Culture, Colonization, and Policy Making (health)

[Okwes]

Culture, Colonization, and Policy Making (health)



Culture, Colonization, and Policy Making: Issues in Native American
Health

Paper presentation for the Symposium on the Politics of Race, Culture,
and Heath
Ithaca College, Nov. 13-14, 2002

Brooke Olson, Ph.D, Assistant Professor of Anthropology
Co-Coordinator, Native American Studies Program
Ithaca College
[phone]; [e-mail]

Introduction

The scope of health problems in Native American is overwhelming as we
enter the new millennium. Native Americans are often listed as the
sickest minority population in America, with some of the highest rates
of diabetes, cancer, substance abuse, suicide, pulmonary disease, and
cardiovascular problems (Trafzer & Weiner 2001). To address these health
issues, many policies and interventions have been developed at the
national and local level, through agencies such as the Bureau of Indian
Affairs and the Indian Health Service. While some of these initiatives
have been moderately successful, the rates of diabetes, cancer, and
alcoholism in indigenous populations continue to increase throughout
North America. Furthermore, focusing on diseases in an individualized
health care approach is inadequate for Native Americans whose health and
well being is inexorably interwoven with their cultural survival. For
this reason, the term cultural wellness is employed as a concept to
index the connection between personal health and cultural continuity in
indigenous populations.

To improve health care, education, and prevention, a larger cultural and
historical contextual framework is needed which pays heed to the impact
of colonization and its effects on Native peoples. Such a holistic
framework evaluates the long-term impact of introduced diseases and the
cultural trauma caused by the removal of Indians to reservations (Jaimes
1992), the boarding school era (Johansen 2000), and the forced
sterilizations of Native women (Carpio 1995; Torpy 1998). Racism and
discrimination in mainstream medical systems and American culture
continue to impact Native health, but are rarely addressed in wellness
programs and health policies. The struggles of Native people to have
treaty rights honored for land, hunting, and fishing also have
repercussions for health and cultural wellness. It follows that health
care policies for Native Americans should also include reparations
policies, as Canada has done by setting up a $350 million healing fund
for the survivors of the boarding school era (Macqueen 2000). This fund
is meant to deal with the emotional, physical, and cultural trauma that
came from the sexual and emotional abuse within those institutional
contexts purporting to “educate” Native Americans.

In addition to thinking more broadly about health care policies as
reparations policies, attention also needs to be given to health
programs developed and overseen by Indian people. A review of Native
Wellness programs across the country reveals that the most successful
intervention and education efforts are those developed and implemented
by Native people in local communities (Heath et al. 1987; Macaulay 1997;
Olson 2001; Olson 1999). However, lack of economic and political power
hinders the efforts of Native Americans to address health and wellness
issues and develop programs.

Based on a review of these broad issues, there are two major areas which
need to be considered in order to make substantive improvements in
Native American health care and cultural wellness: 1) national policy
making organizations need to develop better understandings of the
cultural and historical causes of Native American health problems and
address these causes in policy making and implementation of programs;
and 2) grassroots and collaborative initiatives for Native wellness
promotion need to be encouraged, especially projects that emanate from
Native Americans and incorporate local cultural issues and
sensitivities.

The Backdrop of Native American Health Problems: The Establishment of
Cultural Risk Through Colonialism and Neo-Colonialism

The perspectives of anthropology are useful when considering the total
context of Native health issues. Anthropologists typically include in
their analyses the frames of history, culture, political economy, and
experience, among other viewpoints. When examining Native American
individual and cultural sickness, there must be an assessment of the
effects of colonization, which entailed massive land loss, genocide,
epidemics, racism, and ecocide, or the degradation of Native lands
(Grinde & Johansen 1995).

While these processes have their roots in the first contact between
Europeans and indigenous people, they were intensified in the 1800s with
the political, economic, and cultural appropriation of Native life,
land, and culture as embodied through Manifest Destiny. Ethnocentric
assumptions and stereotypes of Native people were used by non-Natives
throughout the nineteenth century to remove Indians from their cultural
landscapes, confine them on reservations, eviscerate their language and
culture through the boarding schools, and, in some instances, simply
massacre them to remove them from the steam-roller of white “progress.”

In the twentieth century, the Indian Boarding Schools continued, Native
lands and cultural practices were still being eroded through state and
federal policies, and thousands of Native American women were sterilized
without their consent in a eugenics attempt by Indian health care
clinics and agencies (Carpio 1995; Jaimes & Halsey 1992; Torpy 1998).
Government policies in the twentieth century profoundly compromised the
cultural wellness of Native Americans through undermining sovereignty,
testing nuclear weapons on the lands of nations such as the Goshutes and
Shoshone (LaDuke1999), and relocating Native people for projects such as
the Kinzua Dam, which flooded the arable basin of the Allegany Seneca
reservation in southern New York in the mid-1960s (Bilharz 1998). All of
these processes have had a myriad of effects on the health status of
Native Americans through emotional, physical, and cultural trauma.

Neo-colonialism and ethnocentrism continue today through degradation of
Indian lands, political struggles, economic discrimination, and
institutionalized racism in education and medicine. This brief
assessment should leave little doubt as to why Native Americans are
among the sickest and most stressed populations in the U.S. As Klyde
(1994: 701) summarizes,

Why are Native Americans so sick? Suppression of cultural traditions,
language, and spirituality, combined with a depressed socioeconomic
situation has created an apathy so deeply embedded in the psyche of
Native Americans that many attempt to escape reality through alcohol,
drugs, or suicide.

As evidenced in this discussion, the risks to Native health are
historically rooted in colonialism and they persist in neo-colonialist
attitudes and policies today involving Indian health care and culture.
These risks are off-set to some degree by the revitalization efforts of
the last several decades which have given Indian people a renewed sense
of hope for healing the past and the continuity of their cultures in the
future. One area of cultural revitalization is health and wellness
promotion undertaken by Native people which utilizes cultural foods,
practices, and rituals as potent forms of healing today (Olson 2001;
1999). In the next section, I explore a case example of an indigenous
healing workshop that aimed to educate Onondaga Nation members about the
risks and signs of generational trauma so they could address the root
causes of imbalance in their lives. Such programs reaffirm that Native
wellness needs to emanate from a place of recognition of the cultural
trauma experienced by Native Americans.

Healing the Past from Generational Trauma: The Legacy of Indian Boarding
Schools

An important aspect of addressing health issues is acknowledging the
complex causality of such problems, by both Native Americans and health
care personnel. In Native America, the concept of generational trauma
as a causal factor in cultural sickness has a broad base in the many
aforementioned traumas that have befallen Indian peoples. It is perhaps
embodied in the last three generations most profoundly in the Indian
boarding school era. Beginning with Carlisle Institute in Pennsylvania
in 1879, the federally sponsored schools would come to number over 500,
which does not include church run schools (Johansen 2000). Thousands
upon thousands of Indian children were enrolled and coerced into these
schools that operated under a militaristic, patriarchal, and
ethnocentric structure. Children were shaved, deloused, re-named with a
“white” name, and forbidden to speak their languages and practice their
cultures. They were often prevented from visiting their families during
holidays and summer breaks. The majority of children in these
institutions were sexually, physically, and emotionally abused, as well
as being victims of ethnocide in an attempt to “kill the Indian, save
the man” (Barriero 2000; Johansen 2000; Maqueen 2000)

The immediate effects of the boarding schools were many: depression,
shame, emotional illness, rape trauma, substance abuse, suicide, and
homicide. The long term effects have become known as the “lost
generation.” This phrase refers to three generations that grew up in
militaristic institutions where they learned physical punishment and
their “place” in the American social order, which was the lower strata
of the wage labor force (Johansen 2000). This left immense numbers of
Indian adults with little or no parenting skills and a profound
disconnection from the cultural resources of their people. Australian
Aborigines in Australia have faced similar traumas in their history
regarding boarding schools, leading to what has been called the “stolen
generation” (McIntosh 2000; 2002).

One of the first steps in trying to deal with the continued legacy of
the boarding schools is understanding and recognizing what these effects
are, both locally and globally. A recent workshop titled Nightmare to
Vision at the Onondaga Nation (June 23-25, 2000), just south of
Syracuse, N.Y., took this first step in acknowledging boarding school
trauma. The workshop explored how the boarding schools have affected
Native people and their families and highlighted the concept of
generational trauma. The basic premise is that traumas such as wars,
enslavement, holocausts, suicides, or epidemics, are not just
experienced by the first generation, but the aftereffects are felt in
the second and third generations as well. In response to the question of
how the boarding school experience changed their lives, participants in
Nightmare to Vision responded that the experience made them feel stupid,
dependent, ashamed to be Native, angry towards authority figures and
white people, and more prone to family break ups. They also reported low
self esteem, loss of respect for women, difficulties with sexual abuse,
disconnection from community, loss of identity, alcoholism, and pride in
being a survivor. The workshop further delved into the cycle of trauma
through the generations and how to recognize the patterns and triggers
so they can be confronted and transformed. In this case, recognition of
the embedded problems is a huge first step in recovering individual and
cultural wellness.

Health care policies set by the federal government, the Indian Health
Service, and state and local agencies need to adopt such encompassing
frameworks to understand and address Native American health problems. In
the next section, another major area of generation trauma is examined
that has direct relevance for supporting the idea that health care
policies should include reparations policies for the removal and
disconnection of Native people from their land.

Native Lands, Native Culture, and Native Wellness: The Impact of Removal

on Cultural Wellness

Another profound source of generational trauma is the disconnection from
land that indigenous people have endured over the last centuries. In the
twentieth century alone, the profound effects of this can be
demonstrated in the following cases.

? Dine (Navajo): Following the 1974 Congressional Resettlement Act that
mandated the removal of 10,000 Navajos, twenty five per cent of the
first group of Navajo adults were dead within six years (Broken Rainbow
video; Schwarz 1997). Federal court decisions have led to the
persecution of Navajo people who continue to live in the removal zone
and who are denied social and medical services.

? Guarani of Brazil: Before they repossessed their homeland they
experienced crippling rates of suicide; after they repossessed their
land in the 1990s there was a 0% suicide in their homeland (Funari &
Hanna 2001).

? Davis Inlet Innu of Canada: After a mandatory government sponsored
relocation in 1967 to Davis Inlet, the Innu experienced profound
individual and collective trauma, evidenced by the statistic that every
adult had contemplated suicide, and every second person had attempted it
in the years following relocation (Bilharz 1998; LaDuke 1999).

? Dogrib of Canada: In the relocation from the bush settlements to towns
and cities, the Dogrib exhibited a reduced ability to assimilate blood
glucose which was related to dietary changes and stress-related hormones
that inhibit insulin production and utilization (Szamarthy & Ferrell
1990). This situation leaves Native people more prone to diabetes, a
disease that is crippling many Native communities.

? Cayuga of Upstate New York: In phase two of the land claim trial of
the Cayuga Nation in the Federal District Court in Syracuse (2000),
Bernadette “Birdie” Hill (Cayuga Heron Clan Mother) spoke of the long
term loss and damage the disconnection from their homeland has taken.
The Cayuga are the only one of the Haudenosaunee (Iroquois) Nations who
were left with no reservation land after the Revolutionary War. For over
200 years, they have not lived in their homeland, conducted their own
ceremonies on their own land, nor been in frequent contact with their
sacred sites and burial grounds (Birdie Hill, personal communciation).

The sense of loss that Native people feel is profound when dispossessed
of the ethnoscapes, or culturally essential landscapes, where their
cultures are rooted (Cartwright 1998). Many Native American leaders in
the nineteenth century spoke of this in the Indian removal era,
including the Lakota leader, Crazy Horse, who fought mightily to retain
Lakota lands, and Chief Seattle, who made the oft quoted speech about
the profound connection of Indians to the land (Suzuki & Knudtson 1992).
Basso has written about the Apaches and how they use their homeland and
the features in it as a mnemonic device to remember the stories and
morals of their culture (Basso 1996). One Apache man explained it to
Basso this way:

Wisdom sits in places. It’s like water that never dries up. You need to
drink water to stay alive, don’t you? Well, you also need to drink from
these places. You must remember everything about them. You must learn
their names. You must remember what happened at them long ago. You must
think about it and keep on thinking about it. Then your mind will become
smoother and smoother. Then you will see danger before it happens. You
will walk a long way and live a long time. You will be wise. People will
respect you. (Basso 1996: 127).

Basso also describes the disorientation and cultural disconnection that
happens as people move away from the Apache homeland and lose their way
without the anchor of the land. In upstate New York, the Cayugas have
not had that anchor for over 200 years, as mentioned in the case example
above. The area around Aurora, N.Y., was the center of the ancestral
homeland of the Cayuga people. In 1779, George Washington sent troops
throughout the Finger Lakes area in a scorched earth genocide campaign
to eradicate the area of what he termed “hostile Indians.” This has
earned Washington the name “town destroyer” by Native people. Most of
the Cayuga people were forced to flee their homeland. Bernadette
“Birdie” Hill, the Heron Clan Mother of the Cayuga Nation, gave this
emotional statement about how the loss of this land has affected her and
her nation:

For as long as I can remember, I had been told that there was this
beautiful place that was our homeland. Our ancestors lived around this
lake with crystal clear waters, which were abundant with fish. There
were many of us, numbering up into the thousands. All around the lake,
there were fields and fields of our crops – corn, beans, squash. Fruit
orchards and nut trees were plentiful.

When I was younger I would ask, “Why aren’t we living there now?” The
reluctance of our elders to answer this question only peaked my
curiosity. It wasn’t until I was older that I finally learned of the
Sullivan Campaign and how our people were forcefully removed from our
territory. Today our people are living throughout the country, but
mainly in western New York.

Because we do not have a home base, our people have not had the
opportunity to live our lives they way we were meant to live, to care
for Mother Earth as we are to care for her. I have a desire to have all
of our people return to our homeland and live the way we were meant to
live and to care for Mother Earth the way we were supposed to care for
her.

[Okwes]

Our language has been lost. Only a very few know our Native tongue.
Our ceremonies have been lost. We have had to participate in other Long
House ceremonies on other territories. To return home will mean having
our own Cayuga ceremonies once again. (personal communication, 2001)

As evidenced in Birdie’s statement, the lack of access to ancestral
land and sacred sites that are fundamental to cultural wellness can
produce emotional and cultural trauma.
Trauma can also be suffered in a direct physical manner through
environmental degradation that is too common an occurrence in Indian
country (Grinde & Johansen 1995; LaDuke 1999). This is also a matter of
great concern to Birdie, as demonstrated in her work for many years with
the Haudenosaunee Environmental Task Force, whose responsibility it is
to monitor environmental threats from landfills, industrial waste,
illegal toxic dumping, and other assaults to Indian lands that damage
the health of the people and the ecosystem. These threats to health and
environment are often borne disproportionately by Native Americans and
other minority groups, and such environmental racism contributes
significantly to the compromised health status of Native people.

Health Care Policies as Reparations Policies: The Politics of
Accountability

Given the aforementioned issues of colonization, assimilation, and
discrimination against Native Americans, it is clear why their cultural
and personal wellness has been compromised. To fully address this
situation, health care policies should include the concept of the
politics of accountability. This entails: 1) understanding the broad
scope and foundation of Native American health problems, as I have done
in the first part of this paper; and 2) addressing these issues fully in
policy making, health education, and wellness promotion. Including the
idea of reparations in Native American health care may be a foreign
concept to health policy makers, but it is paramount if the cultural
trauma of the past is to be healed. Parallels to including reparations
as a form of healing can also be seen in the movement by
African-Americans to petition for reparations for the generational
trauma instigated by the slave era in America (Raspberry 2002; Teepan
2002).

Reparations in some instances may include financial compensations that
provide resources to Native people. One example of this is the $350
million “healing fund” that was set up by the federal minister of Indian
affairs in Canada in 1998 to address the “cultural genocide” of the
Canadian boarding schools (Macqueen 2000). These funds are earmarked for
“social projects” in Indian communities and are not for individual
compensation or use. In addition to such monetary reparations, such
acknowledgments of cultural genocide have a lot of symbolic capital
among indigenous peoples when they hear government officials and
agencies admit what they have done to Native people. This is also part
of the healing process. Unlike the Canadian example, however, the U.S.
government, and the various church organizations involved in the
boarding schools, have thus far neither issued an apology nor set up any
kind of reparations or healing fund for the victims and survivors of
Indian boarding schools in America.

Reparations should also include the repatriation of sacred items, the
ancestor’s bones, medical samples, and land. Repatriation means to
return home. Many Native people have been working for decades to return
integral parts of their culture back to the people, from institutions
such as the Smithsonian, and other museums and research laboratories.
These items include sacred healing masks, medicine bundles, and other
objects viewed as critical for cultural revitalization and Native
wellness. To assist in this process the federal government did pass an
act in 1990, the Native American Graves Protection and Repatriation Act
(NAGPRA), which states that federally funded museums, universities, and
organizations are obligated to contact the descendants of the cultures
from which they have bones or artifacts. NAGPRA, however, only applies
to organizations with federal funding, giving no recourse to obtain
sacred items from individual and private owners. NAGPRA also is rather
loose in the way the act is interpreted by different states, hence
providing many loopholes for non-compliance (Jack Rossen, personal
communication, 2002). Public policies aiming to address wellness issues
for Native Americans need to broaden the scope and applicability of acts
such as NAGPRA.

More recently, indigenous peoples have become more concerned about
medical samples and having them returned because of fears of scientific
experimentation and genetic alteration of DNA. This issue has been most
recently highlighted by the Yanomami of South America and their journey
to the United States in the Spring of 2002 to collect over 6,000 vials
of blood that were taken from them by medical researchers and
anthropologists in the 1970s and 1980s (Tierney 2001; Turner 2001). Some
Native people have informed me that the issue of medical experimentation
and unauthorized experiments on Indian bodies and tissue samples will be
the next major untold story to emerge from Native America (Tim Warner,
personal communication).

In addition to the repatriation of material objects and the bones of the
ancestors, land can also be repatriated to deal with the issue of
dispossession from homeland for groups like the Cayuga. While this is
sometimes addressed in a different arena, in the land claims court
cases, it needs to be recognized as a fundamental component of cultural
wellness too because of the inexorable links with cultural
revitalization for Native people. Birdie Hill has spoken often of the
pain that dispossession has caused her and her people and of the hope
she has of healing when the people are able to return to the homeland.
More specifically, regarding the Cayuga Nation, we could ask the
rhetorical question, how can you be well when you have not been able to
conduct the ceremonies that are deemed essential for cultural survival
in over 200 years? Related to this area of reconnecting with sacred
ethnoscapes (Cartwright 1998) is the issue of demanding more policies
geared towards environmental and cultural justice. This requires putting
more pressure on federal and state agencies to clean up the uranium on
the Navajo Nation, the PCBs that Mohawk children swim in at Contaminant
Bay on the Akwesasne Mohawk Nation Territory, and the dioxins from
America that poison the breast milk of Inuit women in Nunavut, Canada
(LaDuke 2000; 1999).

Collaborative Local Initiatives to Promote Cultural Wellness: The
Haudenosaunee Whole Health Initiative and SHARE

In addition to understanding the larger scope of Native American health
issues, more programs need to be developed that enhance cultural
wellness. Throughout this paper, I have made recommendations for
national policy making in Native health through highlighting the
foundations of indigenous health problems. Another import arena where
more immediate action can be taken is in supporting local grassroots
initiatives that enhance the cultural wellness of Native American
people. Many Native American Nations and communities have launched their
own locally based projects for cultural revitalization and health care
(in reference to diabetes programs, see Olson 1999), such as the
Haudenosaunee Whole Health Initiative (HWHI).

The HWHI is a program that was founded by Native people who are
concerned about the state of health in their communities in and around
New York State. Their goal to foster Haudenosaunee well being is founded
on four principles: 1) Mental Well-Being: Restoring Haudenosaunee
Thinking; 2) Physical Well-Being: Healthy Living; 3) Spiritual
Well-Being: Assuring a Healthy Spirit; and 4) Social Well-Being: Health
Community Living (Haudenosaunee Runner, Fall 2000; see also
http://www.sixnations.org). According to the special edition of the
Haudenosaunee Runner, Fall 2000, “these four components of well being
will be at the center of our Whole Health Initiative. We only ask that
you start thinking about these things, talking with others, and seeking
practical ways in which you can do your part. We will be hosting a
series of dialogues on these issues, and we need your input. We hope to
have a summer youth program where we can share these ideals with our
youth and empower the next generation to walk the Good Red Road to
Haudenosaunee Well Being” (p. 4). The HWHI has also made connections
with other local groups, such as SHARE, to collaboratively support the
cultural wellness of the Haudenosaunee.

SHARE (Strengthening Haudenosaunee American Relations through Education)
is a not-for-profit organization comprised of community members,
Haudenosaunee people, anthropologists (including myself), and students,
who have worked together over the past four years to educate about
Native American cultures and issues (Olson, Rossen, & Olson 2001). All
of the Haudenosaunee Nations (Seneca, Cayuga, Onondaga, Oneida, Mohawk,
and Tuscarora) have nation territories in their homeland of New York
State except the Cayuga. SHARE has worked to help reconnect Cayuga and
Haudenosaunee people to the land (see http://www.share.clarityconnect.com)
through the acquisition in April of 2001 of a 70-acre organic farm in
Union Springs, N.Y., about forty minutes north of Ithaca, and in the
center of the ancestral Cayuga homeland. The SHARE farm has been the
site for many Native gatherings, and it has featured a Three Sisters
(corn, beans, and squash) garden over the past two summers.

SHARE’s goals are to educate about Native issues and provide a site for
projects that support Native culture and address of concern, such as the
preservation of Native crop varieties and the reconnection of the Cayuga
people with their homeland. SHARE works collaboratively with clanmothers
such as Birdie Hill, chiefs, and faithkeepers to support cultural
revitalization and cultural wellness. A main goal of SHARE is to raise
$250,000 to pay off the farm and turn it over to Cayuga people for the
establishment of a home base for the first time in over 200 years. This
type of repatriation is a significant contribution to cultural wellness
because of the opportunities that are provided for the establishment of
community, the growing of more nutritious Native crops, the revival of
Cayuga ceremonies, and the re-connection with sacred places and sites in
the area.

In the spring and summer of 2003, SHARE will be launching The
Haudenosaunee Herb & Native Food Project. A primary objective of the
project is the construction and maintenance of educational demonstration
gardens at the SHARE Farm, where Native and non-Native people can come
to learn about the role of plant medicines and indigenous crops in
health care. To facilitate the community outreach component, three
workshops on Native plants and foods will be scheduled for the summer.
This project represents an integral part of cultural revitalization and
wellness promotion, not just in Native communities, but also in the
communities surrounding Cayuga Lake who will have the opportunity to
tour the gardens and attend workshops on plants, Native crops, and
health care.

Conclusion

Recommendations for Improving Native American Wellness

• Educate caregivers in all aspects of health care and wellness
promotion to be cognizant of the impact of colonization, assimilation,
and generational trauma on Native Americans.

• Empower indigenous and local initiatives. The comprehensive concept of
cultural wellness is already exemplified in many programs developed and
run by Native people

• Further engage in collaborative projects that address the broad
foundations and scope of Indian health problems


Health promotion for Native peoples needs to encompass the larger
framework of cultural wellness, a perspective that also resonates with
the ways that many Native people view health, essentially as a concept
that encompasses relations with kin, culture, and land. The concept of
cultural wellness is a holistic framework. To fully address it, the deep
historical, social, and cultural injustices that compromised it must be
addressed. This includes an examination of the ways in which the United
States systematically attempted to destroy Indian culture through
federal policies of relocation, the boarding schools, and
institutionalized racism in education and medicine. These views are
inadequately addressed by federal and state health care programs that
take a much more myopic view of health care that is individualized and
depoliticized. Important strides are being made at the local level as
Native Americans empower themselves to start wellness initiatives in
their own communities that emanate from their particular history and
culture. Fostering cultural wellness for Native Americans can also be
achieved through collaborative efforts with local grassroots
organizations such as SHARE.

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