Taking Action Summit: Historical Trauma and the Health Disparities That Perpetuate in American Indian/Alaska Native Communities
All right. (speaking in foreign language) My name is Dean Seneca. I'm a Seneca Indian. A little bit about me, I like to say I was born a poor Indian child in the inner urban area of South Buffalo, but will probably never get to my presentation if I tell that whole story.
I'm a UB grad. I actually grew up in the city of Buffalo. My family's from Cattaraugus, the Cattaraugus territory. We're of the Beaver Clan.
And in Cattaraugus, there's a little community called Bucktown, and that's kind of where my family's from. I'm a, like I said, a UB grad. Did my graduate work at the University of Hawaii at Manoa, which I used to say I will be paying for a very long time, but guess what? I paid my student loans, and that's just like a great feeling.
And I spent 20 years at the Centers for Disease Control and Prevention as a senior health scientist. And I was the lead for American Indian Health at one time. But as our good friend John Lewis has said, and he knew me very well, actually, well I made sure he knew me very well because when I was at CDC, I got into a lot of good trouble that I never am intended to get into. But it just kind of happens when you're one of probably five Native people at an agency of 8,000.
So anyways, we have this partnership with the University of Rochester and Michelle has just been so nice to us. And she has really engaged us and has come and visited our community, attended a smoke dance, and we're like, and she's doing so much to help promote and address indigenous populations from addictions. So when she asked me to be part of this, the answer was automatically yes. So, what I want to talk with you today is about intergenerational trauma or historical trauma.
And it's basically the emotional and psychological wounding of an individual caused by traumatic experiences. And specific experiences related to the Native community include genocide, ethnic cleansing, ripping a culture away and replacing it with someone, making you ashamed of who you are as a Native person, So my talk with you today is really about the changes that Native populations have undergone in a very short period of time, and this convoluted history with the United States. And these changes impacted and caused a lot of trauma in the Indian community, right? Especially over a very short period of time.
We're gonna talk about contact, treaties, boarding schools, and the Dawes Act, reorganization in 1934, termination. All of these things have caused a lot of trauma in the Native community. We have very resilient and very strong people. We've survived all of these horrific US policies, but we've never healed from them.
And that's why in our Native populations, we have a lot of addictions and a lot of alcohol related problems. And just to let people know, I come from an alcoholic family. I get up here and think, and sometimes people think that I'm a preacher and that I'm not impacted by these social determinants or intergenerational trauma or any of these things, but believe me, I am. And my whole family is.
And me and my significant other, when she gets here, you'll meet. She also has been impacted. So, the history of trauma. There's a psychosocial theory which links disease to both physical and psychological stresses.
Then there's a theoretical framework, which is political and economic theory which is addressed as the political and economic structures, if you remember from the conversation earlier that the impact of the economic is at the first level. And then there's the social ecological systems which recognizes the multi-level dynamics and interdependence of the past, present, and proximate, distal life courses. And this is all in understanding how certain populations have a higher disease burden than others. And then what I wanna talk to you is my little hypothesis here is that due to the changes in the environment, due to these drastic changes in the environment the indigenous populations that have endured over a relatively short period of time is the cause of all of these different things that we have to deal with, these social ills that we have to deal with related to domestic violence and addictions and family structure and counterculture.
Dr. Maria Yellow Horse Brave Heart basically does a lot of work regarding historical trauma. And she basically has, I believe is a pioneer. For hundreds of years, Native people endured the physical, emotional, social and spiritual genocide that the colonists, the newcomers brought on to them in this new world.
And it's done primarily done through trickery. My thing is that the Honest Injun, y'know, that Indians were honest. And those agreements that were made verbally meant everything to the Native people. But Dr.
Yellow Horse Brave Heart, a significant portion of Native people are struggling with health disparities that stem from intergenerational trauma. Intergenerational or transgenerational trauma is trauma transferred from first generation of trauma survivors to the next and future generations of offspring of survivors via complex post-traumatic stress disorder mechanisms. And Dr. Cornelia, I think you're dealing with generations of people who have been damaged by colonialism.
And the way that we have been treated by the dominant culture makes you feel dispirited. You feel devalued. And so people will turn to things like addictions as a way of coping, of self-medicating, of not really wanting to be here because of their situation that's so intolerable. During a lot of this intergenerational trauma, they'll talk with survivors of the boarding school, for example, or people in the Native community who grew up watching John Wayne movies.
And they'll ask the Native people, they'll say, well, the Native people will say, we never wanted to be the Indians in cowboys and Indians. And the researchers or social offices, well, why? Because the Indians always died, right? So these are the stigmas that Native people had to endure.
Besides of this intergenerational trauma, there's a significant amount of discrimination and racism. And Natives have been exposed to generations of violence through colonization, broken treaties, removal, reservation, land loss, assimilation, displacement, racism, and anti-Indian policies. And what I want to stress regarding some of these, but what I'm gonna emphasize in my lecture is the removal policies, the reservation systems, the Indian boarding schools, which are all forced assimilation. And these situations currently manifest in high rates of suicide, injury, domestic violence, child abuse, chronic diseases, alcohol, addictions, and others.
And the other big thing I like within my presentation today is that I've actually shared information from my class. I teach a class at the University of Buffalo on Indigenous Health Disparities. And I asked my students these very same questions. And it's really amazing to see the results 'cause they really, I think comprehensively talked, discussed, we comprehensively discussed what are the health outcomes related to treaties, related to removal, related to boarding schools?
And we have some very interesting results. And I like to start off my presentations, and I started off the first, this is my first slide for my class. And the guy there with the cool hat on with the, it looks like a billy club, but it's actually a chair, his name is Norman Jimerson, and that is my cousin. And God rest his soul.
And this picture is the BIA takeover in 1972. What you don't see in this picture is that all these warriors here are facing a whole huge group of policemen in riot gear ready to come in and take the building over. And I look at this picture and I'm thinking to myself, God, our warriors must have been terrified, but they're willing to risk their lives for change. This is 1972, this is before self-determination in 1975.
And my question that I start out my class every semester with is why would these Indians do this? Why would you have all these Indians taking over the Bureau of Indian Affairs? What is that purpose? And then I start out the conversation with that, cuz I wanna leave that.
And we'll come back to cousin Norman. But yeah, what he tells me about is the Black Panthers were calling in. They said, no, this is our fight. And, and basically what they did is they put all their best warriors outside to fight all the people in riot gear, and they chained the doors behind them.
So there was no way back in to the building. Native elders were in this building saying, I prayed for this day, I prayed for this day. And that's where we need to start to measure disparities. We, as Haudenosaunee people, you could see where our lands were traditionally.
And I would attest that this is kind of a New York thing. Our Haudenosaunee people really were very migrant people. We traveled from the top of Quebec all the way to the Ohios to the northern Carolinas all the way up the East coast. And that was kind of our area there, right up next to the Algonquin and the Pawnee.
And then this is a traditional village, a traditional Haudenosaunee village. And you see that each longhouse was for each clan in the community. You could see like the fence. So basically we lived on the mountain tops and we farmed in the valleys.
And this is something that looks a little bit more, and there was always a central longhouse in the middle. And that was kind of the communal house. This is where a lot of the meetings were held, but also where everybody ate and gathered, where a lot of the discussions and the governance of the community were held. And this is kind of like the inside, you could kind of see where people resided.
And they have all of their supplies and things. And there was always a fire where there was always food. Remember, all of our food was always boiled and baked. Nothing was ever fried.
Just a whole different way of living. And then this alteration in this environment, there's huge drastic changes, right? So this convoluted history that we have with the United States started out with contact and it started out with treaties. And some of the main treaties or court cases that the United States were McIntosh versus Cherokee Nation, Johnson versus McIntosh, excuse me, Cherokee Nation versus Georgia and Worcestershire versus Georgia.
All of these basically claim that tribes were seen as dependent nations, a nation within a nation. And these treaties kind of set the stage for tribes as sovereign governments. And I think a lot of our other tribal nations have to owe a lot to those tribes that were in the southeast at the time because they sacrificed a lot in order to have sovereignty for all tribal nations, even though we're all in this battle together. And then the removal policy, I was talking about our friend Andrew Jackson, who really basically spearheaded this whole removal policy that all Indians would be moved to lands west of the Mississippi.
I also made a comment, or someone made a comment to me, it was interesting that Andrew Jackson was the main president that was in the office of our previous administration right over his shoulder. And then removal shifts to the reservation system. And putting a Native on a reservation is literally like putting a Native in jail. It's just not a good way for Native people to be able to sustain theirselves after being so migratory.
And then assimilation and allotment, boarding schools where military installations of assimilation and allotment was the Dawes Act, in which we really lost a lot of our land out of trickery and corruption by the Bureau of Indian Affairs. And then Indian reorganization in 1934, and then termination from 1943 to 1968. All of these have had a significant impact on Native people. The three that I want to point out and the health impacts of them are removal, reservation, and assimilation.
Removal. The most known but recently has been removed from our high school history books was the Trail of Tears. And it was the forced relocation of many Natives, that Natives basically that were in the southeast and they were moved to what was gonna be the Indian state of Oklahoma. And many Natives died on that trail, on that march.
They were told to walk literally from Georgia to Oklahoma, literally. And there's a lot of estimates that 9,000, 5,000, the estimate that I remember reading was that there was 30,000 that started on the march and only about 8,000 survived. So there's a lot of estimates at that time. And it was among our so-called sarcastic five civilized tribes, the Cherokee, Chickasaw, Choctaw, Creek, and Seminole.
This was huge removal. And there was several different routes to Oklahoma throughout this process. And what were some of the main impacts from this? Well, removal policy really changed everything about the Native person, right?
It changed their diet, it changed their cosmology. it changed their whole being. I mean, there was a lot of morbidity and mortality on that route. A lot of people were dying, right?
I mean, a lot of people were forced at gunpoint to make this march. So everything was changed from Native people who were traditional in that area to a whole new area of Oklahoma. And Oklahoma wasn't the best area for cultivation. Oklahoma wasn't the best area for pretty much anything.
And that's why the colonists never gave the Natives or put the Natives on land that could easily be farmed or cultivated or you could live on, even the best farmers had a hard time cultivating in Oklahoma. But when you change everything where the Native people had to rely on the US government for food, that changed everything because the food that the US government was giving the Native people was high in sugar, salts, starches, things that were really foreign to Native people. And when you put a lot of sugar into a body, you're kind of like, you're grooming that body. You're grooming that person to be very susceptible to things like addictions when you add a lot of sugars in your diet.
And then the reservation system. The reservation system, y'know and I say this all the time, it's really Indians couldn't live on one area of land. It was literally like putting a Native person in jail. We needed to hunt and gather.
We couldn't have these borders. And trying to survive in a reservation. And then here's the other thing, the federal government usually put many tribal nations who were historically enemies with each other on the same territory. And they said, hey, go ahead and get along (chuckling).
It was almost impossible. So not only had tribes lost their lands, but it was almost impossible to maintain true cultural traditions inside a combined area. But many Native Americans were forced on the reservations with catastrophic results and devastating, long lasting effects. Poor diet, poor health, poor diet, stress, depression, anxiety.
So we could look at contact on the east, and as Natives were pushed, you could see more of our land base over here. We have 574 federally recognized tribes within the United States. And putting people on the reservation, I like this little caption over here, Chief Eagle Claw, what is your opinion on living conditions of the Native American? And I've got some, I got my reservations.
So I asked my class after we, because basically in my class, what I do is I reteach history from the Native perspective. And then we talk about, well, what are the health implications after all of these policies? And I'm so proud of my students because after we talked about treaties and removal and the Dawes Act, these are the things that came out of my students. And I'm like, this is great.
I've said we need to present this at this conference right here, malnutrition, reliance on food resources, mental health, anxiety, depression, PTSD, suicide, addictions, self hate, domestic violence, obesity. Look at a lot of these, racism and chronic stress, emotional, physical, sexual trauma, reproductive trauma and poverty. All of these were health implications that my students pointed out that were, would be results from this. The other big thing though, there's a lot of study on this, well, not a lot of study, but there is significant study on this.
No matter when you move a population from where their ancestral areas are to wherever they're gonna be moved to, either if it's in the among Native populations or among the African populations over in Africa, wherever you do that, there's always high morbidity and mortality. And what they've found in this is that it's always the women in the group that sustain the community. It's always the women that rise and keep the people together. It's always the women that rise and help the community sustain itself and address all these problems during these kinds of removals.
So some of the other things that we discussed was we must remain in the community in order to address these addictions. Many methods of healing were lost during the implementation of these US policies towards indigenous populations. The thing that gets me is this, is that the US government has taken the last 200 years to rip the culture out of Native people, right? Through boarding schools and things we're gonna talk a little bit about that.
But now, after we have all these addictions and things and all these other problems, the solution is well go back to your culture. Go back and embrace your language. Go back and do all of these cultural things, and this will help you heal. And the boarding schools.
It was the mission of Richard Henry Pratt regarding these boarding schools to kill the Indian and save the man. And this philosophy basically reverberated throughout all of our indigenous communities, both in First Nation among American Indian, Alaska Natives, and Native Hawaiians. That basically kids were taken from their families and communities for long periods of times and sent to these schools. What we're finding out now is that many of these kids actually left their home and went to a boarding school and were never to be seen again.
These mass graves and things that we're uncovering right now in First Nations communities and many of our own communities, it's something that I've always heard from our elders that, yeah, we know this is going on. We knew that there was these mass killings, we just could never prove it. And now the proof is coming out. These boarding schools, Indians, the Native students, and this is actually was the creation of the Indian Health Service in 1955, it started with these boarding schools, because the disease conditions in these schools were awful.
There was a lot of tuberculosis, influenza, whooping cough, measles, pneumonia, trachoma, and even smallpox at these schools. These schools were not schools. These were militarized institutions, labor intensive concentration camps. Schools have playgrounds on the outside of them.
Our schools had graves where the student could actually see their friends and see the graves of their friends if they did not do what they were told to do. And the abuses at these schools were insurmountable, right? Dr. Katrina Walters from the University of Washington said that, and has done some research in this area, that eight outta every 10 kids were sexually abused.
Imagine that. By the time of the turn of the century, between 1800 and 1900, 85% of Native kids were in these schools. And disciplines were awful. It's almost corporal punishment.
Just terrible. We survived, but we've suffered serious consequences. And my biggest thing is this from boarding school era that I always said, it's gonna stop with me, is that Native people coming out of this institution and they start having babies, they really don't know how to be parents because they've never been around or in a role of parenting. That to me is the biggest impact of our boarding schools.
And I look at this picture, and I'm sure many of you have seen this picture, and I get emotional looking at this picture even when I'm teaching in class. Because one thing that people forget when they see this picture is, and this is Carlisle Indian School, in order for this film to develop, these kids had to stay still for a long time. They had to stay still for at least 10 to 15 seconds. Now, to be able to get all these kids to stand this still in order for this photograph to develop had to be a monumental task and or disciplinary measures were in place that these kids knew that they had to be still.
But look at those little babies in the front. Can you imagine how helpless they felt without their parents? How insecure? How not knowing what the future held for them.
They're just babies there. But look at, they're all in uniforms, all getting ready to march in a militarized kind of fashion. And this is also another very familiar picture. And these are our Apache kids that went to Carlisle.
And this is them four months later, because their hair is cut and they're in uniforms. The reformers at this time said that this was a success story. This is a success story. Now, if you notice, and I could click through hundreds of pictures of our Native kids in these institutions and you will not see one smile.
I've looked through 'em, hundreds of pictures, not one smile from our kids. And order, order was incredibly important. That's why we had such a high rate of people going into the military in that we had really good warriors because they literally came from military institutions and went right into World War II, right? And they were good at it.
We were good at it. It was not a huge impact. It wasn't really a change. Actually, probably going into the real military at that time was much easier than it was to be in the boarding school.
Because order was the thing of the day. And if you could see that they're all praying. Look at that, look at their faces. Oh.
What are some of the health impacts, going back to my students, after we talked about boarding schools and I taught a couple weeks on this. So what are the health impacts related to boarding schools? The whole thing of powerless, feeling lesser, chronic racism, medical mistrust from pseudoscience experimentations, unremitting grief, hatred of authority, survivor's guilt, attachment difficulties in children, sexual assault, emotional numbness, generational trauma, health disparities, relationship issues as an adult. These are huge impacts.
These were kids, these are babies. These aren't even kids. And as we know, and I've been talking about it, a lot of this that, the critical years of development for people are between birth and 12 to 14 years old. And that's why we have the ACE Study and things, and we have to make it so that our kids are totally nurtured and are not exposed to major traumas during that time.
Because when they are, then they're gonna have problems as they become adults. And it's interesting. It's not interesting, it's sad that many of our kids are not treated that way. I remember my father telling me after I became an adult, saying when I saw you as kid, I always treated you as an adult.
Now my father's father died at six, alcohol, alcohol car crash. And then my grandmother was in that same accident, and she didn't get outta the hospital for years after that. So my father didn't have any parents, and he was just running around the reservation. He didn't go back to school until he was, didn't get his GED until he was 44 years old.
And I was so proud of him that day he did it. But these are huge impacts. And then it comes to self-determination. And then this is where I say self-determination.
This is where we could start to measure health disparities. Because we really couldn't measure anything previously, because everything was just so, it wasn't a fair measurement, basically. Everything was predicted for us, or policies were instilled on us, right? And we had no choice.
But with self-determination and what we're moving with forward now, Indian people will never surrender the desire to control their relationships, both among themselves and with non-Indian governments, organizations and people. And I love that. And I love that, and that's actually in the self-determination legislation. So yes, we have huge health disparities compared to other Americans because of inadequate resources.
This whole convoluted history that we have with the US government. And then the disparities, this intergenerational trauma, you add discrimination and racism on it. It's amazing that we're still here as Native people. It really is.
It really is. But we're very strong people. And regardless of what everybody thinks, that we have casinos now that we're all rich and we don't need to work. Everything we get is for free and we don't pay taxes.
No, actually, that is far from the truth. Most casinos in Indian country today really just break even. And most casinos actually provide the tribal community with a non-existent tax base, resources for things like clean water, electricity, roads, sanitation, right? We have many of us that still live below the poverty level.
And remember, this data is very good data, but it's undercounted. So I would attest that these figures are much higher than what we're seeing on the screen. And then yesterday, I was talking with my colleague, Ms. Katherine Conley in the back, and I said, oh my God, we have this slide from NIH on methamphetamine use, overdose deaths, compared to all different racial ethnic groups.
And you can see that our line right here, well, excuse me, sorry about that. Our line right here, man, too much coffee. 4.5 times higher than the lowest population, which is the, let's see, the Asian or Pacific Island or African American community.
Look at this. This tells it all. And I would attest that with meth, and if we were looking at any other drugs, that the rates would be as high before. When we look at our youth risk behavior survey, and we look at some of our tribal populations, Indian kids do things first and highest and most, more than any other racial ethnic group.
And at a younger age than all others. And we do have lower life expectancy. Again, I would attest that these numbers are relatively low, but still significant compared to everyone else. Deaths.
I like this slide, it's older data. But basically what this says to me is that, we get to 65, we outlive everybody. Our problem is that, as Native people, we can't get to 65 because look at even in infant mortality, we're still higher than, excuse me, I apologize. This thing is very sensitive.
Right here. But look especially at younger ages, we're dying off at much greater rates. And this is right from the IHS website right here. And if you know how to read rates, there's no big secret that we have a major drinking problem in Indian country.
And many of our elders have told me, if we can get a hold of our drinking issues, get that under control, we probably have about 3/4 of our health issues intact. And it's really not, in my opinion, not from an addiction, it's really more about coping. I have an uncle right now across the road from me, it's 10:19, and I bet you, 10:19, he's probably on his third beer right now, you know? And it's like this every day.
It's just this cycle of hopelessness. Diabetes at a much higher rate, unintentional injuries, assault, homicide, all very significant. And then another disparity is, I was a co-author on some of these papers here in this American Journal of Public Health. And racial misclassification is a huge issue as well.
So the sarcasm here is that Indians are born Indian, but die white. So even our data is misrepresenting us in our disparities. And that's a disparity in itself. Because we don't have good information, we don't have good, we don't have good tribal specific information to compare with other populations.
Unless we do some epi-studies. And then if you look at our 10 top leading causes of death that I've put together compared to the U.S.. And looking from 1999 to 2009, this is pretty much our best data. You'll see that unintentional injuries, diabetes and chronic liver disease and cirrhosis are three, four, and five.
And I just wanted to point out, these are all preventable people. These are preventable. They shouldn't be three, four, and five when you compare it to the rest of the United States. And unintentional injuries are significantly higher than all other racial ethnic groups.
You can see here. And we are in the red. And then male suicides, ages 15 to 24. I get a little fired up about this slide here because I see people's names behind this.
I see our Native young men who feel hopeless and displaced within our communities taking their own lives here compared to everybody else at almost three times the rate of the lowest suicide. Just awful. And then again, like I said, it's no big secret that we have an alcohol issue in Indian country. But if you look at this, it's almost four to five times the rate of the lowest population.
And I usually like to stop here and take a second and make sure that everybody understands this slide. If you've seen the slide in the past. And IHS stopped making the slide under Dr. Ravet Rubido, there's a lot of controversy.
The department started promoting this, stopped promoting this slide. But Katherine, here's your assignment, is that we need to recreate this slide for today. And basically we're basically gonna say that, and I usually stop my whole presentation and make sure that everybody from all the slides that I've presented to you today, that this is the one that sticks out with you. And basically I'm saying that for per capita of people, that Natives get about 2,696, almost like 2600, $2700 in medical care per person.
And if you look at this data, this is 2009, right? Are we tracking it? We understand, we get it? Okay, Now let's go to the Veterans Administration and we'll look at, for 2007, now remember, this is 2009, 2007.
The Veterans Administration gets about 6,100 per person. All right, we got it? And then if you go to Medicaid, Medicare, we're going about 5,100, $5200 per person, okay? If you go to the FEH benchmark, and these are our federal employees, right?
People in the military, et cetera, et cetera. All of our federal employees averaged out for 2009 data, remember this is 2009, we have about almost 5,000 per person. So now if you look at people in federal prison, right? In 1999, people in federal prison, now this is 1999, right?
This is 2009, so 10 years before people in federal prison are still getting higher per capita rates of healthcare at about 3,200, $3,300 per person. So you could say from this slide here that people that are in federal prison have better healthcare per capita than people on the reservation. Are we tracking? I'm sure a couple of you have seen this before.
But look at the difference in dates. This is 10 years after the assessment in federal per capita funding after. So even 10 years earlier, people in prison were getting better healthcare than the Natives on the reservation. Now remember, Indian Health Service only services about 2.9
million people out of the 5.9 million Native people that are in the country. So they don't even service the whole Native population. They only service the Natives that are enrolled in the IHS medical system.
This is a huge disparity. And it says everything here. And that is proper resources and money in order to provide good healthcare and good health insurance. And I'm hearing a lot of horrific stories regarding our Natives here in this part of the world.
And many people don't know this. And even our Native populations don't know this. We have a lot of traditional tribes here. What does that mean, traditional tribes?
Well, our traditional tribes really govern themselves by chiefs, clan mothers and warriors, right? Chiefs, clan, mothers and warriors. When Ben Franklin and all those guys were thinking about how do we create this government? We have to create it so that it's the remnants of the indigenous people here.
They looked at the Haudenosaunee people and they said chiefs, clan mothers, and warriors. It kind of sounds like legislative, executive and judicial branches of government. But here's the thing, we still have our communities that are like that here today. So, and what's the big thing with that?
They don't accept federal money. Only two of our tribal nations here accept federal money, and that is the Senecas and the Mohawks. The rest don't. We have Oneidas, they have a gaming facility.
And I think they're now starting to collect some money, but most of them don't. What does that mean in healthcare? What does that mean in behavioral health? That means we have a huge underserved population in this part of the world of Native people that aren't getting any healthcare at all.
A huge underserved population. And when I tell this story to other Natives that are west of the Mississippi, they're like traditional tribes? They don't take federal money? What does that mean?
That means that they would not sign on to the 1934 Reorganization Act, that's for sure. And changing their political systems. So anyways, and then there's a little, we always have a little, you know how we as Native people always have a little banter toward each other. So believe me, that's always an issue of discussion.
But let's talk about some of the positive things that my class has brought out related to some of this stuff. 'Cause I focus on solutions. We could talk about disparities and the problems all day. And guess what, it's very depressing.
It's overwhelming. You're always sad to see that the Native people literally are winning, and a couple of my colleagues, we sarcastically joke about it 'cause it was so damaging to us to have to present this, that we are leading in every category of a disparity. Every health issue Native people are winning. Except for HIV, morbidity.
But our incidence rates are going up, which is also concerning. So I like to focus on solutions within my class. And this is what my students have brought as some of the solutions that we could address some of these disparities, improve indigenous healing practices, strengthening sovereignty, improvement in social context, social cohesion, empower tribes for betterment, dialogue and health outcomes, civic engagement with tribal leaders, self-actualization, awareness of abilities, and potential community priorities, addressing the intergenerational trauma. One of my main colleagues that I work with, he's also my cousin, his name is JC Seneca.
And he actually, I think he's probably been sober eight years now. He gets this whole intergenerational trauma thing. And it's amazing to see, 'cause I've known him my whole life, and he's known me my whole life, I should say. And it's interesting to watch him how he's now changed his whole perspective on things now that he's sober.
And he's basically telling the community, I got the answer, I got the answer. I got the answer. And the answer is this intergenerational trauma thing. It's all about love.
It's all about love and being loved by your parents. And recently we were at a big meeting at the University of Buffalo, it was a big dinner meeting, and we brought some speaker out from Arizona. And she did an amazing thing. And I was with my significant other.
And my significant other will be here. And she's been traumatized, 'cause she grew up in an alcoholic family. And the things that she tells me are just awful, awful. I mean, I can't even imagine, I don't want to cry.
But one of the things that when we were at this dinner, the speaker said, I just want our kids to know they were loved. I just want our kids to know they are loved. And man, that resonated with my Deanna. I mean, 'cause she knew it.
Then they became really good friends from that meeting 'cause she knew, she knew what it's like to grow up in the Native community. And in COVID, we did not do good. And well, what do you expect? I mean, we have all the highest health disparities, but for COVID we haven't done good in the response.
Some tribal nations have done better than others, but they did because their states did a much better job. Some of our tribal nations have significantly, I know this because I get, I don't know if people know, but I was a first responder for CDC and my claim to fame is Ebola and doing like field epidemiology work. I think I'm the only Native person in the country that has actually changed a life threatening virus in the jungles of Africa, literally. So I get a lot of emails and things from communities throughout the whole country, and I often get one from a specific tribal nation that's really, really big.
And I just found out they shut down their emergency operation center. And I'm going. Oh my God, it's way too early. Way too early.
Because this thing could go sideways on us at a moment's notice. In a moment's notice. And this is what I always say and what we say in epidemiology, is that when things are quiet and everything looks good, that's when you have to be the most alert. That's when you have to be the most viligant.
And we know that hospitalizations were six times higher and that's 12 times higher for COVID-19 patients with reported underlying conditions, cardiovascular disease, diabetes, and chronic lung disease. And who has the highest diabetes rates? We do, we do. I remember I was doing an interview with Indian Country Today, and I do a lot of discussions and things, and one of the interviewer people said, no, it wasn't Indian Country Today.
It was a non-Native publication. And they said, well, how do the Natives do in this? And they said, I don't see any mass deaths. Like we're supposed to have like a million deaths or something, or a hundred thousand deaths or something.
And I'm like, Oh my God. I said you can't measure it based on that. Northern Cheyenne had 50 deaths in like a week's time. That's like 50 deaths there.
That's like 50,000 for the state of Montana. Let's compare populations And the thing with the deaths that occurred among our people is that it hit the most vulnerable, right? I got into a huge discussion and a debate with my own tribal nation because they wanted to know, who do you vaccinate first? Who do you vaccinate first?
I think this is a no brainer. My thing was you got to vaccinate our language speakers first, because they're, our languages are on our brink of extinction. And that is usually our elders. And then the elders, oh my God, they were not having it.
They were not having it. Anyway, so I presented a lot of information to you just now. So where is our workforce to address all of these problems? And this is also another disparity, right?
And this is enroll, and also CDC stopped making these slides too. And this is another thing that I'm very contentious with them and I'm been in conversations with the National Center for Health Statistics to start producing this data, right? We have to revisit this. But if you look at minorities enrolled of schools of health occupations, and this is allopathic medicine, our physicians, you can see the, Oh God.
I apologize. This is really sensitive. You could see our white population, the African American population, but look at what our Native population and look at our disparities. Where is our Native health workforce?
This is where we gotta start, right? And getting our Native people excited about public health, allied health, the importance of good health and wellness. And if you looked at, and this is public health, excuse me. This is medicine, it was at 0.9.
Oh God. What was this? All right. And this is public health, and that's at 0.7.
Still, you could see that the data trends are the same, going down. I apologize for that mistake. This is very sensitive. And then working with tribal nations, people don't know this, and it was actually funny when I was at the University of Hawaii, it was like, there's Indians in New York?
There's Indians in New York? Come on, everybody thinks like New York is this big concrete block and it's the whole state. And there's no Native people here. Actually, there's a lot of Native people here, right?
I mean, we have a huge urban Indian population in New York City. A lot of our Native people, 10 states with the largest Native populations. Arizona, California, Oklahoma, New Mexico, Texas, North Carolina. I bet you that's because of Lumbee Nation, Alaska, Washington, South Dakota, and New York.
So yes, we do have Natives here. And then, what are some of the social determinant of health issues, concerns? And again, this is from my class and we were talking about some of the disparities. And we had a discussion about social determinants of health and what are some of the issues there that relate to our indigenous populations, right?
Displacement, poor housing, underfunded schools, violence, poor or no access to healthcare. And I could really go off on that, especially since my father has been recently diagnosed with stage four liver cancer. And no one ever told him about his previous test about a year earlier, which would've shown when we did find out the evidence, it was stage one. And he was never informed or never put into treatment.
And this is a real story. We're writing some letters to our tribal council and to Indian Health Service regarding this whole event. So, poor healthcare in our Indian communities is really big. Lack of belonging, access to broadband, poor patient child relationships, high rates of teen pregnancy, high poverty rates, lack of continued education, high rates of domestic abuse, unsafe physical environments, environmental racism, intergenerational trauma, sexual abuse.
All of these things result from social determinants of health. And I always like to talk about, let me (laughing), let me tell you, when I was at CDC, this is the most controversial slide I've ever had to get cleared. Let me tell you, I swear to God, Homeland Security had to get clearance for this slide. And why was that such a big deal?
And people, I tell this story, I mean it took forever because the scientists that were analyzing this were one, non-Native. And the other is that they were taking this personally. They were taking it personally. And when I was trying to talk in generalities regarding our traditional Natives and mainstream society.
And what I tell people and when I talk is that we have Natives all the way over on this side of being traditional. And we have Natives all the way over here on their mainstream side. And what I basically say is when you do engagement, you have to be able to be fluid and knowing the people that you're talking with because we're all inclusive in this thing called providing or doing good community development, providing healthcare, doing programs in tribal communities. But the big thing is I think is the respect for age and the whole dominant society's thing for the youth, which right now I'm a little afraid of regarding what's going on in this country and the responsibilities that our youth are gonna have to take on in the future.
And the whole thing with providing indigenous health is that we have to provide holistic healthcare, right? We have to address not only the physical, but the mental, spiritual and emotional conditions of health. We tend to, or Westernization tends to only heal the physical, only address basic clinical care and neglect all the other things. But in our indigenous communities, we've always been about addressing all the whole body, the mental, spiritual, and emotional aspects of health.
And I was always taught, and what I'm learning more of, our traditional medicine was never meant to cure. It was always meant to make comfortable, always meant to make comfortable. And I've been in huge debated discussions with our CDC scientists, physicians, commissioned officers and EIS officers regarding the role of traditional medicine and how they denounced our methods of healing. And we've been fighting that ever since.
And I remember Dr. Trujillo, former director of Indian Health Service, putting a memorandum in place to base all of Indian Health Service, basically saying that we would provide traditional medicine first over western methods of healing. And again, solutions from our class. And this is like one of the last classes that we had.
And man, my students really went to town on this in providing solutions in order to address a lot of the problems that we face in Indian country. Engage the community, begin working with Native students. They were really big on giving free education to Native students to pursue careers in health. Very big on that.
Partnerships, uncover boarding schools for healing, strength and self-determination, improving housing, cultural revitalization, more public health programs. The federal government needs to take accountability so the population can start healing. All of these are very, very good solutions to bring to our Native communities, but will take a lot of resources and commitment and time and people to help make a lot of these things a reality. But we have to start.
And I believe we are starting. We have some communities that are doing really amazing work and then other communities that are just getting off the ground. But we have a lot of work to do. And our traditional Haudenosaunee teaching is, I wanna leave you with is having a good mind.
'Cause when you have a good mind, you do good things. And that's all, that's deep and rooted in our traditions. Having empathy, having love. I remember asking one of our traditional healers and one of our Native leaders here around this area actually, I said, we're always talking about how the Haudenosaunee were so fierce, so strong and so powerful.
We could never let our guard down. My question was, did we love each other? Was there ever love in the community? Was there ever empathy?
And you had to see the reaction from some of our leaders. I mean they were like, Dean, y'know like. Y'know, well explain that to me. Explain that to me.
And they did. They basically said yes, there was a significant amount of love between us. They also explained that, one of the big things I got from it is that when our warriors would go to war, there was a ceremony that we would put them through in order to go to war, and then they would go to war. And that ceremony would almost make them a little insane.
'Cause you have to be insane in order to have this hand in hand combat, to physically kill somebody. But after war, you come back, you go through ceremony to heal and go back into the community. And during the colonial times and the first confrontations with our, the first contact people, we never had the ceremony to go back into our community. And that was a huge, huge, huge, that was a huge issue for us.
And I always do all of my presentations, I always end with this quote. I've had the privilege to speak at many Martin Luther King Heritage Celebrations and very honored to have done so. And I always leave my presentations with this quote by Chief Joseph, 'cause I think it says it all. (speaking in foreign language) (audience applauding) Any questions?
Thank you, thank you. Yes.
Dean, that was great. I guess this is kind of a two part question. One, do you think all the funding that came from COVID-19 to the tribal nations or urban Indian health clinics will make a difference in capacity building? Two, if you were in that position to receive that funding, where would you put that funding to build the capacity to improve healthcare?
- So, I know that a lot of our tribal nations are having a hard time spending this money, right? We have some of our tribal nations that have millions and millions of dollars that they just can't get out the door. I do think that because this $8 billion was the most money that has ever been given to tribes at one time, ever, in the history of this country. This $8 billion.
So I do think it's gonna make an impact. Now the second part of your question is where would you put that money to provide good healthcare? Now is it to address COVID? Because if it were to address COVID, you know what?
I'll tell you, I think the best way that we could use that money would be to invest in the IHS IT modernization project. Because we need to have good data. You know what I mean? Our RPMS system that IHS uses is archaic.
It's awful. We don't have good health information in order to make good informed decisions about our healthcare needs. And I think it really starts with data. So I think in the future, if we're able to take a lot of that money and invest in replacing RPMS, which is an $800 million project, probably more.
Training our people on these data systems in our tribal communities to be able to understand where does this information go? Does it go to the insurance companies? Does it go to the state health department? Does it go to this data management mart in Albuquerque, New Mexico?
Where is this information going? I think getting an understanding of our data and what the health status of a Native people really is, getting and understanding data so that it's tribal specific. So we could say the disparity of this tribe, the Senecas for example versus the Mohawks in this area. Instead of saying, well here's the difference between the use set area and the Oklahoma area.
That's what we say now, which it's just so convoluted trying to do that. So I think that, remember, IHS's budget is only about $4.5 billion, right? We need to raise that budget to about, in the reports I've been reading, it's even more now, 35 billion, right?
Almost like quadrupling it that amount. One is, I do think it's gonna make an impact. Impact is gonna be very short, very short lived. We're having a lot of tribal nations that are having a hard time getting that money out the door.
And we have some of our tribal nations that are doing ridiculous things with it, to be honest with you. I know one tribal nation that bought all police cars for their community. Come on, for COVID? That's not a good, that's not a good way to spend money in order to address viruses in your community, right?
But I do think if we're able to really take that money and how do we improve providing healthcare? One is to invest in getting better data and better resources so that we know exactly what the health status is of our individual tribal nations. That would be my opinion.
Thank you so much, Dean. We are running a little short on time, so we are not gonna be able to take any more questions. I just wanna thank you again, all of you for joining us here, whether you're in person or virtual. And thank you again, Dean, for giving us all of your knowledge and wisdom.
- All right, great. Thank you. (audience applauding)
Dean S. Seneca, MPH, MCURP
Founder & CEO, Seneca Scientific Solutions+