The Value of AI/AN Public Health Curriculum: Challenges and Future Direction

1. One Sky Center/OHSU The Value of AI/AN Public Health Curriculum: Challenges and Future Direction Larry Murillo, DrPH, MPH, MS Assistant Professor School of Medicine Oregon Health and Science University

2. One Sky Center/OHSU Vision Statement • Develop AI/AN specific Public Health Curriculum to encourage community health resource development and access to THP. The long-term result will be stronger communities based on cultural values that promote a broader understanding of health.

3. One Sky Center/OHSU Increase Access to THP • Undergraduate and Graduate Curriculum • Educate community of THP Use • Describe current trend of traditional health practice use in AI clinics and health programs. • Describe THP epistemology used in health care setting

4. One Sky Center/OHSU Today’s situation: Why is THP and public health so important? • Educators see health as vital issue • Culture lends context to health • Medical system is failing to improve health • Healthcare costs are skyrocketing • Increased use of cultural health beliefs and practices

5. One Sky Center/OHSU How Did We Get Here? • American Indian Religious Freedom Act • THP is hidden part of community • AI/AN Professionals develop THP health models. • Clinics now openly use THP. • Health concerns – huge disparity

6. One Sky Center/OHSU Different/Complementary/Alternative • Pluralistic System of Care* • Medical, Alternative, THP • Patients use both medical and THP services simultaneously. • 70% in urban populations** • Biomedicine addresses physical symptoms while THP addresses circumstances from which those symptoms arise.* • Different forms of care are seen as complementary and not in conflict.*** • Gurley, D. et. Al. (2001) • **Buchwald, Beals and Manson (2000) • ***Csorda and Garrity, (1994)

7. One Sky Center/OHSU What Might AI/AN PH Curriculum Look Like? • Balance of three perspectives • Professional • Community • Group and individual • Traditional Health Practitioners Circle

8. Does THP Work? Role of Medicine Person Science vs Cultural Med Medical limits Race, Religion and Medical Model PubHlth Research CA Culture Trends Urban vs. Rural Health IHS and PL 94-638 Cultural Community Based Health Models US Policy and AI Health Land Based Religion and Environmental Health Cultural Models of Health One Sky Center/OHSU AI/AN Public Health Issues Course

9. One Sky Center/OHSU Challenges of THP Education • Medical Model is dominant • Average AI person is THP “expert” • Tension of being “out of loop” • THP stigma • Savage, Paganistic, Unscientific, Family remedy • Privacy/public sharing issue

10. One Sky Center/OHSU Levels of THP Practice • Common family knowledge • Practitioners and protocol • Spiritual Level

11. One Sky Center/OHSU Clinic THP Perception • Administration – Political Issue • Medical – Alternative Medicine Issue • Health Education • Prevention message • Community Intervention • Mental Health – Intervention Issue

12. One Sky Center/OHSU Question • Have you ever been frustrated with college curriculum? • Did “multicultural” classes seem inadequate and too broad? • Have you ever taken a class specific to AI/AN that was not in the ethnic studies department?

13. One Sky Center/OHSU Research Strategy • Describe present use of THP in clinics • Develop ideas from epistemology of current programs. • Encourage community participation in defining and broadening THP programs • Create evaluation models of “Ideal” THP program

14. One Sky Center/OHSU Current Funding • Develop epistemology • Interview Longstanding THP Development Leaders • Community Participation – Phil Lane, Jr. • Cultural Competency – Terry Cross • Wellness conferences – Billy Rogers • Historical Trauma – Maria Yellow Horse Brave Heart • Red Road Alcohol Treatment – Gene Thin Elk • Post-Colonial Psychology – Ed Duran

15. Closing Thoughts • How long before we “define” our own health • Use our own beliefs and ideas • Acknowledge professionals and medicine people • Support existing ceremonies • Interpret our lives and learn from disease