slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
American Indian Health Disparities and Culturally Sensitive Counseling PowerPoint Presentation
Download Presentation
American Indian Health Disparities and Culturally Sensitive Counseling

Loading in 2 Seconds...

play fullscreen
1 / 87

American Indian Health Disparities and Culturally Sensitive Counseling - PowerPoint PPT Presentation


  • 125 Views
  • Uploaded on

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. Overview. Overview of AI Health Policy

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'American Indian Health Disparities and Culturally Sensitive Counseling' - strom


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

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

slide2

Overview

  • Overview of AI Health Policy
  • AI Health Disparities & HIV/STD
  • Cultural Competence in AI Healthcare
  • Strategies to reduce Health Disparities
american indian health policy
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
ihs areas

Portland

Billings

California

Phoenix

Nashville

Tucson

Navajo

Oklahoma

Alaska

Albuquerque

IHS Areas

Aberdeen

Bemidji

indian health service
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
ai health disparities
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

slide10

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
slide19

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

HIV/AIDS in Minnesota: Annual Review

slide20

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

HIV/AIDS in Minnesota: Annual Review

slide21

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

hiv testing
HIV Testing
  • Integral to HIV prevention, treatment, and care efforts
hiv testing1
HIV Testing

CDC, MMWR, Vol. 55, NO. RR14: September2006.

CDC, MMWR, Vol. 52, NO. 15: April 2003.

hiv aids cases by year of diagnosis 2004 2007
HIV/AIDS cases by year of diagnosis, 2004-2007

http://minorityhealth.hhs.gov/templates/content.aspx?ID=3026

hiv testing issues among american indians
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

co morbidities in hiv american indians
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

ai health disparities1
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

slide31

Medical

Behavioral

slide32

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
slide35

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
slide36

MODERNTRADITIONAL

  • Model Allopathic Holistic
modern traditional
MODERNTRADITIONAL

“Medicine” Physical Spiritual

modern traditional1
MODERNTRADITIONAL
  • Provider Physician Healer
modern traditional2
MODERNTRADITIONAL
  • Symbol Serpent & Staff Medicine Wheel
slide45

MEDICINE WHEEL

MENTAL

PHYSICAL

SPIRITUAL

EMOTIONAL

slide46

Traditional Systems of Diagnosis

MEDITATION

HERBS

PRAYER

COUNSELING

Key Components: Ceremony, Family & Community Participation

slide47

MEDICINE WHEEL

DECISIONS

ACTIONS

VALUES

REACTIONS

slide48

MEDICINE WHEEL & Traditional Values

WISDOM

COURAGE

FORTITUDE

GENEROSITY

UP—HONOR

WITHIN— HUMILITY

DOWN—RESPECT

slide49

MEDICINE WHEEL

ATTITUDES

ACTIVITIES

BELIEFS

FEELINGS

slide50

MEDICINE WHEEL & Public Health

EDUCATIONAL

ENVIRONMENTAL

CULTURAL

SOCIAL

slide51

Ed McGaa, Eagle Man

Native American Indians learned how to live with the earth on a deeply spiritual plane. The plight of the non-Indian world is that it has lost respect for Mother Earth, from whom and where we all come.

Mother Earth Spirituality, 1990

slide52

Ed McGaa, Eagle Man

We all start out in this world as tiny seeds—no different from our animal brothers and sisters, the deer, the bear, the buffalo, or the trees, the flowers, the winged people. Mother Earth is our real mother, because every bit of us truly comes from her, and daily she takes care of us.

Mother Earth Spirituality, 1990

slide54

Rick Two Dogs

We need to understand that the primary reason our people are so afflicted with addiction, poverty, abuse and strife, is that our way of life was taken from us. Everything was taken. And nothing was replaced.

Wounded Warriors: A Time For Healing, 1995

slide60

Substance Abuse and theMedicine Wheel

  • What greater grief than the loss of one’s native land
  • Euripides
  • 485-406 B.C.
slide63

MEDICINE WHEEL and Health Behavior

DECISIONS

ACTIONS

VALUES

REACTIONS

slide64

MEDICINE WHEEL and Health Behavior

DECISIONS

SUBSTANCE ABUSE

NEGATIVE EMOTIONS

slide65

MEDICINE WHEEL

MENTAL

PHYSICAL

SPIRITUAL

EMOTIONAL

slide66

CULTURAL COMPETENCE

  • Definitions
    • Culture: The totality ofsocially transmitted behavioral patterns, beliefs, values, customs and thought characteristics of a population that guides world view and decision making.
    • Cultural Competence:The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring care to meet patients’ social, cultural and linguistic needs.
slide67

CULTURAL COMPETENCE

  • Barriers
  • AI/AN under-representation in healthcare leadership and workforce.
slide69

DISPARITIES:

Health Staff/100,000 people

AI/ANUSGap

MDs 73.9 220.6 66% lower

DDSs 24.0 61.861% lower

Nurses 229.0 849.973% lower

RPh 42.8 71.340% lower

slide70

AI Health Related Faculty

  • AI/AN faculty in medical schools are underrepresented
    • 0.1% American Indian
    • Few specialists
  • 16% of Public Health School Faculty are URM
  • >12% Vacancy Rate in IHS Health Professions
slide71

CULTURAL COMPETENCE

  • Barriers
  • AI/AN under-representation in healthcare leadership and workforce.
  • Systems of care poorly designed to meet the needs of diverse patient populations.
  • Poor communication between providers and patients of different racial, ethnic or cultural backgrounds.
  • Cultural disconnect between health beliefs & value systems
slide72

CULTURAL COMPETENCE

  • Benefits
  • Improved communication
  • Improved quality of care
  • Reduction in health disparities
  • Community Participation in healthcare practice and research
slide73

CULTURAL COMPETENCE

  • Purnell’s Model:
  • Person, Family, Community, Society
    • Unconsciously incompetent
    • Consciously incompetent
    • Consciously competent
    • Unconsciously competent
slide74

CULTURAL COMPETENCE

  • Strategies—Organizational
  • Expand AI/AN healthcare leadership development programs
  • Hire and promote AI/AN in healthcare workforce
  • Involve community members in healthcare organization’s planning and quality improvement strategies & training
slide75

CULTURAL COMPETENCE

  • Strategies—Clinical
  • Cross-cultural training as a required, integrated component of training and professional development of healthcare providers
  • Quality improvement efforts that include culturally and linguistically appropriate patient survey methods
  • Patient education regarding navigating the healthcare system—active involvement
slide76

CULTURAL COMPETENCE

  • Personal Perspectives
    • Modern vs Traditional Health Beliefs regarding chronic disease and health behavior
slide78

Medicine Wheel & Cultural Competence

MENTAL

PHYSICAL

SPIRITUAL

EMOTIONAL

slide79

Traditional Medicine Services

  • Talking Circles
  • Healing Ceremonies
  • Herbal Remedies
  • Smudging
  • Sweat Lodge
  • Counseling
  • Regionally Specific Remedies
  • 70% of urban & 90% of reservation AI people use traditional medicine
slide81

Sample Programs

  • Winslow Hospital
    • Medicine Man on Staff
    • Hogan on Hospital Grounds
    • Medicine Man’s Association
slide82

Sample Programs

  • PIMC
    • Traditional Cultural Advocacy Committee
    • Sweat Lodge on Hospital Grounds
    • Intake Form
    • Urban Issues
slide83

Sample Programs

  • Hu Hu Kam Memorial Hospital
    • Traditional Healers on Staff
    • BHC
    • RBHA
    • DEC
    • PL 93-638
slide86

BLACK ELK

Of course it was not I who cured. It was the power from the outer world, and the visions and ceremonies had only made me like a hole through which the power could come to the two-leggeds. If I thought that I was doing it myself, the hole would close up and no power could come through.

slide87

Donald Warne

dwarne@aatchb.org