2023 Alexander D. Langmuir Lecture by Donald Warne

Aug 26, 2023

2023 Alexander D. Langmuir Lecture by Donald Warne

During the 2023 EIS conference, Donald Warne, MD, MPH, delivered the Langmuir Lecture, Engaging Indigenous Communities to Promote Health Equity. Dr. Warne discussed the impact of historical trauma and policies that have marginalized Indigenous peoples in the United States. He encouraged everyone to consider the impact of pervasive crises, use therapeutic communication, abandon judgment, create a healing environment, and practice self-care. Warne reminded conference participants to be aware of our history and cautioned that there is “no path to equity without walking through the truth.” For more information about the EIS program, visit https://www.cdc.gov/EIS.\r
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Content

5.12 -> good afternoon

7.5 -> I want to take a moment to read and

9.78 -> acknowledge a land acknowledgment first

12.139 -> at the Centers for Disease Control and

15.299 -> the agency for toxic substances and

18.24 -> disease registry we strongly support and

21.539 -> respect tribal sovereignty and

23.34 -> self-determination for tribal

24.96 -> governments in the United States and we

27.66 -> appreciate our ongoing collaboration to

30.24 -> protect and improve Public Health

33.12 -> we acknowledge the Muskogee and Cherokee

36.059 -> Nations whose indigenous lands house the

39.12 -> CDC and atsdr Atlanta campuses

44.219 -> we honor the many diverse indigenous

46.44 -> people still connected to this land on

48.539 -> which we gather and pay our respect to

50.52 -> them

51.78 -> may this acknowledgment serve as a

54 -> proclamation of our organization's

56.1 -> continued commitment to growing and

58.5 -> deepening our awareness of

60.84 -> and our appreciation for the vibrant

63.539 -> indigenous communities who continue to

65.7 -> thrive and uphold their sacred relation

68.159 -> to this land

71.159 -> good afternoon

72.6 -> I'm honored to be up on this stage today

74.939 -> to help welcome this year's langmere

77.88 -> lecturer Dr Donald Warren

80.88 -> I first heard Dr Warren speak at a

83.34 -> conference for indigenous people's

84.84 -> health and nutrition many years ago as a

87.659 -> young Public Health student and to be

89.82 -> honest I did not know much back then

93.479 -> that talk was one of the first times I

95.46 -> learned about rates of diabetes among

97.74 -> American Indians and beyond that I

100.439 -> learned more about the context and the

103.439 -> backdrop in which this public health

105.06 -> issue occurred

106.92 -> Dr Warren didn't talk about individual

109.38 -> risk factors or rate ratios

112.5 -> he spoke about American history and

115.2 -> Trauma about environmental and health

117.78 -> policy impacting those tribes

120.54 -> he spoke about education graduation

123.119 -> rates access to healthy and nutritious

125.64 -> Foods on reservations

128.22 -> these facts have stuck with me

131.099 -> for a long time and especially as I

133.44 -> began my work

134.879 -> in Wisconsin on understanding the burden

137.099 -> of hepatitis C infection and treatment

139.379 -> access among American Indians both urban

143.099 -> and rural as an Eis field assignee

147.3 -> as I think about my fellow Eis officers

149.819 -> and the larger Eis Community I hope we

152.76 -> can all learn about the nuances and

154.86 -> complexities of indigenous People's

156.959 -> Health

157.8 -> and keep this in mind as we continue to

160.14 -> improve public health and I hope that

162.48 -> you all enjoy Dr Warren's talk today

165.12 -> and now I'd like to introduce Dr Juliana

167.819 -> Reese Dr Reese is a board-certified

170.7 -> family medicine physician with over 20

173.64 -> years of experience in Primary Care

175.5 -> leadership and administration focused on

178.44 -> American Indian and Alaska native Health

180.42 -> Care

181.739 -> she is an enrolled member of the Navajo

183.959 -> Nation and currently serves as the

186.06 -> Director of the healthy tribes program

187.62 -> for CDC

189.72 -> prior to this role she was the albacore

192.18 -> Albuquerque area Indian Health Service

194.64 -> IHS chief medical officer as well as the

198.18 -> vice chair of the heroin heroin opioids

201.18 -> and pain efforts or hope committee a

204.42 -> national initiative through IHS please

207 -> join me in welcoming Dr Reese

209.38 -> [Applause]

220.5 -> thank you mushing

222.84 -> good afternoon everyone please allow me

225.36 -> to introduce myself in Navajo as is

227.459 -> customary in my culture

229.819 -> Juliana Rishi nishiah

240.9 -> I'm Juliana Reese I'm originally from a

243.36 -> small town on the Navajo Nation called

245.28 -> Fort Defiance Arizona

247.319 -> my Clans denote my matrilineal ancestry

250.08 -> in my family

251.76 -> thank you all for coming today I am so

254.819 -> very honored to be here to introduce to

256.739 -> you my esteemed colleague Dr Donald vorn

260.28 -> Dr Warren is the co-director of the

262.26 -> Johns Hopkins Center for indigenous

263.82 -> health and serves as the University's

265.8 -> new Provost fellow for indigenous Health

267.78 -> policy

268.919 -> he is a physician one of the world's

271.08 -> preeminent scholars in indigenous health

273 -> health education policy and Equity as

276.3 -> well as a member of the uglala Lakota

278.16 -> tribe from Pine Ridge South Dakota

281.4 -> Dr Warren comes from a long line of

283.44 -> traditional healers and medicine men

285.6 -> he is a celebrated researcher of chronic

287.699 -> Health inequities he is also an

290.22 -> educational leader who created the first

292.38 -> indigenous Health focused master of

294.66 -> Public Health and PHD programs in the

296.759 -> United States or Canada at the North

298.979 -> Dakota State University and the

300.78 -> University of North Dakota respectively

303.84 -> his career is informed by Rich Work and

306.419 -> Life Experiences

308.1 -> he served the Pima Indian population in

310.32 -> Arizona as a primary care physician and

312.66 -> later worked as a staff clinician with

314.46 -> the NIH

316.56 -> he has also served as health policy

318.9 -> research director for the inner Tribal

320.52 -> Council of Arizona executive director of

323.28 -> the Great Plains tribal Chairman's

324.72 -> Health Board and faculty member at the

327.06 -> Indian legal program of the sand Sandra

330.12 -> Day O'Connor College of Law at Arizona

332.46 -> State University

334.44 -> Dr Warren received a Bachelor of Science

336.419 -> degree from Arizona State University

338.94 -> doctor of medicine degree from Stanford

341.039 -> University School of Medicine and a

342.96 -> master of public health degree from the

344.58 -> Harvard t.h Chan School of Public Health

347.699 -> the title of Dr Warren's lecture is

350.16 -> engaging in indigenous communities to

352.44 -> promote Health Equity

354.479 -> please join me in a very warm welcome

356.28 -> for Dr Warren our 2023 langmeyer

359.28 -> lecturer

361.65 -> [Applause]

361.93 -> [Music]

369.02 -> thank you

376.039 -> hello thank you and welcome to All My

378.3 -> Relations here today I'm so deeply

379.86 -> honored to be here with you and to share

382.74 -> a few thoughts about working with

384.12 -> indigenous populations and promoting

385.8 -> Health Equity I'm originally from a

388.199 -> small town called Kyle South Dakota on

390.18 -> the Pine Ridge Indian reservation and I

391.979 -> always like to ask how many people have

393.24 -> been to Kyle South Dakota

396.84 -> two that's actually two more than usual

398.52 -> that's kind of really impressive so very

400.62 -> good

401.46 -> um so I'm from a very small community

403.34 -> and growing up I didn't realize that

406.979 -> there are so many different ways of

408.84 -> looking at the world so I just feel very

410.639 -> blessed I've had the experience that

412.139 -> I've had working in public health and in

414.66 -> higher education and also just so deeply

417.72 -> honored to work with tribal nations with

419.58 -> a lot of federal agencies in addition to

421.38 -> IHS NIH and hersa I have served on a

424.62 -> couple of committees through CDC I was

427.44 -> on the Health

429.5 -> Equity committee for the advisory

432.419 -> committee to the director a number of

434.52 -> years ago and also served on the

436.62 -> advisory committee for breast cancer and

438.24 -> young women and unfortunately for

439.979 -> American Indian populations we see

441.84 -> disparities just across the board so

444.12 -> what we'll talk about is looking at

445.5 -> engaging indigenous communities to

447.66 -> promote Health Equity but also looking

449.58 -> at things through a historical lens and

452.52 -> a health policy lens and I think it's

454.86 -> important to acknowledge that when we

457.38 -> look at history and certainly the

459.419 -> history of Federal Indian policy that

461.699 -> has actually been a source of trauma for

464.4 -> indigenous populations so we'll look at

467.099 -> the terminology that we use and are we

469.139 -> American Indian are we American Indian

470.88 -> Alaska native are we Native American

472.319 -> what is the right terminology and when

473.94 -> what do those words actually mean and

476.16 -> then we'll look at a policy history and

477.539 -> the impact of marginalization based on

479.759 -> policy and there is an intergenerational

482.22 -> impact that has a direct impact on the

484.74 -> disparities that we're seeing today

486.78 -> we'll also look at some contemporary

488.22 -> challenges but I think most importantly

490.38 -> let's identify collectively some

492.36 -> potential Solutions and how we can

494.58 -> engage communities appropriately to

496.44 -> promote Equity as we move forward

499.56 -> so the the term that we use on the

502.199 -> census for the race is American Indian

504.479 -> and Alaskan native and it's an

506.819 -> interesting uh kind of grouping of

510 -> populations so if you look at Alaska in

512.94 -> central Alaska the at the Baskin

514.8 -> cultural groups are American Indian

516.659 -> cultural groups and there's at the

518.219 -> Baskins across North America so even the

521.159 -> Navajo and Apache tribes in the

523.08 -> southwest are at the Baskin cultural

524.82 -> groups so at the Baskins are in Alaska

527.58 -> and they are American Indian from a

529.5 -> cultural perspective but we have other

531.36 -> populations in Alaska that are not

533.16 -> American Indian so for example the

535.62 -> anupiak populations were commonly known

537.779 -> as Inuit populations they're more of a

540.18 -> circumpolar cultural group so we have

542.76 -> inupayak people in Siberia Alaska Canada

546.3 -> and Greenland so if you're in Alaska and

548.82 -> you call them American Indian they'll be

550.2 -> offended because they're actually not

551.459 -> American Indian right but why are we

554.1 -> American Indians

556.019 -> why are we called Indians it's really

558.899 -> fascinating history Christopher Columbus

561 -> thought he was in India therefore we are

563.88 -> American Indians so I'm an Indian

566.1 -> because Columbus was lost at sea

570.72 -> so that's why I have a Bureau of Indian

571.8 -> Affairs a Bureau of Indian education and

573.72 -> Indian Health Service but we don't like

576.3 -> to lump all of the indigenous Alaskan

578.58 -> groups into American Indians so that's

580.44 -> why we have kind of this Venn diagram of

582.24 -> American Indian and Alaska native

585.48 -> well within this population we also have

587.399 -> enrolled tribal members and an enrolled

590.519 -> tribal member is not a a racial category

594.06 -> it's actually a political category so

596.64 -> much like being a citizen of the United

598.44 -> States or a resident of a state we are

601.44 -> also citizens of our tribal Nations so

604.08 -> in many ways we have a try citizenship

606.42 -> as enrolled tribal members but also

608.82 -> citizens of the US and residents of the

610.5 -> states in which we reside so enrolled

613.14 -> tribal members is a subset of the

615.779 -> American Indian and Alaska native

617.1 -> population and it's I think from a data

620.04 -> perspective and epidemiological

622.38 -> perspective it's very important to

624.48 -> remember that the Indian Health Service

626.519 -> user population does not represent All

629.339 -> American Indians and Alaska natives so

631.98 -> if we look at the most recent census

633.839 -> data there's well over nine million

636.18 -> people who identify as American Indian

638.279 -> or Alaska native on the census the user

641.279 -> population in the Indian Health Service

642.839 -> is about 2 million so the IHS database

645.98 -> represents actually a minority of

648.36 -> American Indians and Alaska natives so

650.64 -> quite often I see IHS data being used to

653.579 -> characterize the entire population it's

655.8 -> probably the best data set we have to

657.42 -> look at our population but it's not

658.98 -> inclusive of everyone who's American

660.6 -> Indian and Alaska native it's very

661.92 -> important to keep in mind so to be an

664.32 -> active user of IHS you have to have been

666.839 -> seen within the previous three years at

669.18 -> an IHS or tribal facility so I am not in

672.66 -> the IHS database I've been living in

674.88 -> Grand Forks North Dakota there are no

676.44 -> IHS facilities and I have insurance so

678.72 -> why would I go to IHS I can go to a

680.64 -> local provider so someone like me is

682.8 -> actually not in the IHS database so it's

685.2 -> important to keep that in mind when

686.459 -> we're looking at IHS data it's a subset

689.1 -> of the American Indian Alaska native

690.839 -> population

692.459 -> so we've also heard the term Native

694.019 -> American right and we tend to use Native

696.18 -> American and American Indian as

697.98 -> interchange interchangeable terms but

700.56 -> there's actually a legal basis for the

702.6 -> words Native American as well so in 1978

705.779 -> there was the Native American programs

707.459 -> act and that established the Native

709.56 -> American populations as American Indians

712.26 -> and Alaska natives but also native

713.82 -> Hawaiians and Indigenous people to the

715.92 -> U.S territories so American Samoans are

718.92 -> Native Americans the Chamorro groups in

721.26 -> Guam are also Native American from a

723 -> legal perspective so I try to be

724.86 -> cognizant of the terminology that I'm

726.779 -> using and I know a lot of people prefer

728.94 -> Native American because of the word

731.1 -> Indian right we're not in India but even

733.44 -> the word American is interesting if you

735.06 -> look at its history so it was Amerigo

737.279 -> Vespucci another Italian explorer who

740.459 -> actually named the two large continents

742.5 -> after himself so we have North America

744.42 -> and South America because of Amerigo

746.88 -> Vespucci so in truth when we're having

748.56 -> the argument over which is the better

749.94 -> term American Indian or Native American

752.459 -> we're actually having the argument over

753.899 -> which Italian explorer do we want to pay

755.7 -> homage to

759.12 -> so most of us or many of us I should say

761.519 -> now prefer the term indigenous so the

764.339 -> indigenous peoples are the original

765.779 -> inhabitants of various parts of the

768 -> earth so here in what is now the United

771.12 -> States of course the original

772.8 -> inhabitants are American Indians Alaska

775.079 -> natives of course native Hawaiians if

776.76 -> we're looking at the Pacific Islands

778.86 -> so it's really fascinating on the census

780.839 -> I have to check the box American Indian

783 -> and Alaska native even though I'm not

784.56 -> Alaska native right I'm American Indian

786.42 -> so I try to be cognizant of the

787.86 -> terminology that we are using and in

789.959 -> truth historically we did not have a

791.639 -> collective term for all indigenous

793.86 -> peoples of Turtle Island or North

795.959 -> America we had our own tribal names but

799.74 -> many of those tribes also were renamed

801.66 -> of their terminology in the process of

803.88 -> colonization

805.26 -> so one reason why we have a center for

807.839 -> indigenous Health at Johns Hopkins is

810.24 -> that we see a common outcome from

812.459 -> colonization across the globe so

815.519 -> indigenous peoples who have gone through

817.74 -> colonization tend to have the same types

819.839 -> of Health disparities and this was made

822.36 -> very obvious to me about 10 years ago or

825.36 -> so I was presenting at the international

826.8 -> diabetes Federation and we had an

829.62 -> indigenous people's panel and there was

831.839 -> a Maori academic person from New Zealand

835.68 -> and a indigenous person from Australia

838.019 -> one of the Aboriginal population members

840.24 -> and we all worked at Public Health

842.1 -> Schools or medical schools and we had

844.139 -> never met before and we were doing a

845.82 -> presentation on diabetes in our

848.519 -> indigenous populations and we did

850.56 -> essentially the exact same presentation

852.24 -> three times in a row but just different

854.1 -> populations the impact of colonization

856.98 -> in terms of diabetes is really

858.48 -> ubiquitous across indigenous peoples

860.88 -> and if we think about this it makes a

862.56 -> lot of sense we've lost access to

864.959 -> traditional foods less access to

867.18 -> traditional economies in many cases been

869.94 -> marginalized or put into reservation

872.339 -> communities and then become dependent on

875.04 -> federal government food programs and

876.839 -> other types of challenges related to

878.82 -> loss of land loss of sacred sites and

881.76 -> loss of Natural Resources so not

883.98 -> surprisingly there is an

885.24 -> intergenerational impact and we have to

887.639 -> think of this in terms of trauma and

890.399 -> there's many types of trauma right

891.72 -> there's physical trauma like a physical

893.16 -> injury and in recent years there's been

895.68 -> a lot of work looking at emotional and

897.54 -> psychological trauma and what is the

899.579 -> long-term outcome of traumatic events on

902.94 -> long-term health for individuals so

905.579 -> trauma could be a one-time event like an

908.1 -> accident or injury or death of someone

909.839 -> close to us that can have an impact on

912.54 -> our well-being there's also toxic stress

915.24 -> or ongoing Relentless stress and I would

918.36 -> put forth that for many of our

919.56 -> populations just living in poverty and

922.5 -> living in marginalized communities is a

925.199 -> daily source of stress and we know that

927.779 -> stress hormones are not good for us

929.399 -> physiologically right if we have high

931.199 -> levels of cortisol high levels of

932.94 -> epinephrine that's going to have an

934.079 -> impact on us in terms of chronic disease

937.079 -> then there's other issues related to

939 -> Childhood trauma and I know people are

941.339 -> probably familiar with the ace study

942.779 -> adverse childhood experiences but we

944.94 -> know that there's a long-term impact

946.56 -> when children are subjected to traumatic

949.56 -> events but I'd put forth in addition to

951.839 -> physical trauma emotional and

953.88 -> psychological trauma for indigenous

956.399 -> populations there's also a spiritual and

958.5 -> cultural trauma we do have historical

961.68 -> trauma the long-term and

963.66 -> intergenerational impact of colonization

965.839 -> and then ongoing issues related to loss

969.36 -> of land loss of language loss of culture

972 -> loss of Ceremonies it's a little known

975 -> fact but in the United States

977.16 -> a nation that was founded partially on

979.74 -> the idea of freedom of religion our

981.959 -> religious practices were actually made

983.639 -> illegal so you can look this up it's the

986.04 -> code of Indian offenses in 1883 code of

989.699 -> Indian offenses there's the websites

991.44 -> that you can review if you're interested

993.72 -> in this but it made the work of our

996 -> traditional healers Medicine Man

998.1 -> medicine women actually illegal and in

1000.56 -> particular the Sundance one of the most

1002.3 -> sacred ceremonies in my tribal Community

1004.639 -> was actually made illegal it was against

1007.16 -> the law to practice traditional religion

1010.519 -> and traditional ceremony and little

1012.68 -> known fact most people aren't aware of

1014.24 -> this but actually took until 1978 when

1017.839 -> we had the Indian Religious Freedom Act

1019.88 -> to reverse the impact of the code of

1022.579 -> Indian offenses

1024.439 -> cool and most people aren't even aware

1026.12 -> of that and we like to think of freedom

1028.459 -> of religion as a founding principle for

1030.199 -> our great nation but it was freedom of

1032.6 -> religion for all Americans except

1034.939 -> indigenous Americans and that's part of

1037.4 -> our truth and that does have a long-term

1039.74 -> impact on populations

1042.439 -> and I wish we were beyond the point of

1045.819 -> marginalization and racism but we're not

1049.04 -> I mean if we're honest with ourselves

1050.78 -> and honest as a nation we have a lot of

1053.299 -> work left to do to overcome some of

1055.1 -> these challenges that are creating toxic

1057.38 -> stress in many of our communities

1059.059 -> including American Indian populations

1062.12 -> so when I think of this holistically and

1063.919 -> think of it for more of a cultural

1065.179 -> perspective we look at human life as

1068.66 -> four components and health is being

1071.12 -> balanced among these four forces of

1073.52 -> spiritual mental physical and emotional

1075.919 -> and obviously we can have physical

1077.6 -> trauma like injury psychological and

1080.24 -> emotional trauma but again that

1082.1 -> deep-rooted spiritual and cultural

1083.9 -> trauma that many of our populations have

1085.88 -> had to contend with well why is that and

1088.88 -> what is the history behind that so I'd

1092.299 -> like to show this map and say let's talk

1094.22 -> about Indian country

1096.98 -> it's all Indian Country right this is

1100.4 -> all indigenous land and I really

1102.62 -> appreciate the land acknowledgment to

1104.24 -> start the the discussion today to

1107.299 -> recognize that this in historical

1109.039 -> context this is all indigenous land and

1112.88 -> of course the colonies the process of

1115.52 -> colonization was really devastating to

1117.26 -> many of the northeastern tribes so those

1120.2 -> 13 colonies we saw a lot of loss of life

1123.02 -> a lot of warfare and even the spread of

1126.26 -> disease sometimes intentional spread of

1128.96 -> disease I'm sure people are familiar

1131.12 -> with Amherst Massachusetts and Amherst

1133.7 -> College right named after Lord Jeffrey

1136.76 -> Amherst and he's very well known in

1139.82 -> Indian country because he is the one who

1141.919 -> ordered the distribution of blankets

1143.559 -> from a smallpox hospital to the regional

1147.32 -> tribes with the purpose of killing them

1150.679 -> and people have a hard time believing

1152.66 -> this because it's such a devastating

1155.059 -> component of our history and does not

1157.1 -> paint us in a very good light right but

1159.32 -> it is the truth you can actually Google

1161.539 -> I like how Google is a verb right we can

1163.7 -> look this up but Amherst and smallpox

1165.919 -> and you can find these letters that were

1167.48 -> actually written by Jeffrey Amherst and

1169.94 -> I know it's incursive and a little bit

1171.26 -> difficult to read but here he States you

1174.02 -> will do well to try to inoculate the

1176.539 -> Indians by means of blankets

1179.299 -> as well as to try every other method

1181.28 -> that can serve to extirpate or get rid

1183.799 -> of this excerbal race extirpate this

1186.5 -> excerpt race I should be very glad your

1189.62 -> scheme for hunting them down by dogs

1191.539 -> could take effect

1193.46 -> isn't that remarkable

1195.14 -> and this is part of our history and I

1197.9 -> find it really fascinating the time

1199.16 -> frame that we're living in there's kind

1200.299 -> of a pushback against the truth of

1202.28 -> history in some sectors of our society

1204.5 -> but it's important to understand the

1206.96 -> history to understand where we are now

1208.94 -> why is it that we have such tremendous

1211.4 -> disparities we have to be honest about

1213.38 -> history so I talk about these things not

1216.559 -> to make anyone feel bad that's not the

1218.6 -> point I talk about these things because

1220.7 -> it's the truth and if we are ever going

1223.22 -> to get to equity we have to walk through

1225.98 -> truth even when it's unpleasant even

1228.98 -> when it makes us uncomfortable there's

1230.96 -> no path to equity without walking

1232.7 -> through truth and we have to be

1234.08 -> cognizant of that so what do we do now

1236.72 -> we honor Amherst right Amherst

1240.14 -> Massachusetts Amherst College

1242.9 -> UMass Amherst

1244.46 -> so we're celebrating someone

1246.86 -> and in truth this is our earliest

1249.38 -> documented case of bioterrorism

1251.799 -> purposeful killing of indigenous peoples

1255.14 -> by the purposeful spread of smallpox

1258.1 -> isn't that remarkable and this is a part

1260.96 -> of our history it's not a pleasant part

1263.059 -> of our history but it is the truth of

1266.179 -> why we are in the circumstances we are

1267.919 -> now

1269.36 -> so that explains a lot about the

1270.919 -> Northeast but what about the southeast

1272.78 -> in 1830 there was a law called the

1275.96 -> Indian Removal Act think about that just

1278.84 -> the title of the law Indian Removal Act

1282.44 -> and that's the law in which we removed

1285.44 -> tribes from the southeast to what is now

1288.62 -> Oklahoma so it's also known as the Trail

1291.2 -> of Tears I'm sure people have heard that

1293 -> terminology as well

1294.98 -> so so think about that you know why are

1297.08 -> we in Atlanta Georgia instead of home to

1301.159 -> the Cherokee and Muskogee Nations it's

1304.28 -> because of removal the city of Atlanta

1306.32 -> was actually established in 1837 and the

1309.62 -> Removal Act was in 1830 get the American

1312.32 -> Indians out of the way Indian Removal to

1315.2 -> establish

1316.84 -> places like this like Atlanta Georgia so

1320.419 -> how often do we think about that how

1322.22 -> often do we acknowledge that that there

1324.5 -> were policies that led to the removal of

1327.799 -> indigenous peoples to what is now

1329.24 -> Oklahoma well in that process it was

1331.7 -> really fascinating so some of the tribal

1334.1 -> members refused to leave their Homeland

1335.72 -> so they stayed put whereas others were

1337.58 -> removed to Oklahoma so that's why we had

1340.1 -> this interesting Dynamic now where we

1341.9 -> have Seminoles in Florida Seminoles in

1344.24 -> Oklahoma Cherokees in North Carolina

1346.1 -> Cherokees in Oklahoma choctaws in

1348.32 -> Mississippi choctaws in Oklahoma you

1350.12 -> kind of get the idea so in Oklahoma

1352.48 -> there are 38 federally recognized tribes

1356.24 -> of which only four are originally from

1358.88 -> Oklahoma the rest were removed from

1360.98 -> other parts of the country so that's why

1362.84 -> we had these Dynamics now and relatively

1365.36 -> few American Indians left in the eastern

1367.82 -> part of the United States there was a

1369.98 -> policy basis for this and think about

1372.86 -> the loss of land the loss of territory

1375.38 -> the loss of Natural Resources the loss

1377.72 -> of traditional food systems and then the

1380.059 -> dependence on government programs for

1382.4 -> food

1383.9 -> so it wasn't just in the East with the

1386.059 -> discovery of gold was devastating for

1389.12 -> the tribes in California

1391.059 -> and unfortunately after the discovery of

1393.98 -> gold there was a gold rush and there's a

1396.26 -> need to basically get rid of the tribal

1398.96 -> members who are in the way and the

1401.059 -> original governor of California Peter

1403.28 -> Hardiman Burnett from his State of the

1405.38 -> State address in 1851 he said that a war

1408.98 -> of extermination will continue to be

1411.559 -> waged between the races until the Indian

1414.38 -> race becomes extinct must be expected

1417.5 -> must be expected

1420.14 -> well we cannot anticipate this result

1422.12 -> but with painful regret the inevitable

1424.94 -> Destiny of the race is beyond the power

1427.28 -> or wisdom of man to avert and of course

1430.7 -> we didn't have census data back then but

1432.62 -> it's estimated that out of well over a

1435.02 -> hundred thousand I'm sorry over 150 000

1437.96 -> American Indians in California by 1873

1441.14 -> so not too long after the Gold Rush

1443.36 -> there's only about thirty thousand

1444.679 -> indigenous people left in the state of

1446.539 -> California

1447.86 -> so these are parts of our history that I

1450.559 -> wish were better understood I wish they

1452.6 -> even mentioned in history books you know

1454.58 -> the the I went through my own schooling

1456.86 -> and didn't learn about this in school

1458.24 -> and I certainly didn't go to medical

1459.98 -> school planning to become a historian

1461.659 -> but it turns out we have to do this on

1464.299 -> our own to understand the truth of

1466.159 -> History because it's not generally

1467.96 -> provided and we have to look at this in

1470 -> the context of how does this lead to

1472.7 -> Public Health disparities and what are

1475.039 -> the things that we need to do in

1476.539 -> epidemiology Public Health Medicine and

1478.7 -> Health Sciences generally to better

1480.86 -> address these challenges because one

1483.799 -> size does not fit all and historically

1485.96 -> that's kind of the approach that we have

1487.88 -> taken so we have to understand the

1489.799 -> context of history and the communities

1492.02 -> that we are working with

1494.059 -> so in recent years much of my research

1496.28 -> has been focused on the impact of

1498.32 -> historical trauma adverse childhood

1500.12 -> experiences and other social dynamics on

1503.36 -> health outcomes and in even more recent

1506.48 -> years we're looking at also at the

1507.86 -> strengths of indigenous culture and the

1510.62 -> resiliency Focus that there's so much

1512.84 -> about our cultures that are protective

1514.82 -> of hell so it's not just all about risk

1516.74 -> factors but I think it's important to

1518.659 -> acknowledge the the genocide and the

1521.72 -> historical trauma that has had a direct

1524.179 -> link to chronic disease disparities

1526.58 -> today

1527.779 -> another component of our history is the

1529.58 -> boarding school experiences I'm sure

1531.5 -> people are familiar with this and in May

1534.14 -> through Deb Holland's office the

1536.36 -> Secretary of interior they did put forth

1538.7 -> a boarding school report and it was the

1541.22 -> first time that we saw compiled into one

1543.62 -> document the the full extent at least to

1546.5 -> our knowledge at this point of the

1548.659 -> numbers of boarding schools and the

1549.98 -> impact of the boarding schools

1552.02 -> so the the boarding school era was an

1554.659 -> era in which the goal was to basically

1558.02 -> get rid of the culture of American

1559.82 -> Indians and the strategy was putting

1562.34 -> children into boarding schools and

1564.38 -> making it against the rules for them to

1566.36 -> speak their language or practice their

1568.1 -> culture so as a process to integrate

1570.44 -> American Indians

1572.779 -> and the way this was done the way

1574.22 -> families were compelled to give up their

1576.86 -> children is that when we had the

1578.779 -> reservation system we no longer had

1581.179 -> access to our traditional food systems

1582.98 -> right so we're dependent on the federal

1584.72 -> government for food distribution

1587.72 -> or rations so what the families were

1590.6 -> told was either give up your children to

1593.419 -> go to boarding school or we will

1595.4 -> withhold your rations

1598.039 -> so give up your children or starve which

1601.279 -> is why thousands and thousands of

1602.779 -> American Indian children wound up in

1604.58 -> boarding schools and again I don't say

1606.679 -> this to make any one feel bad that is

1608.299 -> not the purpose and and no one here is

1611 -> at fault for what happened well over a

1612.919 -> hundred years ago right but I talk about

1615.32 -> these things because we have to be

1617.059 -> strong enough as a society to recognize

1620.659 -> the truth

1621.74 -> to embrace it for what it is and then

1624.44 -> more importantly find Solutions but if

1626.659 -> we don't know the starting point of the

1628.279 -> disparities how are we going to find the

1630.74 -> solutions we have to really understand

1632.299 -> these things even when they're difficult

1633.86 -> to think about

1636.14 -> this is a picture from the Carlisle

1638 -> Indian School in Carlisle Pennsylvania

1640.12 -> and I know it's difficult to see all of

1643.279 -> the individual faces but I have four

1646.4 -> children and I've seen a multitude of

1648.32 -> class pictures and I always see laughter

1651.74 -> and smiling and joy in those class

1654.62 -> pictures but I look at this one and I

1656.84 -> don't see any of that

1658.64 -> I see anger

1661.039 -> I see fear I see sadness

1664.7 -> all these American Indian children put

1666.74 -> into basically military type uniforms in

1670.279 -> Carlisle Pennsylvania in some cases more

1672.26 -> than a thousand miles away from their

1673.94 -> homes and put into these environments

1677.179 -> and I think about the kids who would

1679.46 -> have had vulnerabilities how many of

1681.919 -> them long before we had an Autism

1683.779 -> Spectrum might have had social or

1685.88 -> communication challenges

1687.5 -> who was protecting them

1689.84 -> so there's just so much

1691.76 -> pain immersed in in this type of History

1695.24 -> that's not really well understood and

1698.6 -> certainly I don't think well enough

1699.62 -> addressed when we think about the

1701.12 -> challenges related to intergenerational

1703.039 -> trauma

1704.659 -> and this is not ancient history my

1706.46 -> mother is a survivor of boarding schools

1708.559 -> she's still with us she's 84. she's a

1711.559 -> nurse still working she tried retirement

1714.32 -> a tease her that she failed retirement

1718.039 -> but there's a lot about the boarding

1719.659 -> schools that she won't talk about

1720.74 -> there's her whole generation has has had

1724.88 -> to deal with this because again

1725.96 -> thousands and thousands of children were

1727.7 -> put into boarding schools

1729.32 -> this is a picture of the graveyard right

1731.24 -> next to the Carlisle Indian School and

1733.58 -> almost all of these boarding schools

1735.02 -> have huge graveyards some with unmarked

1736.94 -> Graves and why was there so much excess

1740.24 -> death at the boarding schools we know

1743.179 -> that there were outbreaks of things like

1744.44 -> tuberculosis and influenza over the

1746.9 -> years but it doesn't really answer the

1748.279 -> question as to why there was so much

1749.539 -> excess death in the boarding schools why

1752.48 -> were so many children dying at such a

1754.82 -> young age we probably will never know

1757.159 -> the full extent as to why that occurred

1759.799 -> but my question is what is the impact on

1763.039 -> the survivors what's the impact on

1765.2 -> children if you see so many of your

1767.179 -> friends and Playmates dying at an

1769.52 -> unnaturally High rate does that

1771.44 -> potentially have a long-term impact on

1774.2 -> the health and well-being of that child

1776.5 -> absolutely and this is just a generation

1779.299 -> ago right this is not ancient history

1783.44 -> so a lot of the work that we're doing

1785.179 -> now is looking at epigenetics and trying

1788.12 -> to understand what are the changes to

1790.64 -> DNA that occur when there's toxic stress

1793.22 -> and might some of those changes be

1795.44 -> transmissible across generations and

1797.48 -> there's some really compelling evidence

1798.86 -> that this does occur and perhaps

1801.86 -> epigenetics will be a scientific

1803.48 -> platform to better understand the impact

1806.36 -> of historical trauma I still come across

1808.899 -> colleagues and people who don't believe

1811.52 -> in historical trauma you know they don't

1813.2 -> believe that there could be an impact

1814.34 -> from what happened in previous

1815.299 -> generations but I think any time there's

1818.059 -> newer Concepts within science it's not

1821.179 -> always easily or readily accepted right

1824 -> but I think that this will be a

1825.679 -> scientific platform to better understand

1827.38 -> intergenerational trauma

1830.6 -> so we see these historical issues

1833.899 -> related to historical trauma and

1835.7 -> boarding schools but we also have

1837.44 -> challenges related to

1839.679 -> poor Food Systems as was mentioned this

1843.5 -> is another arena in which I work and

1845.36 -> looking at the food systems that are

1846.799 -> available to tribal members

1848.96 -> so through the USDA we know there's the

1851.539 -> WIC program right women infants and

1853.34 -> children and they've done a lot of

1855.5 -> improvements over the last decade in

1857.96 -> promoting breastfeeding in the WIC

1859.94 -> programs but when I was a full-time

1861.98 -> primary care physician back in the 1990s

1864.62 -> the reservation where I worked the the

1867.32 -> WIC program was basically a baby formula

1869.659 -> Distribution Center just handing out

1871.58 -> baby formula and think about the word

1874.399 -> formula does that sound appealing to

1876.2 -> anybody come on over we'll have a glass

1878.179 -> of formula right

1880.82 -> so it's laboratory generated

1883.059 -> formulations of nutrition it's not

1885.98 -> natural

1886.88 -> well when you think about the culture of

1888.74 -> poverty and young women who grew up with

1891.62 -> very little possessions and no access to

1894.32 -> nice things or expensive things and

1896.779 -> you're offering them when they're a new

1898.1 -> mom just can you know large cases of

1901.1 -> formula for free are they going to take

1903.559 -> it well of course they are

1905.779 -> so I think one of the unintended

1907.399 -> consequences of the WIC program is that

1910.22 -> we saw higher rates of formula feeding

1912.919 -> in impoverished populations than we saw

1915.679 -> in more affluent populations

1918.38 -> so what we wound up doing is kind of

1920.299 -> throwing a fuel onto the fire of things

1922.7 -> like diabetes because we know that as a

1925.46 -> population

1926.32 -> formula-fed babies grow up to have

1928.64 -> higher rates of diabetes than breastfed

1931.159 -> babies and it's important that we

1933.14 -> understand these things as was mentioned

1935.539 -> I was a staff clinician with naddk for a

1938.299 -> number of years National Institute of

1939.44 -> diabetes and digestive and kidney

1940.88 -> disorders

1942.02 -> and back in 2000s Now 23 years ago there

1945.5 -> was a PBS documentary on Obesity in

1949.1 -> America

1950.059 -> and they interviewed one of our

1951.62 -> scientists and he was a brilliant

1954.38 -> scientist a very good diabetes scientist

1957.2 -> really understood the pathophysiology of

1959.899 -> insulin resistance very well

1961.82 -> and I watched the documentary and he

1965.6 -> said that this population has the exact

1969.2 -> same diet as everyone else but they have

1972.62 -> higher rates of diabetes therefore it

1974.24 -> must be genetic

1975.919 -> so I'm curious how many people here are

1977.299 -> familiar with the commodity food program

1979.039 -> in the USDA a handful of people are so

1981.86 -> there's What's called the food

1983.419 -> distribution program on Indian

1984.679 -> reservations fdpir

1987.14 -> and it consists of a lot of unhealthy

1989.779 -> foods and it's really the source of fry

1992.299 -> bread right that's a source of uh the

1995.539 -> the bleached enriched flower I think the

1998.299 -> word enriched is the the biggest

1999.62 -> nutritional

2001.36 -> um uh misinformation ever there's no

2003.64 -> nutrition in it it's just the starch and

2006.519 -> uh basically the roots of fry bread are

2008.62 -> in the commodity food program

2010.96 -> so after the the our well-respected

2014.26 -> scientists went on National Television

2016 -> saying that this population had the

2018.1 -> exact same diet as everyone else

2020.26 -> I went to his office the next day and I

2021.94 -> asked him well what about the commodity

2023.32 -> food program and you know what he said

2026.019 -> what's the commodity food program

2029.86 -> so if we don't have diversity in

2033.159 -> researchers diversity and public health

2035.2 -> leadership if we don't have the lived

2037.24 -> experience of the populations we are

2040.059 -> studying we won't even ask the right

2041.98 -> questions and what's even more dangerous

2044.08 -> is we will spread misinformation based

2046.6 -> on our own lack of understanding our own

2048.7 -> lack of awareness of the truth of the

2051.46 -> circumstances in which populations are

2053.08 -> living right so it was remarkable that

2056.44 -> you know it was when on national

2057.879 -> television and and talked about being on

2059.98 -> the exact same diet but it's not so the

2062.679 -> the USDA commodity food program has made

2065.139 -> a lot of improvements in recent decades

2067.06 -> but when I was growing up it was really

2068.859 -> unhealthy food here's some pictures

2070.98 -> there's some sort of spam-like meat

2073.54 -> product you know canned beef and canned

2075.58 -> pork very unhealthy of course commodity

2078.52 -> cheese I'm sure people heard of

2079.899 -> government cheese right the big bricks

2081.7 -> of cheese and as a side note I love

2084.04 -> commodity cheese I wish I didn't but

2087.7 -> it's good stuff

2089.98 -> on the right this is a container of corn

2092.919 -> syrup

2094 -> another

2095.22 -> engineered

2096.76 -> food not a natural food right there's

2099.7 -> actually very unhealthy for us pure corn

2102.099 -> syrup and I know it's in fine print but

2104.5 -> if you look closely it says use in baby

2106.66 -> formula

2108.58 -> right using baby formula It also says

2112 -> use on pancakes right as a syrup

2117.22 -> so these are policy based attacks on

2121.54 -> public health

2122.74 -> and we wonder why do American Indians

2124.66 -> have such high rates of diabetes there's

2127 -> reasons for this right and we have to be

2130.24 -> cognizant of the fact that there are

2131.74 -> federal policy decisions that have led

2134.8 -> directly to trauma directly to

2137.26 -> marginalization and directly to diabetes

2139.9 -> and directly to all kinds of mental

2142.48 -> health and chronic disease circumstances

2144.46 -> we have to be cognizant of that because

2147.16 -> unfortunately in my own career in my

2149.02 -> experience I've seen many of my

2150.82 -> colleagues kind of blame the victims

2152.619 -> right

2153.94 -> well they must be too lazy to exercise

2156.28 -> or they just don't care about healthy

2158.5 -> food you know there's all kinds of

2160.3 -> judgment that's being made coming from a

2163.06 -> place of lack of awareness I don't think

2165.46 -> it's you know from an evil place it's

2166.96 -> just lack of awareness we need to be

2169.42 -> more aware of the truth of our history

2171.28 -> if we're going to develop solutions that

2173.8 -> make sense and this is a part of our

2175.66 -> history I remember growing up eating

2177.82 -> these foods and I also remember they had

2180.46 -> a you know they called it grape juice I

2182.26 -> think it was just sugar water with

2183.28 -> purple food coloring but I remember my

2185.68 -> cousins and and Friends we'd all have

2187.72 -> that kind of like Kool-Aid smile you

2189.22 -> know the stain of purple on our face

2190.72 -> just some drinking that uh sugar water

2193.599 -> basically but that's part of our history

2195.94 -> unfortunately but I do acknowledge that

2198.339 -> they made a lot of improvements in the

2199.599 -> commodity food program in recent years

2202.54 -> so there's also adverse childhood

2204.16 -> experiences as we're going through

2205.96 -> history and and looking at more current

2208.78 -> challenges I'm sure people are aware of

2211.839 -> the ace study but adverse childhood

2213.76 -> experiences correlate with worse Health

2215.619 -> outcomes mental health outcomes chronic

2218.14 -> disease outcomes even infectious disease

2220.06 -> outcomes when we have more adverse

2222.94 -> childhood experiences in terms of abuse

2225.52 -> neglect or household dysfunction we tend

2228.46 -> to see worse Health outcomes in

2229.96 -> adulthood

2231.099 -> so long lasting effects so even though

2233.5 -> the adversity could occur before age 18

2235.54 -> we could see lifelong impact on chronic

2238.599 -> disease higher rates of obesity and

2241.42 -> diabetes and some forms of cancer but

2244 -> even impact on life potential when

2246.099 -> there's adverse childhood experiences we

2248.74 -> also see higher rates of Dropout from

2250.599 -> school and long-term higher rates of

2252.579 -> poverty so this really is at the the

2255.339 -> root of many of our disparities as

2257.44 -> ongoing adverse childhood experiences

2260.8 -> so I do want to have a shout out to the

2262.66 -> CDC particularly the national Center on

2264.76 -> injury prevention the ace pyramid

2267.28 -> historically had adverse childhood

2269.14 -> experiences at the base of the pyramid

2271.3 -> but this is right from the ncip website

2274.48 -> looking at generational embodiment and

2277.359 -> historical trauma at the base of the

2279.52 -> pyramid because it's those factors that

2281.74 -> lead to the social conditions and the

2283.9 -> local context in the communities that

2286.18 -> put some communities at greater risk for

2288.46 -> Aces so we can't just blame the families

2291.579 -> right can't just say Well it must be a

2293.38 -> terrible family know that there are

2296.14 -> societal and historical impacts that put

2299.14 -> some populations at greater risk for

2301.42 -> adverse childhood experiences

2303.28 -> So based on that we see disrupted

2305.38 -> neurological development impact on

2307.66 -> Social Development and social behavior

2309.88 -> adoption of high-risk Health behaviors

2312.04 -> and then earlier onset of disease and

2315.099 -> disability essentially all of the

2318.099 -> disparities that we see in American

2319.96 -> Indian Alaska native populations are

2322.48 -> also the same types of health issues

2324.099 -> that are correlated with adverse

2325.96 -> childhood experiences this is where we

2328.42 -> need to put much more effort and much

2330.16 -> more resources in terms of preventing

2332.02 -> Aces from occurring in the first place

2335.56 -> I also want to commend CDC on the the

2338.079 -> wonderful reports looking at the impact

2340.06 -> of covid-19 on life expectancy and

2343.66 -> unfortunately we already had shorter

2346.96 -> life expectancy pre-pandemic in 2019 but

2351.099 -> as we can see we had terrible reductions

2353.5 -> in life expectancy in the American

2355.18 -> Indian and Alaska native population

2357.72 -> through the pandemic and if we look at

2360.88 -> it in terms of years of life expectancy

2363.52 -> lost for males isn't that remarkable

2366.099 -> loss of 7.1 years due to the pandemic

2369.82 -> and this isn't because of less

2371.56 -> vaccinations it's because of all the

2373.599 -> comorbidities that put us at risk for

2375.64 -> bad outcomes so all of those

2377.76 -> comorbidities higher rates of obesity

2380.2 -> diabetes heart disease lung disease that

2382.66 -> puts us at risk for more hospitalization

2384.4 -> more mortality from something like covet

2387.76 -> 19. but it's important that these

2389.92 -> disparities were in place long before

2391.96 -> there was coveted 19 right we're about

2394.9 -> to publish a report using North Dakota

2397.42 -> data

2398.98 -> and if we look at age at death in North

2401.38 -> Dakota the red bars of the American

2403.839 -> Indian population the blue bars of the

2405.7 -> white population in the state of North

2407.26 -> Dakota it looks like two completely

2409.24 -> different populations and look at the

2412.06 -> infant mortality rates just remarkably

2414.76 -> higher you see how high that Peak is for

2418.42 -> the American Indian population before

2420.64 -> age one and you can see the peak of

2423.88 -> death prior to age 60 whereas the peak

2426.88 -> for the white population is over age 80.

2430.119 -> so another way to look at the data we

2432.76 -> here we divide it out by males and

2434.859 -> females the red is American Indian the

2437.8 -> blue is white and the medians at the

2440.26 -> 50th percent

2442.54 -> for males the median age at death is 55.

2447.82 -> isn't that remarkable

2449.92 -> so I'd like to remind my public health

2451.54 -> colleagues that we do not have to cross

2453.64 -> an ocean to find third world health

2456.04 -> conditions right

2458.32 -> we don't have to cross an ocean to find

2460.359 -> it's right here and that's why I think

2462.88 -> Eis is so important so vitally important

2465.52 -> and needs to be a part of the solution

2467.38 -> and working more closely with indigenous

2470.2 -> communities to address these significant

2472.359 -> challenges because it does not have to

2474.579 -> be this way

2475.66 -> most of these deaths are preventable

2477.7 -> that are occurring so early in life it

2480.339 -> does not have to be this way we just

2482.619 -> collectively have to make the commitment

2484 -> to invest the resources where they are

2486.22 -> needed to improve outcomes long term

2490.119 -> so again you can see for males 55 for

2492.88 -> females 62 and in the white population

2495.72 -> 77 for males 85 for women in in North

2500.079 -> Dakota for the white population

2502.359 -> so I'm 56 so I guess I've already you

2506.079 -> know passed the the median age at death

2507.82 -> it's all gravy from here right you know

2510.64 -> but it shouldn't be that way should it

2513.7 -> so the data are right in front of us and

2515.74 -> I think that we have enough empirical

2516.94 -> data to prove that what we've been doing

2519.099 -> is not working

2520.9 -> so let's be smarter about this let's

2523.18 -> invest in new opportunities and new

2525.28 -> strategies

2526.72 -> so of course the adversity does not end

2529.06 -> at age 18. we also have toxic stress or

2531.76 -> adverse adulthood experiences living in

2534.82 -> poverty is stressful living in

2536.859 -> marginalization and where we still see

2539.26 -> racism these things are stressful to our

2541.66 -> populations so we have to be cognizant

2544.72 -> that there's really a whole Continuum of

2547.96 -> traumas and stressors many of it

2550.5 -> policy-based trauma that's actually had

2553.359 -> and is still having a negative impact on

2555.7 -> outcomes

2557.14 -> so I'm sure many people are familiar

2558.64 -> with trauma-informed care

2560.38 -> and when we think of trauma-informed

2562.3 -> care we usually think about that in the

2563.859 -> clinical setting right we have to

2565.18 -> recognize that our patients might be

2566.8 -> dealing with unresolved trauma so part

2569.44 -> of this we have to understand the

2570.579 -> prevalence of trauma very very common

2572.98 -> you know we have universal precautions

2575.619 -> for bloodborne diseases right we wear

2577.66 -> gloves so we're drawing blood

2579.94 -> we should have universal precautions for

2582.04 -> trauma trauma is actually much more

2583.96 -> common than bloodborne illnesses right

2586.3 -> we should just walk into the patient's

2588.46 -> room assuming that they could be dealing

2590.319 -> with unresolved trauma and quite often

2592.9 -> the difficult patients are the ones that

2594.579 -> are just haven't had that addressed

2596.26 -> because the health system hasn't even

2598.06 -> addressed it with them so we have to

2599.92 -> recognize how trauma impacts individuals

2601.9 -> we have to put the knowledge into

2603.28 -> practice and actively resist

2605.7 -> re-traumatizing the people that we are

2607.72 -> working with

2608.74 -> and as a medical educator one of the

2611.74 -> things I'm trying to work on is revising

2614.079 -> the way we train future Physicians

2617.68 -> does it make any sense that we're

2619 -> traumatizing future healers in the

2620.859 -> medical education process

2622.96 -> you know when I was going through my

2624.16 -> training in the early 90s there's almost

2626.98 -> like a sense of Pride on how difficult

2628.72 -> and challenging and traumatic that it

2630.579 -> was you know

2632.02 -> is that smart

2633.819 -> what happens when our next generation of

2635.98 -> healers is traumatized

2638.56 -> that's not smart it's not the way we

2641.56 -> should be doing things and I know it's

2643.48 -> the way we've done things and changing

2645.22 -> systems is difficult but again the

2647.14 -> empirical evidence proves that what

2649.3 -> we've been doing is not working so this

2652.119 -> is part of our solution we just need to

2653.74 -> be smarter about these things but the

2656.38 -> trauma-informed care extends beyond the

2659.74 -> clinical setting we need trauma-informed

2662.319 -> Public Health

2663.88 -> we need trauma-informed education

2666.46 -> we need trauma-informed epidemiology

2668.44 -> right so we'll talk more about this but

2671.74 -> I think we have to open our our minds

2674.14 -> even broader to look at how we might

2676.06 -> address these things

2677.98 -> so again going back to the more

2679.359 -> indigenous perspective and the medicine

2681.099 -> wheel and looking at the impact of

2682.9 -> trauma that can occur spiritually

2684.819 -> mentally physically or emotionally

2686.859 -> actually there's some really good

2688.599 -> compelling evidence in smaller scale

2691 -> studies that show the impact of these

2693.64 -> types of interventions so mindfulness

2695.5 -> and meditation CBT or cognitive

2698.14 -> behavioral therapy is showing some real

2700.3 -> promise in addressing trauma so in

2703.119 -> cognitive behavioral therapy being

2704.98 -> Mindful and conscious of what we are

2707.5 -> thinking about actually has an impact on

2709.66 -> the body's physiology

2711.28 -> we can actually see through mindfulness

2713.079 -> lowering blood pressure lowering blood

2715.359 -> sugar increasing a sense of Wellness to

2718.3 -> the degree that if it was in the form of

2719.8 -> a pill it would be standard therapy but

2722.26 -> since it's mindfulness it's alternative

2723.94 -> medicine right we should be more open to

2726.819 -> these things because for many of our

2728.859 -> people they work

2730.42 -> also physical activity and movement

2732.52 -> obviously that's important for for

2734.74 -> physical health but it's also good for

2736.42 -> mental health and emotional health and

2739.18 -> unfortunately a lot of our communities

2740.74 -> we don't have safe places to even go for

2743.5 -> a walk and many of our reservation

2745.18 -> communities the old Bia roads are very

2747.46 -> narrow they're very dangerous

2749.339 -> there's certain circumstances where it's

2751.72 -> not safe to even go outside to go for a

2753.46 -> walk that has an impact on what we need

2756.4 -> to be doing in public health to address

2758.619 -> better outcomes also social

2761.079 -> connectedness we know that social

2762.819 -> isolation is bad for health and think

2765.88 -> about what's happened during the

2766.78 -> pandemic and higher rates of suicide

2768.7 -> higher rates of Overdose higher rates of

2770.8 -> depression higher rates of substance use

2772.599 -> to self-medicate the impacts of social

2775.48 -> isolation

2776.8 -> so we know historically that the the

2779.98 -> connectedness to each other is vitally

2782.319 -> important for our individual health and

2784.66 -> I wish we had never used the term social

2786.339 -> distancing right six feet apart is not a

2789.7 -> social distance that's a physical

2791.5 -> distance right if anything we need

2794.079 -> social connectedness during a pandemic

2796.66 -> not social distancing right we I wish we

2799.9 -> had thought more about how the

2801.04 -> terminology that we were using in that

2803.02 -> space

2804.099 -> so we know that social isolation is bad

2806.2 -> for health and having social

2807.28 -> connectedness is actually a protector

2809.079 -> for health and there's also again it's

2811.96 -> limited studies but the impact of prayer

2815.02 -> the impact of participation in ceremony

2817.359 -> and the impact of cultural preservation

2820.359 -> for indigenous peoples is a protector of

2823.599 -> health so we need to expand the work

2825.4 -> that we're doing in all of these arenas

2828.52 -> so some considerations the several

2830.68 -> things just to think about there's been

2832.3 -> a lot of contributions to U.S Public

2834.28 -> Health from American Indians and Alaska

2835.96 -> natives particularly through our Center

2837.52 -> for indigenous Health at Johns Hopkins

2840.339 -> back in the late 1980s there were a lot

2843.94 -> of American Indian children dying from

2845.859 -> dehydration particularly at the White

2847.42 -> Mountain Apache tribe in Arizona and

2850.54 -> they were dying from dehydration due to

2853.48 -> infectious diarrhea and there was no

2856.18 -> picu no Pediatric Intensive Care Unit

2858.52 -> it's very rural and remote and

2860.02 -> impoverished very difficult to get an IV

2862.18 -> line started and children who are going

2864.46 -> through terrible dehydration

2866.26 -> so they started to work on and develop

2868.24 -> an oral rehydration solution Johns

2871.66 -> Hopkins working with this particular

2872.8 -> tribe and that oral rehydration solution

2875.5 -> became Pedialyte so if you ever used

2877.9 -> Pedialyte that's actually from an

2880 -> American Indian population that actually

2881.8 -> studied this and tested it and proved

2883.66 -> its efficacy and then multiple vaccines

2886.42 -> including Hib rotavirus copin 19 and

2889.359 -> others that have been studied in

2891.76 -> American Indian populations also again I

2895.06 -> used to work for NIH a lot of what we've

2896.98 -> learned about preventing diabetes like

2899.2 -> the diabetes prevention program but also

2901.3 -> treating diabetes and trying to prevent

2903.88 -> kidney failure a lot of that was learned

2906.46 -> from studying American Indian

2908.079 -> populations

2909.94 -> thus have to promote more respect for

2911.5 -> indigenous healing systems and

2912.819 -> methodologies you know historically we

2915.22 -> would use willow bark as a medicinal tea

2917.98 -> and of course that's the source of

2919.9 -> aspirin right acetyl salicylic acid

2922.06 -> comes from Willow tree bark so

2924.819 -> historically it was willow tree bark

2926.38 -> until Bayer discovered it and now it's

2928.78 -> aspirin right and so now it's a Accepted

2931.359 -> Modern Western medicine

2933.64 -> you know we might have some osteopaths

2935.619 -> in the room doctors of osteopathy the

2937.96 -> individual considered the father of

2939.28 -> osteopathy is at still he grew up in

2941.98 -> Missouri and he actually learned the

2944.5 -> principles of osteopathic medicine from

2946.359 -> the Shawnee and Oto Indians

2948.96 -> osteopathic medicine is traditional

2951.339 -> indigenous medicine but in many ways

2953.98 -> these things are co-opted and then no

2955.96 -> longer understood to have the indigenous

2958.119 -> roots that they do

2959.98 -> so we have disparities Pre-K to post-doc

2962.74 -> we unfortunately have few role models in

2964.599 -> public health leadership Health Sciences

2966.16 -> and higher education I always like to

2968.5 -> point out

2969.579 -> um well I'll ask how many deans of a

2972.819 -> medical school Medical School Deans are

2975.7 -> American Indian in the U.S

2978.099 -> I'll give you a hand you can count them

2979.96 -> on zero hands

2982.96 -> this is 2023. zero American Indians

2986.319 -> serving as the dean of a medical school

2988.42 -> is that acceptable

2990.52 -> is that the way it should be but even

2992.56 -> other agencies it wasn't until Deb

2994.42 -> Holland became the Secretary of interior

2996.819 -> that we finally had an American Indian

2998.56 -> in a cabinet level role isn't that

3000.839 -> remarkable it took till the 2020s for

3003.119 -> that to occur so a few role models and

3005.7 -> still ongoing challenges including a

3007.319 -> one-size-fits-all approach and I know

3009.599 -> this image is used a lot in different

3011.339 -> settings I'm sure you've seen this one

3012.599 -> are similar ones

3014.04 -> but we are trying to achieve Equity it's

3016.26 -> not just the package of services or the

3019.02 -> curriculum that has to be the same what

3021.18 -> we need is Equitable outcomes which

3023.64 -> means that sometimes we have to do

3025.38 -> things in unique ways we have to find

3027.48 -> unique solutions for populations that

3029.4 -> have unique histories in many ways it

3031.68 -> feels like I'm saying one plus one

3032.76 -> equals two but it's very difficult for

3035.22 -> systems to change and to recognize that

3037.319 -> some populations need unique

3039.42 -> interventions and it's incumbent on us

3042 -> to find those interventions in close

3044.099 -> collaboration with the communities that

3046.26 -> we are working with

3047.579 -> so I'd shown this image for years and a

3049.619 -> few years ago someone sent me an image

3051.42 -> that I think is just brilliant and the

3053.099 -> question is what is that fence doing

3055.26 -> there in the first place right

3058.079 -> is it the package of services to

3059.819 -> overcome the barrier or do we just need

3061.68 -> to get rid of the barriers and I think

3063.78 -> there's a multitude of things that we

3065.099 -> could consider things that we should try

3066.839 -> to do starting with respecting and

3069.24 -> integrating indigenous knowledge and

3071.579 -> Indigenous Health Sciences education we

3074.52 -> have our own ways of doing things that

3076.14 -> are valid they haven't been adequately

3078.24 -> studied we don't have enough indigenous

3080.94 -> researchers looking into these things

3082.559 -> but we also have to be able to respect

3084.48 -> and understand history right the true

3087.78 -> history that has led to some of the

3089.94 -> challenges we're facing we also need a

3092.64 -> wise practices approach to Public Health

3094.68 -> and epidemiology so quite often we say

3097.68 -> evidence-based practices right my

3100.5 -> question is always whose evidence is it

3103.5 -> if it worked effectively in Atlanta does

3106.02 -> that mean you can just package it up and

3107.579 -> plop it down into Pine Ridge South

3108.96 -> Dakota and expect it to be effective

3110.819 -> maybe but maybe not the context of

3114.54 -> community is vitally important in

3117.48 -> developing meaningful Solutions that's

3119.52 -> got to be part of our approach so let's

3121.02 -> look at evidence-based and best

3123.3 -> practices but let's also use indigenous

3125.64 -> knowledge indigenous language indigenous

3128.599 -> methodologies when we're applying those

3131.64 -> those practices

3133.619 -> so in addition to trauma-informed care

3135.72 -> in the clinical setting again we need

3137.28 -> trauma-informed epidemiology

3139.4 -> trauma-informed public health and we

3141.9 -> need to better understand the impact of

3144.18 -> historical and intergenerational Trauma

3146.76 -> we need to develop the indigenous Public

3148.68 -> Health evidence base right we need more

3151.46 -> studies more evaluation of programs that

3154.8 -> are going on in our communities and we

3156.359 -> have so many programs that look highly

3158.76 -> effective and very promising but they've

3160.44 -> never been formally evaluated

3162.3 -> and we have to respect indigenous

3164.64 -> evaluation methodologies we have

3167.22 -> different ways of evaluating and think

3169.26 -> about the word evaluation the core of

3171.119 -> that is values right what is important

3174 -> to us

3174.96 -> are we even measuring the right things

3177.02 -> are we measuring things in a culturally

3179.64 -> relevant manner right so we have to open

3182.88 -> our minds to understand that there's

3185.339 -> other ways of looking at this we've had

3187.38 -> some wonderful discussions in the last

3189 -> day and a half looking at how we could

3190.8 -> expand the American Indian or indigenous

3192.72 -> Public Health Workforce that's something

3194.16 -> that's desperately needed we need more

3196.74 -> of our own people going into this work

3199.26 -> but also more indigenous Eis

3201.42 -> participants as well right that's got to

3204.119 -> be part of our priority

3206.16 -> very challenging we need to respect and

3207.78 -> integrate principles of tribal data

3209.94 -> sovereignty that's a challenging task

3212.04 -> right the tribes are sovereign Nations

3214.38 -> Sovereign entities they own and control

3216.18 -> their data but how can we work

3217.98 -> collaboratively to ensure that we're

3219.78 -> using the data to address Health

3222 -> inequities and to improve health

3223.8 -> outcomes

3225.119 -> need more funding for infrastructure to

3227.7 -> support our populations and certainly

3230.099 -> for data collection as well so we need

3233.4 -> those resources at the tribal level

3236.76 -> um using indigenous methodologies but

3238.619 -> also engaging communities and focusing

3240.72 -> on community-based priorities a

3242.76 -> Community Driven priorities quite often

3245.28 -> the priorities are set at the agency

3247.02 -> level kind of at a national level and

3249.42 -> then those priorities then trickle down

3251.28 -> into the communities whether or not it's

3253.26 -> their priority right is that smart

3256.5 -> is that effective

3258.14 -> the I'm from the government and I'm here

3260.579 -> to help approach it's probably not the

3262.14 -> best strategy in a lot of our

3263.4 -> communities right let's work in

3265.38 -> collaboration let's jointly develop the

3267.78 -> priorities let's jointly develop the

3269.64 -> evaluation measures let's jointly

3271.44 -> develop the research questions let's

3273.54 -> jointly develop the programming we need

3275.94 -> Community engagement to do that but we

3278.339 -> also need more Champions within the

3281.339 -> these arenas

3282.96 -> so for all of you as critical allies of

3286.5 -> Public Health and Indigenous Health we

3288.839 -> need to respect and honor you and be

3291.119 -> inclusive we don't have enough of our

3293.28 -> own people in these roles to adequately

3296.04 -> address the challenges we're facing we

3298.319 -> need each of you to work with us we need

3301.38 -> allies that are genuinely committed to

3303.839 -> improving outcomes

3306 -> and then why not an indigenous Eis

3307.92 -> programmer field Epi training program

3310.619 -> wouldn't that be a wonderful outcome

3312.78 -> thinking about these discussions

3315.66 -> so I'd like to end with a quote from

3317.579 -> blackout Black Elk was a traditional

3319.5 -> Lakota leader from more than 100 years

3322.26 -> ago and I really like this quote from

3325.559 -> him

3326.76 -> he said of course it was not I who cured

3329.04 -> it was the power from the outer world

3330.66 -> and the visions and ceremonies had only

3332.88 -> made me like a whole for which the power

3334.92 -> could come to the two leggeds if I

3337.26 -> thought that I was doing it myself the

3339.18 -> hole would close up and no power could

3342.359 -> come through

3343.619 -> and what he's talking about is humility

3345.42 -> and recognizing that he does not own the

3348.48 -> healing power and when he's humble and

3351.24 -> operates in a humble manner he has

3353.579 -> access to healing power that he can

3355.14 -> channel in the right direction and I

3357.48 -> think about that in health care when we

3358.98 -> lose our humility we lose our ability to

3361.26 -> heal in education when we lose our

3363.72 -> humility we lose our ability to teach in

3366.599 -> law enforcement when we lose our

3367.92 -> humility we lose our ability to promote

3369.78 -> Justice and that's incumbent on all of

3372.18 -> us to have enough humility to recognize

3374.819 -> that there might be other ways of doing

3376.5 -> things and when I was a full-time

3378.42 -> clinician

3379.559 -> I would think to myself every time I

3381.059 -> went into that clinic room what an honor

3383.819 -> it is that this person would allow me to

3386.7 -> be a part of their healing process

3388.619 -> in education for all of my students what

3390.9 -> an honor it is that they would allow me

3392.76 -> to be a part of their educational

3394.38 -> process

3395.88 -> and I mean this very sincerely that I'm

3398.4 -> deeply honored that you'd allow me to be

3401.22 -> a part of your Eis conference and this

3404.339 -> distinguished lecture

3408.5 -> thank you all very much

3410.92 -> [Applause]

3415.44 -> [Music]

3419.04 -> thank you

3420.56 -> [Music]

3421.89 -> [Applause]

3425.5 -> [Music]

3447.119 -> thank you all we have time for questions

3449.7 -> and I I'm sure that we have many

3452.52 -> questions that you want to ask Dr Warren

3454.92 -> so please come to the microphone and

3458.78 -> identify yourself from where you work

3461.4 -> I'm going to start with my colleague Dr

3463.92 -> Barfield

3465.48 -> good afternoon hi Dr Warren Wanda

3468.42 -> Barfield division of reproductively I

3470.4 -> hope Eis class 2000. I think your

3473.52 -> suggestion of an endogenous Eis

3476.76 -> csde everything would be fantastic but

3480.48 -> the question I have for you is one about

3482.72 -> data sovereignty could you just talk a

3486.119 -> bit about that in terms of what it means

3488.88 -> why it's important for epidemiologists

3491.7 -> and public health officials to

3493.2 -> understand yeah absolutely and it's a

3495.839 -> very challenging Arena and there's been

3497.52 -> a lot of recent work and Publications

3500.059 -> addressing some of the challenges from a

3501.96 -> tribal perspective but the tribes are

3503.52 -> sovereign Nations and own their own data

3506.76 -> and even when we're funding research

3508.559 -> through NIH that it's clear that there's

3511.44 -> data sharing agreements where the tribes

3513.24 -> do control their own data and I think

3514.559 -> the challenge is that historically

3516.599 -> particularly in the research Arena I

3518.76 -> think tribes feel like they've been

3519.839 -> taking advantage of and haven't had

3521.46 -> their priorities necessarily addressed

3523.44 -> so in a in a way it's almost a pushback

3525.78 -> against some of the historical

3527.099 -> challenges but tribes own their data and

3530.64 -> they choose how to use it and how to

3532.319 -> share it the challenge with that is then

3534.54 -> quite often we have smaller denominator

3536.7 -> right we don't have enough data in some

3538.859 -> of our populations so ideally we would

3541.079 -> be pulling data and accessing it and

3543.66 -> analyzing it but it has to be done in a

3545.819 -> manner that respects tribal sovereignty

3547.26 -> so there's ways to do it there's very

3548.52 -> good case examples of how to do it with

3550.44 -> data sharing agreements and then I just

3553.2 -> I would love to see in the future with

3554.76 -> the tribes tribal epidemiology centers

3556.559 -> and CDC are just working in close

3558.24 -> collaboration for data sharing and using

3561.48 -> the data to address and measure outcomes

3564.299 -> thank you very much

3567.54 -> hi I'm Bob Brewer I'm the former

3569.579 -> director of the CDC alcohol program

3571.5 -> thank you for your excellent talk

3574.2 -> um as I'm sure you're well aware

3575.46 -> excessive alcohol use is a key risk

3577.319 -> factor and you alluded to this in your

3578.579 -> talk for a lot of Aces and of course a

3580.619 -> lot of other problems too and given

3583.079 -> where you are from the Pine Ridge

3584.76 -> reservation you're probably well aware

3586.559 -> of what was the environmental disaster I

3589.079 -> would call it in white clay Nebraska

3590.46 -> right across the border with the beer

3592.74 -> stores that were basically engaging in

3594.66 -> predatory marketing with the Native

3596.22 -> American population in Pine Ridge so

3599.28 -> um the the good news there as you may be

3601.38 -> aware is that those stores were closed

3603.18 -> down and it was through activism

3605.16 -> involving members of the tribe other

3607.5 -> tribes and then outside partner groups

3609.66 -> but it took a long time and there were

3612.42 -> an awful lot of harms that resulted in

3615.059 -> the intervening period so my question to

3617.4 -> you is I think you gave us a lot of

3618.839 -> really good recommendations but how can

3620.88 -> we better Empower or help to support

3623.22 -> empowering uh tribal members so they can

3626.04 -> push back against invite environmental

3628.2 -> hazards like like existed in white clay

3630.359 -> that are not actually within their

3632.46 -> Sovereign Nation that basically are

3634.2 -> taking advantage of that population yeah

3636.18 -> it's an excellent point an excellent

3637.5 -> question and I think one important

3638.94 -> starting point is when we look at all of

3640.98 -> the data sets that address alcohol use

3644.48 -> we do have a higher percentage of people

3647.099 -> who binge drink and that's where we see

3648.599 -> a lot of the dangerous Health outcomes

3650.04 -> but in every data set I've seen among

3653.339 -> American Indians we also have the

3654.54 -> highest rates of abstinence from alcohol

3656.66 -> so isn't that interesting we could look

3658.799 -> at one data set and see there's problems

3660.96 -> with alcohol but we could also look at

3662.46 -> that same data set and say American ages

3664.079 -> are the most sober population in the

3665.46 -> country because we are right so what is

3668.579 -> it on that end of the the bell curve so

3671.88 -> to speak that is providing the strength

3674.4 -> and the resilience and the cultural

3676.38 -> factors that are leading to sobriety and

3678.839 -> very high rates in many of our

3680.579 -> populations including Pine Ridge so I

3682.92 -> think in the general population we see

3684.559 -> lower rates of binge drinking more

3687 -> social drink thinking and less

3689.099 -> abstinence for American English is kind

3691.02 -> of an inverted curve higher rates have

3693.96 -> been drinking less social drinking and

3696.78 -> much more complete abstinence so instead

3699.66 -> of just the negatives we also need to as

3701.819 -> part of the solution identify what are

3704.04 -> those resiliency factors how do we

3705.9 -> strengthen those and how do we invest in

3707.46 -> those but it also requires a new way of

3709.079 -> thinking to invest in culturally based

3711.42 -> resiliency strategies but that's got to

3713.28 -> be part of our solution right right and

3715.559 -> I would just add changing the

3716.7 -> environment around the tribes around the

3718.799 -> the reservations which so often are very

3721.98 -> toxic yeah the Border communities can be

3724.38 -> very challenging absolutely so thank you

3725.7 -> so much for that question yeah

3729.26 -> from the CDC uh Central America regional

3732.54 -> office in Guatemala

3734.52 -> um and so I worked my entire career at

3736.38 -> CDC in in global Health which is really

3738.66 -> you know about reducing inequities uh

3741 -> inequities and focusing on equity and

3742.619 -> then and I guess one of the things I've

3744.299 -> noticed working in Guatemala is um is is

3747.299 -> the need to engage with indigenous

3749.28 -> communities that's uh in some ways that

3750.96 -> elephant in the room in terms of how we

3752.579 -> can improve health so so my question is

3754.68 -> what's your advice to those in CDC

3756.78 -> working in global Health on on how they

3758.94 -> can you know apply some of the

3760.02 -> principles you've discussed in your work

3761.7 -> here in the U.S to to working with

3763.44 -> indigenous communities globally and it's

3765.18 -> a very important issue and I think one

3766.799 -> one thing to keep in mind is that

3768.299 -> there's such diversity across indigenous

3770.099 -> populations diversity in cultures

3772.38 -> diversity and health patterns and

3774.599 -> diversity in language but also even

3776.819 -> diversity in the governance structures

3779.339 -> of the countries in which they are

3780.66 -> located so there wouldn't be kind of a

3782.52 -> one-size-fits-all approach it would have

3784.319 -> to be each population

3786.14 -> engaged with a unique strategy energy

3788.28 -> but the best way is to have local

3789.72 -> Champions you know that at least with

3791.64 -> the community engaged research and other

3794.28 -> projects that I've done having local

3795.839 -> Champions who can advocate for these

3798.299 -> efforts is much more effective than

3799.74 -> having teams of well-trained scientists

3801.54 -> for example so cultivating and growing

3804.66 -> the the local indigenous champions for

3807.54 -> these efforts would probably be a good

3809.22 -> strategy but I would Envision each

3811.38 -> Community would be just a little bit

3812.579 -> different each Nation would be different

3813.9 -> in terms of how that's done thank you

3817.559 -> hi thanks thanks so much for the the

3820.2 -> talk I'm parts of asani I'm a first year

3823.02 -> Eis officer

3825.24 -> um my my background's in anthropology

3826.859 -> and so this question is a little bit

3828.72 -> based in in that past training I had but

3831.48 -> one one of the the I don't know Concepts

3836.04 -> or topics that I heard a lot um while I

3838.74 -> was doing my PhD from indigenous

3840.48 -> Scholars was that you know to push

3842.339 -> against the idea that settler

3843.66 -> colonialism is something of the past and

3846.119 -> it's very much active today in the

3847.799 -> United States and it's there's it's not

3850.38 -> just a legacy it's continuing and I was

3852.96 -> just wondering if you could speak about

3854.28 -> that a little bit and also you know

3856.5 -> speak about how if if you know what your

3859.14 -> thoughts are in that but if we do think

3861.18 -> of settler colonialism as something

3862.92 -> that's continuously happening how does

3864.96 -> that affect what we think about public

3867.24 -> health for indigenous communities you

3868.799 -> know that you know some of these

3870.72 -> offenses are continuing to happen not

3872.7 -> just we're not just facing the

3873.96 -> consequences of something that happened

3875.46 -> 50 100 200 years ago yeah a great

3879.72 -> question there's clear examples just in

3881.579 -> the state of North Dakota the Dakota

3882.9 -> access pipeline issue for example the

3885.78 -> the more direct route and the narrower

3889.079 -> part of the river where that pipeline

3890.88 -> would have gone for oil was actually

3892.98 -> right next to Bismarck the state capital

3894.42 -> but they didn't want it there so they

3895.68 -> put it just north of the reservation The

3897.42 -> Standing Rock Community so the that is

3900.24 -> just a clear example of looking at our

3903.66 -> population as less valued right and

3906.299 -> that's that's still going on now and

3907.74 -> even challenges in some states pushing

3910.619 -> back against tribal ID to vote you know

3912.96 -> trying to marginalize even further you

3915.66 -> know so so it's still going on and

3918 -> there's just many many examples of that

3920.099 -> occurring now so we can't think of the

3922.44 -> impact of settler colonialism or the

3924.78 -> idea of colonization is just something

3926.339 -> that's in the past there's remnants of

3928.38 -> that activity going on forward and

3929.94 -> certainly has an impact on public health

3934.98 -> hi thank you so much Pauline Harvey

3937.319 -> epidemiologist division division of

3939.299 -> global HIV and tuberculosis I was

3941.819 -> particularly struck by your reference to

3944.46 -> um

3945.44 -> naturopathic medicine medicine

3948.559 -> coexisting along with allopathic

3950.88 -> medicine clearly you're talking to a

3953.04 -> population here in this room

3955.559 -> um that primarily practice or within our

3958.74 -> Public Health sphere uh allopathic

3961.5 -> medicine what are your thoughts around

3963.98 -> pushing this space more in terms of

3966.42 -> having both coexist and looking more

3968.52 -> towards leveraging nature in healing and

3972.059 -> for preventive medicine yeah and you

3974.46 -> know it's really fascinating when I

3975.54 -> think about this it's really through

3976.799 -> more of an indigenous lens and the

3978.72 -> Lakota tribal systems that I was taught

3981.18 -> from a very young age and that we have a

3983.339 -> much more holistic view of health and

3985.74 -> healing and that there are remedies that

3989.16 -> have been used for thousands of years

3990.78 -> but once they're isolated in the

3992.099 -> laboratory then suddenly they're they're

3993.42 -> validated I guess but we have so many

3995.46 -> other types of Remedies and

3996.78 -> interventions that are of value so again

3999.119 -> even thinking of mindfulness if the

4001.64 -> impact and the outcomes of mindfulness

4003.799 -> were in the form term of a pill it would

4006.5 -> be standard practice right but since

4008.24 -> this mindfulness is alternative and it's

4009.799 -> not integrated so I think that what we

4012.079 -> have to recognize is that in allopathic

4014.72 -> medicine we're very good at dealing with

4018.14 -> physically based types of issues we can

4021.14 -> prescribe medications to address

4023.319 -> hypertension or infectious disease but

4026.599 -> when we're looking at unresolved trauma

4028.16 -> there's no pill that's going to fix that

4030.14 -> right we have to recognize that not

4031.76 -> every health condition is going to be

4033.38 -> resolved in the pharmacy we have to have

4035.359 -> other types of interventions and I love

4037.039 -> the old saying when your only tool is in

4039.26 -> a hammer every problem becomes a nail

4040.88 -> right and that's what I observe in

4042.38 -> modern medicine but in traditional

4044.299 -> indigenous forms of medicine we're much

4045.92 -> more open-minded about that so I think

4048.14 -> we just need to have the humility to be

4050.059 -> open-minded enough to recognize that

4051.68 -> there's other Solutions

4054.5 -> uh thank you for your uh amazing talk my

4058.4 -> name is Noah Berg and I'm one of the

4060.079 -> laboratory leadership service fellows uh

4062.66 -> first year and

4064.64 -> um you talked a little bit about trauma

4066.559 -> informed care and you talked a little

4068.359 -> bit about trauma-informed epidemiology

4071.48 -> um as a laboratory and I'm curious if

4073.94 -> you could talk at all about perhaps the

4075.98 -> concept of trauma-informed laboratory

4079.28 -> Sciences within the public health sphere

4081.14 -> yeah thanks yeah absolutely and I think

4084.079 -> part of what we just have to recognize

4085.7 -> is that what we're finding in the

4087.619 -> laboratory data that there is a unique

4090.859 -> basis for it for for many populations

4093.38 -> not just indigenous peoples but

4095.66 -> recognizing that when we see uh

4098.299 -> disparities in outcomes that there are

4101.48 -> reasons for it and I think in any

4104.719 -> setting where we can decrease the amount

4107.239 -> of

4108.739 -> um maybe judgment that occurs against

4110.839 -> populations or perhaps even look at how

4114.02 -> we might have more empathy toward

4116.48 -> populations in any setting in the health

4118.94 -> system that's of Great Value and

4121.16 -> recognizing that when we're looking at

4122.9 -> the data there's a lot of human

4125 -> suffering associated with that you know

4127.46 -> I showed a chart with infant mortality

4129.92 -> rates for example look at all of the

4132.319 -> tremendous human suffering associated

4133.819 -> with that and we have to be mindful of

4135.799 -> that and cognizant of that and certainly

4137.6 -> a non-judgmental approach toward it so I

4140.779 -> think there's just room for all of us

4142.1 -> and any system within health care and

4145.58 -> epidemiology where we could have more

4147.92 -> empathy and understand the bases for the

4149.839 -> disparities but thanks for the question

4153.5 -> hey um Aaron Moritz with environmental

4156.62 -> health

4157.819 -> very nice presentation I grew up in

4161 -> North Dakota so I feel like I have to

4163.4 -> say hi to anybody else who lived in

4165.38 -> North Dakota

4169.64 -> pointed out the this is these are very

4172.16 -> unique communities

4174.319 -> um and rural areas as well can be very

4176.96 -> unique communities to go into from

4180.08 -> public health perspectives I would if

4182.96 -> you have just like two or three maybe

4184.94 -> pieces of advice that you could give to

4187.279 -> officers

4188.679 -> especially you know because their

4190.94 -> officers go into maybe outbreak

4193.759 -> situations or very

4196.46 -> um you know very high pressure

4197.96 -> situations

4199.42 -> where you know tensions are high any

4203.719 -> advice that you have to give to our

4207.02 -> officers I think that would be really

4208.58 -> helpful yeah and that's a great question

4210.98 -> I know that quite often when there's a

4212.96 -> response there's immediacy and there's

4215.48 -> challenges just related to getting

4216.98 -> everything set up but in an ideal

4219.56 -> setting which does not always occur of

4221.6 -> course but having a good understanding

4223.04 -> of the history of that community that

4224.6 -> we're working with what is their history

4226.52 -> what is their language why is it that

4228.62 -> they live in the certain Arenas that

4230.6 -> they do and what are their perspectives

4233 -> on health what is what are the sources

4234.86 -> of some of the challenges you know when

4236.6 -> we had the hantavirus response back in

4239.36 -> the 80s and 90s it was really remarkable

4241.699 -> they actually convened Eis convened

4244.04 -> traditional Navajo medicine men and they

4246.14 -> said well it's because you know we had a

4249.32 -> lot of rain an unusual amount of rain

4251.3 -> upset the balance of things and led to

4253.34 -> this virus and one of the CDC

4256.1 -> Representatives was just wonderful he

4258.199 -> said well that's absolutely true because

4259.58 -> of that there was more vegetation there

4261.32 -> were more field mice therefore there was

4263.239 -> more Hunters so I think being respectful

4265.88 -> of traditional perspectives and seeing

4268.1 -> where the touch points are where there's

4269.54 -> integration of indigenous knowledge and

4271.94 -> and medical science or epidemiological

4274.1 -> science because those are not mutually

4276.02 -> exclusive so as much as we can

4278.179 -> understand the communities that we're

4279.56 -> working with and being respectful of

4281 -> indigenous knowledge

4282.8 -> thank you

4284.54 -> thanks so much for terrific talk my name

4286.34 -> is Karen landman I'm a health reporter

4288.14 -> at box and Eis class of 2012.

4291.26 -> um STIs are on the rise especially

4293.12 -> syphilis and especially especially

4294.5 -> congenital syphilis and the racial

4297.08 -> ethnic group with the highest rates of

4298.58 -> rise and the highest rates altogether

4299.96 -> are American Indian Alaska native

4303.679 -> um I wonder what you think are the most

4305.42 -> important components of a good Public

4309.02 -> Health response to this emergency

4310.88 -> unfolding in these communities yeah and

4313.28 -> again the messenger really matters in

4315.679 -> Indian Country probably any population

4317.06 -> the messenger really matters and the

4319.82 -> more we can do to identify and cultivate

4323.38 -> champions from within the community who

4325.64 -> can help share the messaging and who can

4327.26 -> help with the health education and again

4329.42 -> it's not just I mean historically in

4331.219 -> public health we haven't done a real

4332.36 -> good job of that type of communication

4333.739 -> or like really busy posters with lots of

4335.78 -> words and put it on the wall that's not

4337.159 -> going to do anything right we actually

4338.42 -> have to make sure that the messenger is

4340.58 -> someone who's respected and will be

4342.62 -> listened to so the more that we can do

4344.96 -> to identify champions for this type of

4347.719 -> an issue an effort for response and

4349.88 -> prevention I think that's going to be

4351.62 -> our best strategy is making sure the the

4353.48 -> people relaying the messages are

4355.64 -> actually community members so it's got

4357.56 -> to be important part of community

4358.52 -> engagement yeah

4361.52 -> hi uh my name is Soylent Banerjee I'm a

4365.42 -> mathematical statistician here in CDC in

4368.3 -> in Center for environmental health

4371.42 -> and thanks for so powerful

4375.32 -> talk about

4377.32 -> these issues and it seems to me that I

4381.14 -> am I was watching your picture of all

4384.679 -> these things that you have shown here

4386.62 -> this is this is an enormous problem but

4390.14 -> but do you think that only the

4393.14 -> epidemiological studies that you are

4395.84 -> showing can solve the problem I

4398.659 -> I was thinking that like what about the

4401.36 -> political representation of

4404.08 -> indigenous people

4406 -> and do you feel like that you should

4409.64 -> work towards that that way you will have

4412.4 -> like Senators have some Representatives

4414.98 -> who can take the issues of the

4418.28 -> indigenous people they will understand

4420.62 -> what is going on like you've pointed out

4423.28 -> that people really didn't understand

4425.48 -> what was and even now maybe there are

4428.32 -> issues that people will not understand

4430.94 -> these epidemiological studies of course

4433.34 -> help people become knowledgeable about

4435.98 -> it but I was thinking that

4439.1 -> a politically do you have any solution

4443.06 -> to intervene in the society well that's

4446.06 -> there's certainly a lot of work going on

4447.32 -> in that space we need a multi-pronged

4449.42 -> approach it's a very Dynamic challenge

4451.28 -> we need a dynamic response so the

4453.739 -> political side certainly is a component

4455.48 -> of that and we just don't have adequate

4457.219 -> representation as I mentioned it took

4459.679 -> until this Administration before we

4461.06 -> finally had an American Indian cabinet

4462.62 -> level position you know with the

4464.42 -> Department of interior but we also need

4466.4 -> more of our own elected officials the

4468.44 -> challenge is that where we see the

4470.719 -> highest concentrations of American

4472.46 -> Indian population we also see a lot of

4475.88 -> political challenges and pushback

4477.679 -> against ideas related to equity and

4479.659 -> diversity so we just happen to be

4482.179 -> located in states where that's not well

4484.4 -> received and there's pushback active

4486.199 -> pushback against it but we still need to

4487.82 -> push in that direction we need more

4489.98 -> people even on school boards look at

4491.54 -> curricula and the books that we're using

4493.28 -> we need more people at State Legislative

4495.5 -> decision making regarding things like

4497.84 -> Medicaid and other real practical

4500.44 -> programs and solutions to address

4502.28 -> address Health Equity but certainly at

4504.739 -> the national level and I don't know if

4506.659 -> I'll see it in my lifetime but I would

4508.219 -> love it if eventually an indigenous

4510.44 -> American was the president of the United

4512.12 -> States I would love to see that thank

4514.58 -> you

4515.84 -> thank you

4517.88 -> please

4519.98 -> we have time for one more question I

4521.84 -> think yes thank you my name is Eric

4524.3 -> Mooring Eros class of 2019 and now at

4527.3 -> the center for forecasting and outbreak

4529.28 -> analytics I was really struck by your

4531.14 -> comment about uh values being the

4533.659 -> central part of evaluation and how

4536.179 -> different people and groups have

4537.5 -> different values they are working

4539.659 -> towards different goals and that's an

4541.219 -> eminently reasonable thing I wonder if

4543.14 -> you have some examples of evaluations of

4547.82 -> public health programs or I guess any

4549.56 -> other sort of program for that matter

4550.699 -> that have really tried to start from the

4554 -> perspective of understanding what are

4556.46 -> even the the values and the outcomes

4558.62 -> that that we're trying to optimize as

4560.179 -> opposed to just assuming that there's

4561.62 -> some thing to be evaluated and then kind

4564.14 -> of going off to evaluate that absolutely

4565.76 -> so when I worked at the Great Plains

4567.92 -> tribal determinants Health Board I was

4569.3 -> executive director there and we did have

4571.28 -> a grant from a federal agency which will

4573.32 -> go nameless

4574.34 -> um but uh we we actually part of our

4577.28 -> outcomes evaluation included

4579.82 -> intergenerational communication we

4582.38 -> wanted elders and youth to to come

4584.36 -> together and what we were told by the

4586.699 -> program official is that no no that's a

4588.44 -> process

4589.58 -> right no no for us that's an outcome

4591.62 -> right so so and that's just a difference

4594.26 -> in values right what's more important I

4596.6 -> mean from maybe the non-indigenous

4598.64 -> purely scientific perspective that is a

4600.56 -> process but for us that's an outcome you

4602.6 -> know so even just how we frame what's

4604.52 -> process and outcome is purely values

4606.32 -> based and again I think with the lack of

4608.54 -> diversity in those decision-making

4610.46 -> Arenas where we're identifying outcomes

4613.46 -> that we we tend to see challenges

4615.8 -> related to culturally relevant

4617.38 -> evaluation measures so but that's just

4619.46 -> one example of many many that we could

4621.199 -> talk about thank you yeah thanks

4623.78 -> okay you can have the last question if

4626 -> you're if you're if you're quick it's a

4628.28 -> very small question hopefully not silly

4631.1 -> um my name is Francis Knight I'm an

4632.54 -> incoming LLS fellow and I'll be working

4634.34 -> with the division of healthcare quality

4635.96 -> promotion and I really appreciated you

4638.54 -> talking about the terminology at the

4640.64 -> beginning and I agree like Words matter

4642.679 -> but a lot of people don't want to bother

4645.679 -> with it um so I was when you discussed

4648.62 -> how indigenous is like kind of the term

4651.199 -> that captures all these different groups

4653.12 -> I was wondering if you think it's

4654.62 -> important in the future to change the

4656.48 -> name of the Indian Health Service to be

4658.76 -> indigenous instead or is that like

4661.1 -> technically incorrect or not a battle

4663.38 -> worth fighting yeah so that's a great

4665.239 -> question very timely because OMB is

4667.159 -> going through uh reassessing the race

4669.56 -> and ethnicity designations and the

4672.02 -> challenge is that the word Indian is so

4673.82 -> embedded into our legal history it's

4676.04 -> even in the Constitution Indian tribes

4678.02 -> in the Commerce Clause of the US

4679.4 -> Constitution and there's legal basis for

4682.76 -> Indian Health Service and Bureau of

4684.8 -> Indian Affairs so it would be a huge

4687.26 -> heavy lift to change the terminology in

4689 -> the future it'd be wonderful to do but

4690.8 -> I'd rather see our Health Equity

4693.08 -> achieved first then we could look at

4694.88 -> some of those other challenges but but I

4696.62 -> agree I wish we had better terminology

4698.12 -> thank you I was thinking at least it's

4699.8 -> already an eye so yeah you're right

4703.46 -> very good point thank you so much good

4705.14 -> well please join me in thanking

4708.38 -> um Dr Warren and I'll invite him to come

4710.65 -> [Applause]

4713.38 -> [Music]

4717.7 -> [Applause]

4722.16 -> [Music]

4728.93 -> [Applause]

Source: https://www.youtube.com/watch?v=F0KyGX5FxHU