Presentation on theme: "American Indian Health Disparities and Culturally Sensitive Counseling"— Presentation transcript:
1 American Indian Health Disparities and Culturally Sensitive Counseling Donald Warne, MD, MPHOglala LakotaExecutive DirectorAberdeen Area Tribal Chairmen’s Health BoardHIV/STD/TB/Hepatitis SymposiumMay 20, 2010Fargo, ND
2 Overview Overview of AI Health Policy AI Health Disparities & HIV/STD Cultural Competence in AI HealthcareStrategies to reduce Health Disparities
3 AMERICAN INDIAN HEALTH POLICY Do people have a legal right to healthcare in the US?Approximately $2.5 trillion spent annually on healthcare in the USNearly 50 million uninsured people in the US
8 INDIAN HEALTH SERVICEThe Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian peopleIts goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people
9 AI Health Disparities Life Expectancy in Years: Men Women Total U.SAAIHSDisparity:Median age at death in SD (2007):81 Years in the General Population59 Years in the AI Population
10 National Survey on Drug Use & Health AI/AN Substance Use DisordersIn , AI/ANs were more likely than other racial groups to have a past year alcohol use disorder (10.7 v 7.6 percent)In , AI/ANs were more likely than other racial groups to have a past year illicit drug use disorder (5.0 v 2.9 percent)Rates of past year marijuana, cocaine, and hallucinogen use disorders were higher among AI/ANs than other racial groups
19 SOURCE: U.S. HIV/AIDS Surveillance Report, Year-end 2007 National Center for HIV, STD, and TB Prevention, CDCHIV/AIDS in Minnesota: Annual Review
20 Minnesota Department of Health For adults and adolescents living with HIV/AIDS, prevalence rates per 100,000 population are shown for 33 states and 5 U.S. dependent areas with confidential name-based HIV infection surveillance.Areas with the highest prevalence rates in 2006 were New York, the U.S. Virgin Islands, Florida, New Jersey, and Louisiana.The following 33 states and 5 U.S. dependent areas have had laws or regulations requiring confidential name-based HIV infection surveillance since at least 2003: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.The data have been adjusted for reporting delays.SOURCE: U.S. HIV/AIDS Surveillance Report, Year-end 2007 National Center for HIV, STD, and TB Prevention, CDCHIV/AIDS in Minnesota: Annual Review
21 Minnesota Department of Health U.S. State-Specific AIDS Rates per 100,000 Population Year 2007HIV/AIDS in Minnesota: Annual ReviewSOURCE: U.S. HIV/AIDS Surveillance Report, Year-end 2007 National Center for HIV, STD, and TB Prevention, CDC
22 HIV TestingIntegral to HIV prevention, treatment, and care efforts
23 HIV Testing CDC, MMWR, Vol. 55, NO. RR14: September2006. CDC, MMWR, Vol. 52, NO. 15: April 2003.
24 HIV/AIDS cases by year of diagnosis, 2004-2007 200520062007% of total 2007 casesAmerican Indian/Alaska Natives1771801632280.5%White10,83610,81810,81512,55628%Total Population38,39838,03238,53144,084
25 HIV testing issues among American Indians Perceived HIV riskHIV testingConfidentialityMisclassified in terms of race/ethnicity on data formsCDC, MMWR, Vol. 52, No. SS07: August, 2003.
26 Co-Morbidities in HIV + American Indians Disparities in risks for chronic diseasesDiabetesAlcoholism / SACancerHeart Disease~ 50 years ago, leading health problems-infectious diseases, malnutrition, and infant mortality
27 AI Health DisparitiesDeath rates from preventable diseases among AIs are significantly higher than among non-Indians:Diabetes 208% greaterAlcoholism 526% greaterAccidents 150% greaterSuicide 60% greaterIndian Health Service. Regional Differences in Indian Health
28 Diabetes Death Rates (Rate/Per 100,000 Population)
29 Alcohol Related Death Rates (Rate/Per 100,000 Population)
35 A BRIEF HISTORY OF MEDICINE 2000BC—Here, eat this root1000AD—That root is heathen, here say this prayer1800AD—That prayer is superstition, here drink this potion1900AD—That potion is snake oil, here swallow this pill1950AD—That pill is ineffective, here take this antibiotic2000AD—That antibiotic is artificial, here eat this root
48 MEDICINE WHEEL & Traditional Values WISDOMCOURAGEFORTITUDEGENEROSITYUP—HONORWITHIN— HUMILITYDOWN—RESPECT
49 MEDICINE WHEELATTITUDESACTIVITIESBELIEFSFEELINGS
50 MEDICINE WHEEL & Public Health EDUCATIONALENVIRONMENTALCULTURALSOCIAL
51 Ed McGaa, Eagle ManNative American Indians learned how to live with the earth on a deeply spiritual plane. The plight of the non-Indian world is that it has lost respect for Mother Earth, from whom and where we all come.Mother Earth Spirituality, 1990
52 Ed McGaa, Eagle ManWe all start out in this world as tiny seeds—no different from our animal brothers and sisters, the deer, the bear, the buffalo, or the trees, the flowers, the winged people. Mother Earth is our real mother, because every bit of us truly comes from her, and daily she takes care of us.Mother Earth Spirituality, 1990
54 Rick Two DogsWe need to understand that the primary reason our people are so afflicted with addiction, poverty, abuse and strife, is that our way of life was taken from us. Everything was taken. And nothing was replaced.Wounded Warriors: A Time For Healing, 1995
66 CULTURAL COMPETENCE Definitions Culture: The totality of socially transmitted behavioral patterns, beliefs, values, customs and thought characteristics of a population that guides world view and decision making.Cultural Competence: The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring care to meet patients’ social, cultural and linguistic needs.
67 CULTURAL COMPETENCE Barriers AI/AN under-representation in healthcare leadership and workforce.
69 DISPARITIES: Health Staff/100,000 people AI/AN US Gap MDs % lowerDDSs % lowerNurses % lowerRPh % lower
70 AI Health Related Faculty AI/AN faculty in medical schools are underrepresented0.1% American IndianFew specialists16% of Public Health School Faculty are URM>12% Vacancy Rate in IHS Health Professions
71 CULTURAL COMPETENCE Barriers AI/AN under-representation in healthcare leadership and workforce.Systems of care poorly designed to meet the needs of diverse patient populations.Poor communication between providers and patients of different racial, ethnic or cultural backgrounds.Cultural disconnect between health beliefs & value systems
72 CULTURAL COMPETENCE Benefits Improved communication Improved quality of careReduction in health disparitiesCommunity Participation in healthcare practice and research
74 CULTURAL COMPETENCE Strategies—Organizational Expand AI/AN healthcare leadership development programsHire and promote AI/AN in healthcare workforceInvolve community members in healthcare organization’s planning and quality improvement strategies & training
75 CULTURAL COMPETENCE Strategies—Clinical Cross-cultural training as a required, integrated component of training and professional development of healthcare providersQuality improvement efforts that include culturally and linguistically appropriate patient survey methodsPatient education regarding navigating the healthcare system—active involvement
76 CULTURAL COMPETENCE Personal Perspectives Modern vs Traditional Health Beliefs regarding chronic disease and health behavior
78 Medicine Wheel & Cultural Competence MENTALPHYSICALSPIRITUALEMOTIONAL
79 Traditional Medicine Services Talking CirclesHealing CeremoniesHerbal RemediesSmudgingSweat LodgeCounselingRegionally Specific Remedies70% of urban & 90% of reservation AI people use traditional medicine
86 BLACK ELKOf course it was not I who cured. It was the power from the outer world, and the visions and ceremonies had only made me like a hole through which the power could come to the two-leggeds. If I thought that I was doing it myself, the hole would close up and no power could come through.