VERMILLION, S.D. -- The prolonged history of trauma and pronounced oppression experienced by American Indians has created a “public health crisis screaming for intervention,” native health expert Dr. Donald Warne said recently in a speech at the University of South Dakota.
Modern, mainstream society has failed to recognize and understand the inequalities and other challenges that Native Americans have been through, and modern medicine has yet to provide an adequate solution, he told USD medical and health sciences students and health care professionals.
“If we’re going to solve this problem, we need to think about it from a more holistic and intelligent way, recognizing that many of the past events and current situations are connected,” Warne said.
His presentation was the first in what will be a series of distinguished lectures at USD focusing on problems related to Native American health care.
Warne, a member of the Oglala Lakota Tribe from South Dakota’s Pine Ridge Indian Reservation, is professor and chair of the department of public health in North Dakota State University’s College of Health Professions. He oversees the nation’s only master’s of public health degree with an American Indian public health specialization.
His USD lecture not only defined how past issues have led to present hardships, he also proposed how the medical and general communities can help. He suggested the following ideas and approaches:
Rethink health care priorities: Crisis prevention needs to be prioritized over crisis management. Diabetes, for example, has exploded among the American Indian population due to a lack of both preventative education and healthy food and lifestyle options. “We spend money on programs to help those already affected by a disease but not for education and healthy food to prevent the disease from happening,” Warne said.
Equity over equality: Equality gives everyone the same care, while equity would give people the appropriate care based on community and cultural needs. “Equality is giving everyone a pair of shoes. Equity is giving everyone a pair of shoes that fits,” Warne said. Traditional American Indian healing methods, such as meditation, prayer and healing ceremonies, can help the treatment and recovery processes, but modern health care often leaves those powers untapped.
Raise awareness of historical trauma: The concept of historical trauma suggests that terrible events can be passed on to subsequent generations. Warne retraced more than 500 years of oppression and suffering endured by the Native American population, most of which society has failed to recognize. “Populations are just now starting to experience the effects of past stressful experiences,” he said. Increased awareness of such a traumatic history could initiate positive change in the societal and living conditions of American Indians, which improves their future, he said.
Epigenetics: The study of what causes certain genes to be expressed in an individual will be the platform on which to build a better understanding of how health conditions like diabetes have impacted American Indian over time. “If a gene is impacted and its ability to make the appropriate proteins is damaged, this can mutate the gene and lead to disease or a disorder which can then be passed on to future generations,” Warne said. By combining epigenetics with social genomics (the study of how everyday life circumstances influence gene expression), a more solid connection between historical trauma and current disparities could be made.
“Dr. Warne very eloquently addressed several of the issues, policies and situations that have contributed to the level of health disparities generally experienced by American Indian people in this region,” said Gerald Yutrenka, Ph.D., associate dean of diversity and inclusion at the USD Sanford School of Medicine. “The School of Medicine is positioning itself to assist in helping to address some of these elements.”