1. HISTORICAL AND CURRENT TRAUMA: EXAMINING COMMUNITY MEMORIES FOR THE HEALTH OF A NATION A Community-Based Participatory Research initiative by the Seneca Nation and The University of New Mexico – School of Medicine, Center for Native American Health, & Department of Family & Community Medicine

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3. Seneca scholar Dr. John C. Mohawk on colonization: “…it is the greatest health risk to indigenous peoples as individuals and communities. It produces the anomie - the absence of values and sense of group purpose and identity - that underlies the deadly automobile accidents triggered by alcohol abuse. It creates the conditions of inappropriate diet which lead to an epidemic of degenerative diseases, and the moral anarchy that leads to child abuse and spousal abuse. Becoming colonized was the worst thing that could happen five centuries ago, and being colonized is the worst thing that can happen now.” 3 Photo: http://www.hartwick.edu/x23075.xml, viewed 11-25-08.

4. The Seneca Study  2 Linked Investigations 2 Focus groups of Seneca Elders (N=16): ○ What are the traumatic events in our history? ○ How have the events affected our health? Mail survey of current users of SN Health Department services (N=559): ○ Historical Losses & Historical Losses Associated Symptoms ○ Individual health, health-related quality of life, coping ○ Social support – family, friends, significant others ○ Community caring ○ Cultural identity and values 4

5. Participant Characteristics (Enrolled Seneca Adults) Focus Groups (N=16)Survey (N=559) Gender: 9 females, 7 malesGender: 67% female Age Range: 50-90+ yearsAverage age: 49.5 years Residence: On-TerritoryMarital status: 47% married Roles & Backgrounds: Elected tribal official, traditional healer, tribal health professional, lay health worker, homemaker, ironworker, railroad worker, educator, veteran. Residence: 70% live on Territory Education: 24% college graduates Employment status: 19.2% unemployed/working only part-time Annual family income: 61.1% < $40,000 Average # People in household: 2.57 5

6. Focus Groups 6

7. SENECAELDERS Pollution and Chemicals White Man Alcohol Food Inter- generational Relationships Medicine, Healing, and Health Education, Schools, Knowledge A Common Dialogue – 7 Domains of Historical Trauma or Historical Loss 7

8. Traumatic Events identified by Elders Buffalo Creek Removal; Elected form of government; Thomas Indian School; Kinzua Dam; Land Claims; All wars; Gas stations; Cigarette sales; Smoke shops; Casinos; Loss of food sources because of pesticides and chemicals; Packaging of food in cans and plastics; Loss of Seneca language; Removal to reservations; The Smithsonian National Museum of the American Indian; 1924 Citizenship Act; Indian prohibition of alcohol; Tribal politics interferes with relationships; Invaded by Whites; White educational system; Seneca children in 3 different and competing White school systems; Labeling Seneca students with attention deficit; Non-Native teacher orientation about culture; School-based learning of Seneca language in 15 minutes; School children taught White ways, leave Seneca ways behind; White influence on Seneca parent and child relations; Loss of respect for elders by kids; Loss of respect between parent and child; Health care, too many pills; Western medicine, pushing pills; Traditional healers as health option; Loss of medicines because of pollution; Disrespect by Western medicine for natural circle of life; People not sharing Seneca land; No access to natural medicines if on personal property; Loss of family members because of wars; Seneca names changed to White names; Depression Era; Quaker schools; Bussed from Red House Indian School to Salamanca school; Pollution of creeks and rivers; Introduction of alcohol to American Indians; White religions instead of traditional way of life; Parenting changes because of parents working outside of home; Parenting changes because of single parents; Assault on Seneca identity; New housing instead of older housing; Location and closeness of new houses; Railroads through Seneca land; Changes in eating habits; Lower activity level; Bingo; Loss of Seneca lands due to alcohol use; Loss of active lifestyle. 8

9. Seneca Elder Beliefs About the Association between Historical Traumatic Events and Health  Seneca male elder (placed in the Thomas Indian School at age 5): “I used to drink in school. I made sure I had a bottle in the locker. I don’t know why, maybe that got me through the day. I don’t know.”  “The memories of it are all right there.”  “My form of therapy is to talk about it because if you hold it in it brings on that depression, I’ve been in that.”  “Some people have so much anger and they don’t understand why they are so angry.”  “Nerves, being nervous fits in there too.”  Response from Seneca female elder to above: “…the mental is what brings on the physical, inside, like diabetes and the high blood pressure.”  Additional response from another Seneca female elder: “And the end product is your heart, heart problem after all that. If you want to take it in sequence.” 9

10. Health Survey 10

11. Coping Self-efficacy Calm/Peace Vitality Lonely/hopeless/ worthless Reciprocity Spiritual Importance Frequency of Spiritual Practice Sense of Harmony Depression Symptoms Anxiety Symptoms PTSD Symptoms Tobacco Use Alcohol Use Illegal Drug Use Obesity High Blood Pressure Heart Disease Diabetes Asthma Arthritis PhysicalMental Emotional Spiritual 11 Historical Losses/Historical Losses Associated Symptoms

12. Historical Loss Scale* % who think of the following losses at least weekly : N = 543-558. * Source: Whitbeck et al. 2004, Conceptualizing and measuring Historical trauma among American Indian people. Amer j of comm psy, 33(3-4):119-130.

13. Historical Loss Associated Symptoms Scale* % who frequently experience the following feelings/symptoms when they think of historical losses. N = 546-557. * Source: Reference listed on previous slide.

14. Symptoms of Psychological Distress (%) 14 N = 559 (Depression), 559 (Anxiety), 539 (PTSD). Depression & Anxiety symptoms in past month.

15. Chronic Conditions (%) L to R: N = 521, 547, 545, 547, 544, 543 (BMI ≥ 30) 15 36.4% 22.9% 07.7% 12.9% 07.0% 26.0% New York State Prevalence Rates (above each bar) Source: http://www.health.state.ny.us/statistics/)

16. PTSD Symptoms Age (-) Community Vitality & Caring (-) Depression Symptoms (+) Historical Losses Associated Symptoms (+) Historical Losses due to Effects of Alcohol (+) Self-Efficacy (-) N = 420; Adj R 2 =.249 16 Wisdom-based Knowledge about Historical Losses: PTSD & Diabetes Diabetes Age (+) Body Mass Index (+) High Blood Pressure (+) PTSD (+) N = 499; Nagelkerke R 2 =.312, Hosmer & Lemeshow  2 = 5.276, df=8, P=.728 Conduct path analysis to explore links & develop interventions.

17. Seneca Nation 17

18. Practical Implications  Achieving good health for American Indians requires more than symptom-focused, clinic-based care. It requires an informed consideration of tribal history, an awareness of demographic influences and social determinants, and a complementary system of wisdom-based knowledge, cultural practices, and culturally sensitive Western medicine approaches.  Health is not the sole responsibility of a tribal health department. In tribal communities the Western notion of integrated care must be indigenized to include health-related linkages across ALL programs (community caring), e.g., every program must demonstrate how its mission and vision contributes to the health and well being of the People. 18

19. Policy  Lead & Live by example… Resolution by the Tribal Council on Nov 15, 2008, as recommended by President Snyder, to adopt a zero tolerance drug and alcohol policy imposed upon members of Tribal Council and Executives.  SN Health Department reorganization plan to include requirement for all SNHD personnel to complete an orientation to SN history and culture.  Strategic planning by the SNHD in partnership with all other SN programs to develop an integrated and health vision and universal health policy with benchmarks for ongoing evaluation. 19

20. Strengthen Knowledge & Dissemination of Seneca History Address historical trauma – eliminate influence of colonization under Seneca elders’ guidance. Factual Seneca history must be made available to every Seneca, e.g., develop a timeline of significant events in Seneca history, publish in tribal newsletter. Strengthen Cultural Health Reclaim/restore the Seneca language – it is the cultural foundation of Seneca life. Create opportunities to know, practice, & be proud of the Seneca way of life. Strengthen Community Health Create a vision for the health of the Seneca Nation that allows all Senecas to contribute and that models core cultural values and social caring and vitality. Make Seneca health and well-being a living and annually renewable tribal policy. Strengthen Family Health Create opportunities that strengthen families and intergenerational relationships. Support heads of households, i.e., physically, emotionally, spiritually, socially, and economically Strengthen Individual Health Recognize and respond to the multi-dimensional nature of health. Include the individual as a health partner and expert in Seneca community health promotion and disease prevention. 20 IMPROVING PRACTICES: Strengthening our Sovereignty