Community rethinks Native American health

By Cody Jones, contributor – [email protected]
Panelists at a Native American health forum held on Sept. 30 in the Sherrill Center said the chronic health problems in Native American communities need to be addressed.
“There is a serious need for a different way of working with Native youth, particularly those who have experienced adverse childhood experiences,” said Lisa Lefler, director of Western Carolina University’s Culturally-Based Native Health Program.
“We were very unfortunate to hear that there were 10 young Lakota women, from the ages of 10 to 13, who committed suicide this summer,” Lefler said.
Suicide rates among Native American youth are 13 times the national average, Lefler said, and Native American youth depression rates range from 10 to 30 percent.
“I have a profound love and interest for Native youth,” Lefler said. “Particularly for those young folks who have already fallen through the cracks and are in the system for treatment.”
In Native American communities, treatment for mental health is largely based on Western models. They are sometimes modified to incorporate Native American health care traditions, but those models are broad and not specific to each community or tribe.
“I’m interested in being more tribally specific,” Lefler said. “We can do this by engaging elders and speakers of the Cherokee language in order to develop treatment models for their own communities.”
On Thursday, the new Cherokee Indian Hospital officially opened. This $90 million facility was entirely built and funded by the Eastern Band of Cherokee Indians, unlike previous facilities partially funded by the government. The health system serves approximately 11,500 people.
Though they aren’t required to, as they are a federally-recognized sovereign nation, the Eastern Band of Cherokee Indians chose to operate their health facilities under the statutes of North Carolina’s public health law.
Within the health system, which is called Public Health and Human Services, there are three areas of focus: quality of care, population health and the experience of care.
“We’re the equivalent of a local county health department and a local department of social services,” said Vickie Bradley, deputy health officer for the Eastern Band of Cherokee Indians.
After two years of planning and preparation, the health system’s department of social services officially launched Oct. 1. It is the first time that the health system has been given authority by North Carolina to be fully operational and provide the community’s own social services.
“Our vision is seven generations of wellness with family strong in mind, body and spirit,” Bradley said. “So every decision that we make, we think, ‘will it affect families for seven generations?’ and if it won’t and if it doesn’t matter, then is the juice worth the squeeze?”
Public Health and Human Services has a total of 18 programs ranging from women’s health, to a long-term health facility, to Special Supplemental Nutrition Program for Women, Infants, and Children.
“We have a huge chronic disease load in our community. Our largest diagnoses are depression, diabetes and substance abuse,” Bradley said. “We call it our triple epidemic. It’s costing a fortune, and it will break our health care system if we don’t change its trajectory and if we don’t do something to change the way people live and eat.”
In a 2013 tribal health assessment, 23 percent of the Eastern Band of Cherokee Indians’ population reported, at some point in the previous year, they went hungry because of a lack of access to food or a lack of money.
The issue of food sovereignty is an important one in the Eastern Band of Cherokee Indians community.
“As a sovereign nation, we govern ourselves, so we’re impacted by the question ‘can we even provide our own food?’ and the programs I’ve been able to work with have started to make that impact,” said Joey Owle, program coordinator of Healthy Roots, a project of the diabetes prevention program Cherokee Choices.
According to the Food Sovereignty Assessment Tool published by the First Nations Development Institute, food sovereignty is “that state of being in which all community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes community self-reliance and social justice.”
Besides local stores, Owle said, the majority of accessible food sources are brand name fast-food chains and restaurants. There is only one grocery store which serves 8,000 people.
“This is where we’ve got to change that, to help influence people’s minds to grow more food and to stray away from what seems to be the only option for food, especially in limited income areas,” Owle said. “But the future is not bleak. We are making progress.”
In four years, members of Healthy Roots grew 6,000 pounds of food that was sold, distributed, donated, and taken to family support services. All 6,000 pounds of food were grown on under half an acre of land.
The social services program arm of the Public Health and Human Services system was started with the intention of being distinct, said Dallas Pettigrew, social worker and manager of administrative operations for the Eastern Band of Cherokee Indian’s Pediatric Behavioral Health System.
“Our community has a bad taste in their mouth for the DSS systems that have been in place, and they don’t want us to be that,” Pettigrew said. “So we call ourselves Family Safety.”
Family Safety focuses on keeping a child in the community so long as the parents or guardians are willing to cooperate and work toward a solution to any problem.
If Family Safety finds that a child is living in unsafe conditions, they will open up a “voluntary case.”
In a voluntary case, a family agrees to send a child to live in a kinship placement. Family Safety will work with the parents in order to solve the problem until the case is closed and the child is returned home.
“Our law is very special. Our law tells us that we’re responsible for the protection of children and to intervene in instances of child maltreatment,” Pettigrew said. “But not only that, I am charged with the responsibility of preventing child maltreatment.”
Pettigrew said there is evidence that links chronic health problems in Native American communities to childhood traumas.
“We have extremely high rates of preventable chronic health conditions: depression, substance abuse, diabetes and heart disease,” Pettigrew said. “There’s really strong evidence that tells us why and how that happens.”
The Adverse Childhood Experiences Study, commissioned by Kaiser Permanente in the late 1990s, demonstrated a connection between traumatic childhood experiences and the development of chronic health problems. According to the study, traumatic childhood experiences include maltreatment, sexual, physical and emotional abuse, absent parents, and household substance abuse.
“The more of these adverse experiences children had, the worse their chronic health outcomes were when they were adults and, ultimately, they died younger,” Pettigrew said. “They died younger and in worse health.”
“When a child is living in a healthy, well-functioning household, the child will experience normal stress cycles,” Pettigrew said. “Stress goes up and, in the company of a nurturing adult, stress comes back down and children learn how to manage their stress.”
Children who are maltreated, however, experience elevated levels of stress for prolonged periods of time. Because of this, they do not experience proper social and emotional development. As they grow older and the problems go unresolved, Pettigrew said they attempt to fix their own problems.
    “So then what happens? They start to self-medicate,” Pettigrew said. “They get on alcohol or marijuana or cigarettes, or they start to skip school and do other bad things. Juvenile delinquency arises from this.”