native villages - Move to cities by some may contribute to health problems (e.g., as a result of adopting unhealthy diets) - In spite of such cultural dislocations, Alaska Native culture still observable Native Alaskans in the U.S. Languages - 20 known Alaska Native languages - Many languages expected to go extinct by next generation - Linguistic diversity may contribute to some educational disparities Native Alaskans in the U.S. Social Patterns - Villages typically consist of related families with close-knit relationships - Food shared when animals are killed - Elders highly respected and are given the entire first kill of young males - Men typically do the strenuous hunting, while women do the food gathering and preparation Native Alaskans in the U.S. Traditional diet - 40% protein, coming from fish, deer, moose, caribou, duck, whale, seal, sea lion, and walrus - Typically deficient in calcium and in vitamins C and D - Common methods of food preparation have resulted in world's highest rates of botulism - Toxic bacteria also is found naturally in the soil Organized religion not a significant part of traditional native village life Beliefs About Health and Illness Among Alaska Natives Causes of illness are seen as related to spirit world Shamanistic practices believed necessary to cure illness Healing practices include public ceremonies Beliefs About Health and Illness Among Alaska Natives Many ancient traditions are used Some shamans have specific skills (e.g., treating burns with fat, cleaning wounds with urine, amputating gangrenous frozen limbs, and setting broken bones) Beliefs About Health and Illness Among Alaska Natives Healing Traditions Among Alaska Natives - Restoration/maintenance of harmony with oneself, one's community, and one's culture is emphasized - Medicinal plants and herbs are commonly used - Communal drumming, dancing, and singing are considered powerful sources of healing Beliefs About Health and Illness Among Alaska Natives Beliefs about health/illness are beginning to shift - Greater acceptance of scientific biomedicine - Shamanistic and Western medicine sometimes used in combination to treat illness Beliefs About Health and Illness Among Alaska Natives Healing Traditions Among Alaska Natives - Traditional healers are often complemented by \"tribal doctors,\" who typically have some formal standardized training and often work with medical physicians - Openness to Western biomedicine is increasing Behavioral Risk Factors and Common Health Problems Among Alaska Natives Major behavioral risk factors - Alcohol consumption (average starting age is 9) - Smoking and chewing of tobacco - Drug use - Inadequate exercise - Obesity - Unhealthy diet Behavioral Risk Factors and Common Health Problems Among Alaska Natives Major behavioral risk factors (continued) - Violence and unintentional injury - Suicide - Nonuse of automotive seatbelts and motorcycle helmets - Prevalence of guns in the home - High rates of mental health problems Considerations for Health Promotion and Program Planning Tribal names preferred - Find out how the individual or group prefers to be addressed Acculturation levels vary - Determine patient's level of acculturation Recognize diversity among tribes and avoid facile assumptions Use holistic thinking wherever possible Accommodate complementary/alternative healing Considerations for Health Promotion and Program Planning Be aware that handshakes are often gentler than in White culture Be patient in allowing patients time to respond Avoid prolonged eye contact, which is considered disrespectful Work with families and bear in mind the traditional respect for elders Cooperation highly valued; don't encourage competitive behavior Keep nonverbal behavior to a minimum Summary History of being conquered by other nations Have held onto to many traditional practices Major disparities in health exist High-quality and culturally sensitive health promotion programs are needed Chapter 9 African American Populations Overview of Chapter Topics Chapter introduction History of African Americans African Americans in the United States Beliefs about causes of health and illness Behavioral risk factors and common health problems among African Americans Considerations for health promotion and program planning for African Americans Chapter summary and review questions Case study: A low-birth weight African American newborn Model program: SISTERS Terminology African American: The current, politically correct term for those of sub-Saharan African descent Black - Defined by some as including only people of relatively recent sub-Saharan African descent - Used by others to refer to anyone of very dark skin color, including sub-Saharans as well as some South and Southeast Asian populations Negro and Colored: Older terms preferred by some African Americans aged 60 and over African American and black are commonly used in the literatureblack is a broader term and includes Caribbean Islanders History of African Americans Slave trade of 16th-19th centuries was forced migration of Africans to the New World An estimated 12 million were forced to migrate Africans taken by force were made into slaves rarely leaving families intact History of African Americans Roles of African Americans in colonial America and during the Revolutionary War included farming, constructing forts and shelters, defending colonies Oppression and brutalization of African Americans under slavery and during the postCivil War era - Experienced sexual assaults, lynchings, and other forms of violent acts and discrimination - Each state had slave codes that gave rights to slave owners as having near-absolute power over slaves (human property) African Americans in the United States General demographic facts - African Americans make up almost 13% of U.S. population - Live mostly in southern states - In 2000 census 58% lived in urban areas - These urban environments tend to be surrounded by poverty, crime, and inadequate housing leading to stress - Murder is the leading cause of death among young African American males African Americans in the United States African Americans in the United States High poverty levels, which is related to - Low level of access to health insurance coverage - Relatively low levels of academic achievement - High incidence of single-parent households - Crime General social attitudes - Reliance on extended family networks - Reliance on faithchurch is a cornerstone for black community African Americans in the United States General attitudes toward the health care system - Widespread mistrust of the health care system Low numbers of African American health professionals - Discrimination and disrespect widely experienced when interacting with health care system African Americans in the United States The health effects of pervasive, longstanding racial discrimination - High levels of stress, often leading to emotional, physical, and behavioral problems (i.e., aggressive or illegal acts such as fighting or shoplifting, high blood pressure, drug use, binge eating, depression, low self-esteem) - Heightened propensity toward unhealthy behaviors i.e., drug use, smoking Beliefs About Causes of Health and Illness Traditional tendency to distinguish \"natural\" from \"unnatural\" illnesses - \"Natural\" illnesses seen as resulting from God's will or from unhealthy contact with the forces of nature i.e., temperatures, air, food, or water - \"Unnatural\" illnesses seen as a result of evil influences that alter God's plan e.g., witchcraft - This belief systems has African origins Many see health as a gift from God; illness is a result of something that was not pleasing to God Beliefs About Causes of Health and Illness Healing traditional among African Americans - Wide variety of African American healing traditions, many with roots in African beliefs and practices Use of faith or spiritual healers Use of rituals, charms, and/or herbs Reliance on prayer Practices based on Voodoo, Santeria, and possibly on Candomble Beliefs About Causes of Health and Illness - Voodoo Originated in West Africa One the world's oldest religions Four themes include 1. Spiritual force 2. Preparing medicine brings healer closer to spiritual power 3. Healing maintains relationships between living and ancestors 4. Power can be used for healing and harming Two types: white (harmless), black (dangerous) Practice was made illegal in 19th and 20th centuries Beliefs About Causes of Health and Illness - Santeria Includes tradition of possession trance to communicate with ancestors and deities, use of animal sacrifice, drumming, dancing Aka \"Way of the Saints\" - Candomble Developed in Brazil Includes tradition of possession trance to communicate with ancestors and deities, use of animal sacrifice, drumming, dancing Use of spiritual healing practices may be concealed due to the stigma associated with such practices by mainstream culture Behavioral Risk Factors and Common Health Problems Among African Americans Drug and alcohol abuse Smoking Obesity Limited physical activity Behavioral Risk Factors and Common Health Problems Among African Americans Poor nutritional habits - Diets typically high in fat, sugar, and sodium - High consumption of pork products, fried foods, and heavy gravy - Low consumption of complex carbohydrates and dietary fiber, though consumption of specific vegetables may be appreciable in many diets - Relatively low consumption of fruits Behavioral Risk Factors and Common Health Problems Among African Americans Behavioral Risk Factors and Common Health Problems Among African Americans Common health problems - Relatively high incidence of: Diabetes: 1.8 times that of non-Hispanic Whites Infant mortality: 2.4 times that of non-Hispanic Whites Heart disease and mortality from heart disease HIV/AIDS - In 2005, 49% of new AIDS diagnoses were among African Americans Behavioral Risk Factors and Common Health Problems Among African Americans Common health problems - Relatively high incidence of: STDs other than AIDS -Gonorrhea rates 18 times those of Whites -Syphilis rates 5 times those of Whites - Teen pregnancy rates more than 2.5 times that of Whites - Relatively high exposure to violent crimes High homicide rates, especially among those aged 15-24 Behavioral Risk Factors and Common Health Problems Among African Americans Cancer - Compared with non-Hispanic White men, African American men have relatively high rates of: Stomach cancer (2x) Lung cancer (1.4x) Prostate cancer (1.4x) - African American men are 2.4 times as likely as non-Hispanic White men to die of prostate cancer Behavioral Risk Factors and Common Health Problems Among African Americans Cancer - Comparisons between African American women and non-Hispanic White women African American women are 10% less likely to be diagnosed with breast cancer, but 36% more likely to die from it African American women are more than twice as likely to be diagnosed with and to die from stomach cancer Behavioral Risk Factors and Common Health Problems Among African Americans Immunization rates - In 2005, older African Americans were 30-40% less likely than non-Hispanic Whites of similar age to have received flu or pneumonia immunizations - African American children 19-35 months of age have immunization rates for hepatitis, flu, MMR, and polio comparable to those of similarly aged non-Hispanic White children But African American children in this age group were slightly less likely to be fully immunized than Whites of the same age Behavioral Risk Factors and Common Health Problems Among African Americans Pregnancy/birth issues - Comparisons between African Americans and nonHispanic Whites Overall infant mortality rates: 2.4 times that of Whites Death from low birth weight: 4 times that of Whites Death from SIDS: 2.1 times that of Whites African American mothers 2.6 times as likely as non-Hispanic White mothers to receive no prenatal care or to begin such care only in 3rd trimester Behavioral Risk Factors and Common Health Problems Among African Americans Stroke - African American adults are 50% more likely than White adults to have a stroke - African American males are 60% more likely to die from stroke than White males - African American stroke survivors are more likely to become disabled or to experience daily-life difficulties than non-Hispanic White stroke survivors Considerations for Health Promotion and Program Planning Be aware: - of the possibility that African American patients may harbor a significant degree of mistrust for the medical establishment - that peer educators are not likely to be an effective component of a health program targeting this group - of dialect or regional terminology used by some subgroups in reference to medical conditions i.e., bad sugar Considerations for Health Promotion and Program Planning Consider using churches as sites for education and/or health screenings Focus on positive health messages instead of attempting to achieve behavioral change based on fear of negative outcomes Until invited to do otherwise, use formal titles when addressing participants Take especial care to ensure that the verbal and nonverbal messages you communicate are congruent Summary Initially came to U.S. primarily through slavery Some beliefs about health and illness are related to religion and ancestral roots Main behavior risk factors are smoking, weight, and limited physical activity