In this Special Feature, we highlight the unfair disparities that this population experiences as a result of historical trauma by drawing on the work of experts on American Indian health inequities.
The effects of trauma on both mental and physical health are significant. Health disparities can persist for millennia as a result of historical trauma.
Injustice has been exposed during the last few years at all levels of society.
Black Lives Matter (BLM) and the coronavirus outbreak have ruthlessly highlighted racial and social inequities. The past's whitewashed tales can no longer be clung to.
For instance, Thanksgiving is a widely celebrated holiday in America, yet it is also divisive and rife with historical misconceptions.
For other people, the word's associations with peace, harmony, and understanding are superseded by recollections of genocide, colonialism, and historical pain.
Recognizing historical trauma and the effects it has had on the health and well-being of entire populations is the first step in achieving health equity, as American Indian health specialists have noted.
Examining the effects of historical trauma on current injustices among American Indian and Alaska Native (AI/AN) communities is crucial on Native American Heritage Day and every day, as shown by the studies of specialists in the field.
Health of American Indians and Alaska Natives
Few groups are as underrepresented when it comes to health inequalities as AI/AN communities. The discrepancies in this group's health are severe.
At the 2020 Journalism Summit on Infectious Disease, Roger Dale Walker, MD, director of the One Sky Center for American Indian/Alaska Native health, education, and research, made this point plain.
Dr Walker described the differences in morbidity that afflicted AI/AN people even before the pandemic in a speech titled "Native mental health during COVID-19."
In contrast to the general population, he highlighted that several conditions were disturbingly more common and severe in AI/AN persons, citing:
- an increased chance of alcohol use disorder by six times
- a 3.5 times greater risk of diabetes
- a six-fold increased risk of tuberculosis
- an increased risk of depression by three times
- a twofold increase in the suicide risk
Donald Warne, MD, the associate dean for diversity, equity, and inclusion at the University of North Dakota School of Medicine and Health Sciences, has made comparable remarks. Dr Warne discussed the unresolved trauma that AI/AN people have inherited over centuries as a result of genocide, displacement, and forced enrollment in boarding schools in a 2019 speech at the University of Washington School of Public Health. He focused on health disparities in Kyle, South Dakota, which is a part of the Pine Ridge Reservation and where he was born and raised.
He claimed that the average age of death for men in Pine Ridge is 48. It is 54 for females. The average age at death for the white population in North Dakota is 77.4, in contrast.
He noted that Kyle is located in a food desert. There are few options for healthy food, and the nearest grocery is 90 miles distant.
Because of the way our population is distributed, there is a lot of inherent inequality, according to Dr Warne. He made the point that 15 states in the US do not have federally recognized tribes, and as a result, their elected officials might not be as motivated to support national health services that benefit AI/AN people.
It was "nearly a complete genocide" in the past.
The historical setting that led to these communities' collective suffering was then highlighted by Dr Warne.
He said that the "Indian Removal Act" of 1830 violently removed Choctaw, Seminole, and Cherokee people from their homes and families. In the "first documented case of bioterrorism" on American territory, thousands of AI people were killed when the government gave them blankets contaminated with smallpox. Additionally, during the Dakota War of 1862, bounties justified the scalping and killing of AI people.
The population of AI decreased from about five million in 1492 to less than 200,000 in 1900 as a result of these and other actions.
Dr Warne remarked, "It was virtually a full genocide." "This is the American Holocaust in many ways,"
The 2010 Census revealed that there were once more than five million AI/AN people in the world, but Dr Warne questioned the toll that the past had caused.
He questioned, "Does it have a health impact when you have this pattern of loss — loss of life, loss of people, loss of land, loss of culture, loss of resources — and can that health impact be carried from one generation to the next?"
"Historical trauma is similar to generational PTSD."
According to Dr Warne, historical trauma is "the collective emotional wounded that arises from major cataclysmic events over generations."
It is "kept individually and passed down through generations." As a result, even relatives who were not present during the trauma can nevertheless feel its repercussions today.
Doctor Walker, a Cherokee, agrees. He told MNT that "historical tragedy is like generational PTSD." "We now hypothesise that epigenetic modifications happen throughout generations to prolong the symptoms of PTSD [Post-traumatic Stress Disorder]."
Future generations will experience the same symptoms, including anxiety, depression, a lack of coping skills, and impulsive behaviour. The prevalence of substance use problems and suicide has grown.
- Roger Dale Walker, M.D.
Unknown factors can cause trauma to result in early death. As Dr Warne noted in his presentation, there have been more deaths among children compelled to attend boarding schools, while the exact cause is not always known.
Dr Warne went further in a webinar. In the United States, Canada, Australia, and other countries, he added, "We have entire generations of Indigenous peoples, where boarding schools and residential schools were utilized to try to assimilate people, get rid of the Indigenous customs." It was accomplished through abuse, including sexual, emotional, and physical abuse.
adolescence, hazardous stress, and epigenetic modifications
How then is this trauma perpetuated? Drs. Warne and Walker noted that it might be partially brought on by epigenetics, the study of how environment and behaviour affect gene function.
DNA sequences are unaffected by epigenetic alterations, but they can affect how the body "reads" DNA sequences, which can modify how genes are expressed. Some genes are activated by the environment and psychosocial factors, whereas others are turned off.
The expression of genes can also be influenced by factors like toxic stress. Prenatal and postnatal experiences have the power to chemically alter the structure of genes, which can have long-lasting effects on a child's brain development.
Detrimental early experiences can have a long-term negative impact on a child's mental and physical health. In a paper that he co-authored with Denise Lajimodiere, a recently retired associate professor of educational leadership at North Dakota State University, Fargo, Dr Warne made the following observation:
Several chronic and behavioural health issues, including heart disease, diabetes, cancer, depression, suicide attempts, and tobacco use, are strongly predicted by adverse childhood experiences.
Later, Dr Warne hypothesized that epigenetic modifications could account for some of the boarding school survivors' shorter telomeres, which are protective protein structures that generally shorten with ageing.
He pointed out that certain research indicates that Holocaust survivor descendants of Jews have worse health outcomes than controls who are not descended from that group.
Although more thorough research is required to demonstrate a connection between trauma, epigenetics, greater mortality, and poor health outcomes in American Indians, In their paper, Warne and Lajimodiere discovered that:
"A lengthy history of genocide and the experience of American Indian boarding schools has resulted in persistent and unresolved historical trauma and its related poor mental health outcomes," according to the study.
The impact of maternal stress on future generations
Gestational stress, which can be brought on by stressful life events, depression and anxiety, economic injustice, racism, and poverty, among other things, is another link in the chain of intergenerational trauma Trusted Source.
This type of stress alters the developmental biology of the kids, raising their risk for diabetes, heart disease, and obesity while diminishing their capacity for resilience and effective stress management. In adulthood, people can discover that any stress amplifies the effects of that first stress on their mental and physical health.
"[A]dverse adulthood experiences, including poverty, racism, and substance abuse, lead to sadness, anxiety, and poor health outcomes," continued Warne and Lajimodiere. The quality of parenting abilities for the following generation may be impacted by these societal factors, perpetuating health inequities across generations.
"We must travel through truth to reach equity."
Although many people find it uncomfortable to consider historical injustices, the experts in this article argue that it is necessary to do so to address health disparities and attain parity.
If we are ever going achieve equity, we have to walk through the truth, even when it's uncomfortable, as Dr Warne himself has remarked. even if it causes us discomfort.
Readers of MNT were given one final idea by Dr Walker.
"I think it's time to think about a Marshall Plan for Native Americans across North America. We must help tribes and Native communities adopt effective governance policies and enable them to do so, as well as provide them with the same level of education and health care as the mainstream public.
- Roger Dale Walker, M.D.