Dr. R. Dale Walker

Indian country. The phrase, used by nearly all speakers at a research symposium held in conjunction with NIH’s 7th annual observance of American Indian and Alaska Native Heritage Month, conjures images of pristine mountain vistas and endless skies.

But it also signifies a host of public health challenges, including high rates of diabetes, obesity, cardiovascular disease, alcoholism, tuberculosis, depression, violence and motor vehicle accidents.

Add to that widespread poverty and poor access to health insurance and health care, said Dr. James Herrington (Chickasaw) of the Fogarty International Center and a native Oklahoman, and it becomes a very good thing indeed that American Indians are known for three traits: love of laughter and humor, the capacity to suffer long, and tenacity, or stubbornness.

The symposium at Natcher auditorium on Nov. 7, featuring two investigators funded through NARCH—Native American Research Centers for Health, a collaboration between NIH and the Indian Health Service—and a keynote talk by an NIAAA grantee offered reasons for hope.

Dr. Tassy Parker (Iroquois-Seneca), a medical sociologist at the University of New Mexico Health Sciences Center, has studied the characteristics of teens jailed in that state for a variety of offenses. Overwhelmingly male, and typically having begun substance abuse by age 11, the kids also typically faced trouble in school, demonstrated behavioral problems and ran a high risk of physical abuse.

But what struck Parker and her team most was that the typical detainee had few or no visits from family members during an average incarceration term of 2 years. That kind of abandonment and alienation is a strong risk factor for future incarceration, she said.

How do we reacquaint these youngsters with a rich cultural tradition that will support and nourish them, she wondered.

Parker’s team tested an intervention—recruitment of adults in the community who could mentor the kids and involve them in such structured activities as a drum group and sweat lodges.

“Once these activities started, the amount of acting-out behavior among the kids was reduced,” she reported. The state detention system has now hired two adult liaisons with local communities to help reorient the youngsters in a more positive direction. The goal? “To promote more accountability and responsibility for our children,” Parker said.

While the mentoring project is a step in the right direction, she suggested, it is still daunting that 63 percent of the kids who leave New Mexico juvenile jails do not go home to their parents.

A more startlingly effective public health intervention was next described by Dr. Eugene Millar, an infectious disease epidemiologist at the Johns Hopkins Center for American Indian Health. He reported on the benefits of a vaccine in reducing “exceedingly high rates of invasive pneumococcal disease” among kids age 2 and under in Arizona’s Indian country.

Dr. Tassy Parker (Iroquois-Seneca) and Dr. Eugene Millar were two of three featured speakers at the research symposium held in conjunction with NIH’s 7th annual observance of American Indian and Native Alaska Heritage Month.

Millar showed that the pneumococcal conjugate vaccine Prevnar has dramatically lowered the incidence of pneumonia, meningitis and bacteremia in the pediatric population of the White Mountain Apaches of northeastern Arizona.

The day’s keynote speaker, Dr. R. Dale Walker (Cherokee), professor of psychiatry and public health and preventive medicine at Oregon Health and Sciences University, emphasized the need to “combine American Indians’ indigenous knowledge with evidence-based knowledge to yield best public health practices…camaraderie with the community is essential,” he said.

A native Oklahoman, Walker noted that “Indians have the same disorders as the general population, but greater prevalence [of disease], greater severity and much less access to therapy… cultural relevance issues are also much more challenging.”

The American Indian population, about 1 percent of the total U.S. population, is quite diverse; 60 percent do not reside on reservations, Walker said. And according to IHS, there are more than 560 different tribal entities in the U.S.

Walker envisions a model of community-based health care that takes advantage of Indians’ tribal and community strengths. He predicted that “school-based health care delivery is the wave of the future” in Indian country.

Walker also called the Indian Health Service “tragically underfunded,” an observation underscored by Dr. Jared Jobe (Cherokee) of NHLBI, also an Oklahoman and president of the NIH American Indian and Alaska Native Council who offered concluding remarks: “The per-capita federal expenditure on health for American Indians and Alaska Natives is about half of what is spent per capita on federal prison inmates. That is a violation of treaties.”