Across hundreds of reservations, similar scenes are found.
The infrastructure here is rundown.
So are the people.
More than half of the kids starting kindergarten quit before graduation.
Limbs that should appear on adults are absent.
Poverty is widespread, as is smoking, alcoholism and cancer.
Funerals are more commonplace in the community than they should be.
“One does not have to cross an ocean to find third-world health conditions,” Dr. Donald Warne said Monday. “It’s right down the street.”
American Indian men in North Dakota have a life expectancy 20 years shorter than male Caucasians in the state.
In North Dakota, American Indian men can be expected to live to be almost 58 years old.
Early retirement in the United States starts at age 62.
Dr. Warne, who received his MD from Stanford and his Master of Public Health from Harvard, said the dismal numbers are appalling.
“This is a public health crisis just screaming for intervention,” he said, “but most people are not aware of these statistics.”
He hosted an hour-long presentation in the Mandan Room of the Memorial Union Monday called “Everything You Weren’t Taught about Native American History.”
“If we’re going to try to understand American Indian disparities,” he said, “doesn’t it make sense that we understand American Indian history?”
However dark American Indian history was before and persists today, people are trying to alter the landscape, Dr. Warne said.
Innovation is occurring exclusively at North Dakota State; original programs are addressing problems found in the lives of the afflicted American Indians.
Poor, hungry and homeless
In Maslow’s Hierarchy of Needs, the first level, physiological, has requirements that must be fulfilled before climbing the pyramid toward self-actualization.
American Indians who struggle cannot climb above that first level because of an absence of basic necessities.
The United States Department of Agriculture found food insecurity to be twice as prominent in American Indians as the general population in 2003.
In Fargo, nearly 20 percent of the homeless population is made up of American Indians, a 2012 City of Fargo point in time survey said.
Twice as many American Indians and Alaska Natives are at or below the federal poverty level.
That level is defined as anything below $21,000 for a family of four, which Dr. Warne said is already a low figure to set as the precedent.
As a result, Dr. Warne said problems like food deserts can be identified on reservations, including the one he grew up in.
The native from Kyle, South Dakota (pop. 846), said fresh food is hard to come by on the Oglala Lakota Pine Ridge Reservation.
“You can bread and deep fry anything and serve it for lunch,” Dr. Warne said of Kyle’s café, The Food Stop.
This lack of healthy food leads to unhealthy lifestyles and to another phenomenon: a poverty or ghetto tax.
This tax is defined as the extra cost it takes for anything to be shipped into an impoverished area.
It costs more money to bring fresh produce to food deserts, Dr. Warne said.
“You are already living in poverty. You want to live healthily. But the choices are so difficult, the cost so much.”
Traditional foods like bison are leaner but not as readily available as cheaper options. Bison burgers are not found in the drive-thru lane.
From a cultural standpoint, American Indians have been reduced to a minority group.
The dominant, Caucasian culture implemented ideals in America that were foreign to the Natives.
“Money is an odd concept,” Dr. Warne said, as is the “silly” idea of owning physical property.
Without a grasp on the concepts of currency and owning land, American Indians started at a disadvantage, creating a disparity that has yet to be closed.
With high-end approximations estimating 18 million Natives lived throughout America before colonization, American Indians once comprised of 100 percent of population and land possession.
Across the U.S., American Indian numbers dropped to a low in 1950, making up 0.2 percent of the population. Today, the number has rebounded 1.2 percent, or about 5 million.
American Indians claim about 300 reservations scattered across the country, representing 2.3 percent of the nation’s landmass.
“Does loss of territory, loss of land, loss of economy, loss of purchasing power – does that have an impact on health status?” Dr. Warne asked, “Absolutely.”
American mass graves
Dr. Warne asked the audience how he should respond to his boy when he asks about the shirts.
Some students at the University of North Dakota wore T-shirts last spring with the words “Siouxper drunk” typed across the front, with the traditional, headdress-wearing Sioux logo underneath.
The tribesman’s had beer bong, a funnel attached to a tube to guzzle beer, inserted in his mouth.
“I’m open to suggestions,” Dr. Warne said.
He showed a newspaper clipping in his slideshow pulled from The Daily Republican of Winona, Minn., circa September 1863.
“The State reward for dead Indians has been increased to $200 for every red-skin sent to Purgatory,” the clipping said, referring to the scalped head of an American Indian as a “red-skin.”
“This sum is more than the dead bodies of all the Indians east of the Red River are worth.”
This should be offensive to everyone, Dr. Warne said, not solely American Indians.
Dr. Warne also placed photos of American Indians killed by U.S. troops side-by-side with Holocaust victims killed by Nazis.
He included photos of the aftermath at Wounded Knee Massacre, which, like the Holocaust, had ditches where bodies were dumped.
“I have ancestors in that mass grave,” Dr. Warne said.
“I don’t bring this up to make people feel bad … I talk about these things because it’s important to understand the truth … The truth about the history — not the sugar-coated version that’s in our history books, but the truth.
“We have a population within the United States that has been terribly oppressed.
“And there are lingering health disparities as a result … If we don’t know the history, we don’t know the best starting points.”
The lack of physiological necessities coupled with oppression has led the American Indian population to have among the worst health statuses in the nation, Dr. Warne said.
A simple, overarching fix is unattainable for all the American Indian tribes, he said, because there are hundreds of tribes with their respective cultures and challenges.
Type 2 diabetes is a manageable disease, but it ravages the American Indian population, with the American Indian population at a 177 percent higher risk of dying from diabetic complications than the general population.
A common program instilled nationally will pay for a ramp if a diabetic has an amputation, but that does not solve future problems, Dr. Warne said.
“We’ll pay for the ramp, but we will not pay for healthy food that prevents Type 2 Diabetes,” he said. “We invest much more in (addressing) complications of diabetes than trying to prevent it.”
Alcoholism leads to chronic liver disease. American Indians are 368 percent more likely to die from liver failure than the general population.
Cancer rates are higher among American Indians than the general population. Cancer is even more evident in the Upper Plains’ tribes, Dr. Warne said.
“What we have is a disparity within the disparity,” he said.
American Indians living in the Dakotas, Dr. Warne said, are twice as likely to commit suicide than the general population.
More troubling, those killings themselves are increasingly teenagers and young adults.
“The years for potential life loss are tremendous,” he said.
“What are we doing about it?”
Amber Cardinal is a second-year master of public health student specializing in management of infectious diseases in American Indian public health.
She is a part of an innovative program that “doesn’t exist anywhere else in the world,” Dr. Warne said.
The master of public health program is in its third year of existence and has 30 accepted students studying strategies that address health concerns and promote healthy living within the American Indian community.
It is the “largest cohort of American Indian public health students in history,” Dr. Warne said. “And it’s happening right here at NDSU.”
“The American Indian population suffers from some of the greatest health care disparities of any population within the United States,” College of Pharmacy, Nursing and Allied Sciences Dean Charles Peterson said. “We have a significant American Indian population right here in North Dakota, so we are hopeful that this new program will have a significant impact on improving the health and well-being of the American Indian population within our state.
“It is an exciting program with huge potential for putting NDSU on the map as a national leader in American Indian public health. ”
Of the 30, seven American Indians have been accepted, including Cardinal.
“Cultural competence is vital in health care, education and all other industries,” Cardinal said. “It is hard to be competent in something that you were hardly made aware of.”
Shedding light on American Indians plight is important, she said, and the NDSU American Indian public health specialization “provides education.”
Founded in 2011, Dr. Warne became the first and, to this day, only American Indian to direct a master of public health program.
“There’s been a huge neglect of American Indian specific issues,” he said, referring to his studies at prestigious schools.
Harvard professors knew nearly everything, Dr. Warne said, except about American Indians.
Why it took so long for the American Indian community to be addressed by higher education, he does not know.
What Dr. Warne said he does know, however, is students from around the country are interested in NDSU’s program.
“It’s taking off,” he said.
While NDSU is leading the world in American Indian public health education, Dr. Warne does not want NDSU to be the only university researching this topic.
He said he wants other schools to compete with NDSU, even offering NDSU’s curriculum.
“The winners of that will be tribal populations,” he said.