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American Indian Health Disparities and Culturally Sensitive Counseling

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American Indian Health Disparities and Culturally Sensitive Counseling

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  1. American Indian Health Disparities and Culturally Sensitive Counseling Donald Warne, MD, MPH Oglala Lakota Executive Director Aberdeen Area Tribal Chairmen’s Health Board HIV/STD/TB/Hepatitis Symposium May 20, 2010 Fargo, ND

  2. Overview • Overview of AI Health Policy • AI Health Disparities & HIV/STD • Cultural Competence in AI Healthcare • Strategies 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 US • Nearly 50 million uninsured people in the US

  4. Portland Billings California Phoenix Nashville Tucson Navajo Oklahoma Alaska Albuquerque IHS Areas Aberdeen Bemidji

  5. AAIHS / AATCHB

  6. INDIAN HEALTH SERVICE • The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people • Its goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people

  7. AI Health Disparities Life Expectancy in Years: MenWomenTotal U.S. 74.1 79.5 76.9 AAIHS 63.571.067.3 Disparity: 10.6 8.5 9.6 Median age at death in SD (2007): 81 Years in the General Population 59 Years in the AI Population

  8. National Survey on Drug Use & Health • AI/AN Substance Use Disorders • In 2002-2005, AI/ANs were more likely than other racial groups to have a past year alcohol use disorder (10.7 v 7.6 percent) • In 2002-2005, 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

  9. American Indian Disparities

  10. American Indian Disparities

  11. American Indian Disparities

  12. American Indian Disparities

  13. American Indian Disparities

  14. American Indian Disparities

  15. SOURCE:U.S. HIV/AIDS Surveillance Report, Year-end 2007National Center for HIV, STD, and TB Prevention, CDC HIV/AIDS in Minnesota: Annual Review

  16. SOURCE:U.S. HIV/AIDS Surveillance Report, Year-end 2007National Center for HIV, STD, and TB Prevention, CDC HIV/AIDS in Minnesota: Annual Review

  17. U.S. State-Specific AIDS Rates per 100,000 PopulationYear 2007 HIV/AIDS in Minnesota: Annual Review SOURCE:U.S. HIV/AIDS Surveillance Report, Year-end 2007National Center for HIV, STD, and TB Prevention, CDC

  18. HIV Testing • Integral to HIV prevention, treatment, and care efforts

  19. HIV Testing CDC, MMWR, Vol. 55, NO. RR14: September2006. CDC, MMWR, Vol. 52, NO. 15: April 2003.

  20. HIV/AIDS cases by year of diagnosis, 2004-2007 http://minorityhealth.hhs.gov/templates/content.aspx?ID=3026

  21. HIV testing issues among American Indians • Perceived HIV risk • HIV testing • Confidentiality • Misclassified in terms of race/ethnicity on data forms CDC, MMWR, Vol. 52, No. SS07: August, 2003. www.cdc.gov/hiv/resources/factsheets/aian.htm

  22. Co-Morbidities in HIV + American Indians • Disparities in risks for chronic diseases • Diabetes • Alcoholism / SA • Cancer • Heart Disease • ~ 50 years ago, leading health problems-infectious diseases, malnutrition, and infant mortality www.cdc.gov/mmwr/preview/mmwrhtml/ss5207al.htm

  23. AI Health Disparities Death rates from preventable diseases among AIs are significantly higher than among non-Indians: • Diabetes 208% greater • Alcoholism 526% greater • Accidents 150% greater • Suicide 60% greater Indian Health Service. Regional Differences in Indian Health 2002-2003

  24. Diabetes Death Rates (Rate/Per 100,000 Population)

  25. Alcohol Related Death Rates (Rate/Per 100,000 Population)

  26. Medical Behavioral

  27. AI Resource Disparities • Per capita medical expenditures in 2005 • federal budget: • Indian Health Service $2,130 • Medicaid recipients $5,010 • VA beneficiaries $5,234 • Medicare $7,631 • Bureau of Prisons $ 3,985

  28. AI Healthcare Resource Disparities Bureau of Prisons

  29. A BRIEF HISTORY OF MEDICINE • 2000BC—Here, eat this root • 1000AD—That root is heathen, here say this prayer • 1800AD—That prayer is superstition, here drink this potion • 1900AD—That potion is snake oil, here swallow this pill • 1950AD—That pill is ineffective, here take this antibiotic • 2000AD—That antibiotic is artificial, here eat this root

  30. MODERNTRADITIONAL • Model Allopathic Holistic

  31. MODERNTRADITIONAL “Medicine” Physical Spiritual

  32. MODERNTRADITIONAL • Provider Physician Healer

  33. MODERNTRADITIONAL • Symbol Serpent & Staff Medicine Wheel

  34. MEDICINE WHEEL MENTAL PHYSICAL SPIRITUAL EMOTIONAL

  35. Traditional Systems of Diagnosis MEDITATION HERBS PRAYER COUNSELING Key Components: Ceremony, Family & Community Participation

  36. MEDICINE WHEEL DECISIONS ACTIONS VALUES REACTIONS

  37. MEDICINE WHEEL & Traditional Values WISDOM COURAGE FORTITUDE GENEROSITY UP—HONOR WITHIN— HUMILITY DOWN—RESPECT

  38. MEDICINE WHEEL ATTITUDES ACTIVITIES BELIEFS FEELINGS

  39. MEDICINE WHEEL & Public Health EDUCATIONAL ENVIRONMENTAL CULTURAL SOCIAL