Welcome back to the TEDMED at CDC.
Our next presenter is Dr. Ursula Bauer.
She is the director of CDC's National Center
for Chronic Disease Prevention and Health Promotion,
a position that she has held since 2010.
Her topic today is culture is prevention, overcoming trauma
and nurturing resilience through identity and connection
to culture, Dr. Bauer.
>> Good morning.
I've had the privilege during my time at CDC to spend time
with American Indians and Alaska Natives on their land,
in their homes, with their government and in dialogue.
As impressed as I've been with the challenges they face,
I've been more impressed with the drive
to thrive on their own terms.
As overwhelming as the challenges may seem
in Indian Country, the solutions are there too,
growing from within.
I'm going to talk about trauma
and resilience among American Indians and Alaska Natives
in the context of names.
Names say a lot about who we are, both positive and negative.
When Michelle Obama welcomed a group of American Indian
and Alaska Native youth to the White House this summer,
she talked about all the beautiful places in our country
and how our language, English,
lacked the words to describe these.
So we use the indigenous names, Alaska, Connecticut,
Mississippi, Missouri, Nebraska.
That's a positive aspect of names.
But there's a negative aspect as well, and I'm not even going
to mention the R word.
We have a saying that we learned in our culture
when we're very young.
And by we, I mean, white Americans of European ancestry.
If I give you the first line,
I'm sure you can give me the second line.
Sticks and stones will break my bones --
>> But names will never hurt me.
That's the way I learned the saying.
Names say a lot about who we are
and names have characterized the adversarial relationship
that we've had with American Indians and Alaska Natives
over our entire history.
Navajo, for example, is a Spanish adaptation
of a Zuni Pueblo phrase, Apache de Navajo
where Apache means enemy
and Navajo means farms in the valley.
To the Zuni Pueblo and thus to the Spanish and then to us,
the Navajo were the enemy who farmed in the valley
and the people we came to call Apache were the other enemy
who lived to the north.
The Navajo and the Apache each have a word for themselves
and that word means people.
Pequot is derived from a Narragansett word
meaning invader or destroyer.
Comanche is derived from an Ute phrase meaning the
ones who hate everyone.
Sioux is a French corruption
of an Ojibwe word meaning "snake" referring to their enemy
and Iroquois is a French corruption of an
Algonquian word meaning "snake" referring to their enemy.
The Pequot, Comanche and Iroquois have a name
for themselves in their own languages it means people.
And the Sioux have a word for themselves.
It means allies or friends.
I could go on but you get the picture.
Throughout the 21st century, we Americans are still referring
to our fellow citizens by names they never called themselves.
These names are on our treaties.
They're in our government documents.
They're in our official correspondence.
They're on our CDC cooperative agreements.
They're in our everyday speech.
So even with something as basic as a name, we're still defining
who people are and it's not the way
the people define themselves.
If you think that these names and languages
that few people understand don't convey their original meaning,
consider the study
of kindergarten students in Minneapolis.
Over three-quarters of them have negative views of Indians
and of those, 25% use these terms to describe Indians,
enemy, killer, mean, I don't like them.
Here's another aspect of names.
My colleague, Chris Percy says,
"If you ask a Navajo grandmother how to prevent heart disease,
she'll tell you it begins with the naming."
Now does she mean it begins in infancy
which is something I understand and something
around which I can build a logic model that begins at birth
and ends with a lower risk of heart disease?
Or does she mean it begins with culture, with the communal act
of welcoming a new person into the world and among the people
which is something I understand less or not at all and around
which it's almost impossible to build a medical model
of discrete cause and effect all driving toward a lower risk
of heart disease?
That failure of understanding marks the entire history
of our relationship with the people,
with American Indians and Alaska Natives.
And that failure, our failure manifests itself today
in a tremendous amount of trauma that reflects as poor health
and social outcomes for example.
But as brutal as that failure has been,
it has not extinguished an extraordinary resilience
which I'll talk about in a minute.
The willful lack
of understanding is particularly pernicious
because when we don't understand, we prohibit.
So we prohibited the sacred rituals and ceremonies
the religious practices, language,
the right to educate your children,
to practice your own medicine, to wear your own clothes,
to sing your own songs, to choose your own hairstyle,
we took that all away or tried to, just like we took the land.
And that's the crux of the trauma.
We killed people and we took land
which was traumatic but familiar.
That had been going on the world over
and long before Europeans ever arrived on these shores,
the people versus the enemy, stealing each other's children,
enslaving each other's captives, killing each other's warriors,
pushing each other off the land.
That's the history of human beings on this earth.
We just took it to a new level.
And we did something different.
We did something more.
In addition to killing people and taking land, we took culture
and identity and that was unfamiliar.
And we didn't take it like the land to make it our own.
We took it like murder, to destroy it.
That's the trauma and that's what's still going on today.
We haven't succeeded though.
And that's the resilience.
The people are continuing to preserve their culture,
to rebuild their populations, to nurture their traditions,
to rediscover their food, practice their healing,
and they're gaining political strength.
There's an emerging movement in Indian Country
that culture is prevention.
That naming ceremonies actually do prevent heart disease.
That traditions and community do support and sustain health
and healthful behaviors.
That connecting people to culture and heritage save lives
by building esteem, by grounding values,
by creating belonging, and purpose, and pride.
The movement is building against all the failed policies
of the past two centuries, allotment, assimilation,
relocation, boarding schools, termination,
all our best practices, all done our way, all failures.
We've gotten it so wrong for so long, one failure after another,
creating quite a bit of misery along the way and
yet we continue to think that we know what's best.
And we keep imposing our terms.
Religion is done this way.
This is food.
Education happens this way.
This is the way governance works.
This is what a constitution looks like.
This is the way you'll do it, our way.
This is another aspect of names.
Commodity canned beef.
I was visiting friends
on the Pine Ridge Indian Reservation this summer
and I had breakfast at Kathy High Hawk's home.
This is Kathy.
Her T-shirt depicts some Lakota ledger art of a buffalo hunt.
You can't see it but the title is Fast Food [laughter].
So Kathy always has a big crowd at her house for meals.
People sit around the table.
They stand around the room.
They take her food and go outside.
I was sitting at the table and the plate of fried eggs came
around and I took some.
The plate of saltine crackers came around and I took some.
And then a bowl of something I didn't recognize came around.
It didn't look good.
It didn't smell good.
I didn't take any.
I just passed it on.
Well, the bowl made its way to the head of the table
where Kathy's cousin Bryan picked it up
and brought it right back around to me.
He put a spoonful of this stuff on my plate and he said,
"This is the meat your government gives us.
You can't pass on this.
You have to eat it."
So I ate it.
It tasted like rancid fish.
And I thought, this is what my government says food is.
My government removed access to buffalo, for example,
and replaced it with this.
Separating people from their land
and their culture means separating people
from their food.
And for 150 years, this or worse is what we've provided instead.
It's gotten a lot better recently
but this has been the state of the art for a long time.
Separating people from their food is particularly harmful.
It harms the spirit as well as health.
It's demoralizing on a massive scale.
One tenet of culture is prevention is returning the
locus of control so that the people decide what food is.
The failure of understanding might persist
but it matters less if we are not dictating the terms.
We get out of the way and the people decide what food is,
how religion works, how government works,
how education is delivered, how healthcare is delivered.
The people take the traditions and the innovations that work
for them, just as they always have adapting, innovating,
incorporating the new even
as they are reclaiming their identities,
strengthening their culture and defining themselves
and their practices on their own terms.
I'm guessing that you're all with me, that you all think
that buffalo is better than commodity canned beef.
And you probably think if the people want
to have a naming ceremony, no reason for our government
to have an opinion about it, much less pass a law against it.
But I'm guessing I'm going to lose you when I extend
that self-determination to our work,
to CDC grants, for example.
We're CDC after all and we're really smart.
But is it really our call for people
in cultures we don't understand
to decide what the evidence based practices are,
to set the goals, to monitor the progress?
Why wouldn't we say, "We don't really understand what works.
You give it a go.
You do what you know works.
We'll provide the resources.
We'll provide any assistance you ask for.
But you decide what you're going to do.
And if you fail, no worries.
We have centuries of experience with failure.
Just keep trying.
In the 1950s, the people numbered fewer than 400,000.
Today, there are more than four million American Indians
and Alaska Natives in this country.
That's resilience.
In the 1950s, the people were prohibited
from speaking their languages.
Today, many Native children attend language immersion
programs in their tribally-run schools.
That's resurgence.
The past 20 years has seen an explosion of hunting, fishing
and gathering rites and the integration of western
and traditional healing.
Today, Native-owned businesses provide salmon and bison
to the food distribution program on Indian reservations.
That's resurgence.
The American Indian Freedom
of Religion Act was signed into law in 1978.
We finally got out of the way.
Today, most Indian health service dollars go directly
to tribes to deliver their own healthcare.
We're getting out of the way.
Last year, Congress gave USDA authority to pilot a process
for tribal organizations to purchase
and distribute their own food,
to make those decisions for themselves.
We're taking a step to the side.
This resurgence isn't happening
because the U.S. government started implementing
evidence-based practices
or because we suddenly really did know what's best.
It's happening because American Indians
and Alaska Natives are asserting themselves,
connecting to their culture, demanding the right to define
who they are and creating progress on their own terms.
We can follow on by investing our resources
in what the people know will keep their people strong,
by providing the assistance they request and checking
in to see the great work they're doing
to thrive on their own terms.
And when we check in, maybe we can call the people
by the names they call themselves because enemy,
destroyer, snake really don't describe these remarkable,
resilient people.
Thank you.
[ Applause ]
>> So what is CDC doing specifically to address some
of these historical inequities?
>> So CDC is not doing enough
to address these historical inequities.
We have a lot to do and a lot more to do in terms
of greater investment of resources,
and we have a lot more to do in terms of engagement,
and listening, and empowering so that
we can deploy our resources to the greatest effect.
>> And which program in chronic should we rename
with that awesome Native name?
>> Well, I don't use the word chronic.
That's a street name for marijuana.
>> Oh [laughter].
I wish I had known that before I asked that.
>> I would rename my center to the National Center
for Chronic Disease Prevention
and Health Promotion, how's that?
>> I sit corrected, thank you very much.
>> Thank you.
[ Applause ]