NATIVE AMERICAN CULTURE – EMILY KENNEDY AND HEIDI SCHULTZ

NUTN 505 Final Paper

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Chapter 1: Demographics of the Native American population in the U.S. and in OregonThe 2000 US Census report indicates that there are 4.3 million Americans that identify themselves as American Indian or Alaska Native. In the United States, there are 562 federally recognized tribes. The language, culture, traditions and belief system of each tribe varies significantly based on the region in which they live1. As of 2000, the two largest tribes by population in the United States were the Cherokee, with a population of just over 300,000, and the Navajo, whose population was just below 300,000. The Cherokee tribes were originally in the Southeastern U.S., but were forced to move and now reside in Oklahoma and North Carolina. The Navajo’s live in the Southwestern U.S.

As of 2000, the two largest tribes by population in the US were the Cherokee, with a population of just over 300,000; and the Navajo, whose population was just below 300,000. The Cherokee tribes were originally in the Southeastern United States, but were forced to move and now reside in Oklahoma and North Carolina. The Navajo’s live in the Southwestern United States.

Locally, the 640,000 acre Warm Springs Indian Reservation2, located in central Oregon, is home to three main tribes: Warm Springs (originally called Walla Walla), Wasco, and Paiute. There are close to 4,000 tribal members that live within or near to the reservation2.

In the early 1800s, the Warm Springs bands lived along the Columbia River and spoke Sahaptin. Their main livelihood was harvesting and trading salmon. The Wasco bands lived along the Columbia River and spoke Chinook. The Paiutes lived in Southeastern Oregon; hence they lived off of wild game rather than salmon. The Paiutes spoke a Shoshonean dialect.

The tribal way of life was jeopardized by settlers in the mid-1800s. In 1934, Congress passed the Indian Reorganization Act (Wheeler-Howard Act) which secured certain rights to Native Americans3. This included a return to local self-government. The Indian Reorganization Act recognized the necessity for tribal governments to manage their own affairs, and offered Federal assistance to tribes organizing under its provisions. In 1937, Warm Springs, Wasco, and Paiute tribes organized as the Confederated Tribes of the Warm Springs Reservation of Oregon by adopting a constitution and by-laws for tribal government.

The treaty that established the Warm Springs Reservation allowed the tribes to maintain specific acreage of land for their exclusive use. The reservation government is led by an 11-member tribal council. Three are chiefs who serve life terms, and the remaining eight are elected from reservation districts for 3-year terms2.

Chapter 2: Literature review regarding research and prevention of nutrition-related health disparities

Health disparity is defined by the Minority Health and Health Disparities Research and Education Act as “a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population”5. Similarly, diet-related disparity is defined as “differences in dietary intake, dietary behaviors, and dietary patterns in different segments of the population resulting in poorer dietary quality and inferior health outcomes for certain groups and an unequal burden in terms of disease incidence, morbidity, mortality, survival, and

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quality of life”6. When researchers study the health of the Native American population compared to the majority population of non-Hispanic whites, many health related disparities are evident.

Health disparities among the Native American population have existed for the past 500 years. With the arrival of explorers and colonists came the arrival of tuberculosis, smallpox, influenza, malaria, and alcoholism, each of which had a much greater impact on the Native American populations than on the white explorers and colonists who brought the diseases. Despite the fact that the health environment of the United States has changed dramatically over these 500 years, Native American health disparities have remained.

For the Native American population, many disparities can be seen across a range of health and nutrition related areas. According to the Center for Disease Control and Prevention, in 2008 12% of the Native American population in the United States was in fair or poor health. This compares to only 9.5% of the total non-Hispanic white population who were considered to be in fair or poor health7. During the same year, over a quarter (28%) of the Native American population age 65 years or older were without health care coverage; whereas only 17% of the non-Hispanic white population age 65 years or older were without health care8.

From the early 1900’s until the late 1960’s, the primary diet-related disparity and health concern in the Native American population was malnutrition. Malnutrition in this population arose primarily from having insufficient amounts of food or sufficient amounts of food at certain times of the year but insufficient amounts of food at other times of the year9. These trends were not mirrored in the majority population during most of this time.

Since then, health concerns for both the Native American population as well as the entire US population have shifted immensely. The number one health concern in the United States today for all racial and ethnic groups is obesity (BMI > 30) and obesity related diseases, such as diabetes. The increase in obesity in the United States is primarily due to an increase in consumption of calories and decrease in caloric expenditure though physical activity. In 2007, 33.2% of the adult Native American population was obese compared to 24.8% of the adult non-Hispanic white population. Also, 39.6% of the adult Native American population reported physical inactivity compared to 34.7% of the adult non-Hispanic white population10.

Health and diet-related disparities can also be seen in the rates of certain obesity-related diseases among Native Americans. While diabetes is a health concern for all races and ethnic groups in the United States, the disease affects no group as significantly as it does the Native American population. In 2007, 16.5% of the Native American population had diabetes. This is compared to 11.8% of the black population, 10.4% of the Hispanic population, 7.5% of the Asian population, and 6.6% of the non-Hispanic white population8.

Alcoholism first became a health issue for the Native American population when it was introduced to them via the arrival of the European explorers. To this day, alcoholism remains a serious health and nutrition concern for this population. Alcoholism can lead to many health and nutrition related diseases and conditions, including liver disease, heart disease, and vitamin and mineral deficiencies. Alcohol-related death is approximately three times higher among the Native American population compared to the non-Hispanic white population12.

The specific cause of Native American health disparities has been debated since they were initially observed over 5 centuries ago, and many different people have given many different explanations for these observed health disparities. Originally these included religious explanations but have changed and evolved to cover behavioral, genetic and socioeconomic explanations13. Are Native American health disparities the result of genetic differences making Native Americans genetically more susceptible to certain diseases than their non-Hispanic white counterparts? Or are the health disparities the result of socioeconomic differences between the two populations? Some indicate that Native American health

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disparities resulted from personal choices or disruption of normal society by colonization. It is obvious that there is not one clear-cut answer to the question of what causes Native American health disparities. Regardless, continual work and research is needed to help move society in a direction that is free of health disparities among Native Americans, as well as all other minority groups in the United States.

The Indian Health Service (IHS), since its establishment in 1955, has sought to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level14. IHS provides health care services to approximately 57% of the Native American population through 45 hospitals and over 600 other facilities across the country. The IHS works in collaboration with local Native American tribal agencies and the federal government to promote Native American health and eradicate Native American health disparities.

Chapter 3: Analysis of the cultural values, health beliefs, and communication styles of the Native Americans

The Warm Springs tribe of Central Oregon, as well as many other Native American tribes, embraces many core cultural values. These values are often what make Native American culture unique and set apart from the majority culture in the United States. Although different individuals and groups within the Native American population might practice or follow their tribe’s specific cultural beliefs, values, and traditions to varying degrees, there are several key cultural values that are specific to the Native American culture in general. Some key cultural values common throughout most Native American tribes or groups are self as part of a greater, universal whole; emphasis on relationships, particularly relationships as part of an extended family; respect of elders for their knowledge, wisdom, and insight; mutualism, or the sense of belonging and solidarity; spirituality; and the interconnectedness of all14. There are also several personal traits, characteristics or skills that are highly valued within the Native American culture. These include patience, silence, work ethic, listening, and practicality. Little is done within the Native American culture that does not serve a purpose. For example, small talk and idle chatter are not highly valued, because they serve little purpose. Because of the value placed on practicality, most Native Americans prefer to listen rather than to speak. Also, Native American culture is very much oriented to being rather than becoming16. Native Americans are generally focused on the present, and pay little attention to the vagueness of the future. For the most part, these cultural values of the Native Americans are starkly contrasted to the outspokenness and future-oriented majority culture in the United States. Traditional Warm Springs and Native American culture embraced health practices that combine religion, spirituality, herbal medicines, and rituals. While modern Western medicine has been accepted by most of the Native American population, today many Native Americans still seek some kind of traditional healing method in combination with modern medical treatment. These traditional healing practices may include sweat lodge ceremonies, herbal remedies, and spiritual healing. In fact, one research study showed that 38% of Native American/Alaska Native people studied engage in methods of traditional healing in conjunction with their regular medical treatment. 86% of study participants said that they would consider seeking traditional healing in the future17.

Native American culture also encompasses many unique communication styles. As mentioned before, Native Americans place a high value on relationships, family, and interconnectedness. Because of this, most Native Americans communicate well in group settings where they can participate in group discussions, storytelling, and other group activities18. It may be considered inappropriate to ask direct questions within the context of Native American culture. Questions are asked indirectly to allow the respondent to within a context and manner they deem appropriate. Native American culture also emphasizes proper introductions through hand-shaking, stating where you’re from, etc. Silence and listening are also highly valued within the Native American culture, as stated earlier. This means that Native Americans will generally remain silent, often closing their eyes to concentrate on listening. Native Americans will often not open up verbally to someone until they know the person; this compares to the majority culture where people speak to get to know one another. Direct eye contact may also be considered rude within the context of Native American culture.

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The cultural values held by Native Americans permeate through all aspects of Native American society and culture. The value placed on relationships, spirituality, listening, and practicality influences the health beliefs and communication styles of Native Americans and is what makes the Native American culture unique.

Chapter 4: Description of traditional and contemporary food habits of the Native American population

The traditional food habits of Native Americans varied widely depending upon the region in which they lived. Regardless of region, most Native Americans survived on hunting and fishing, gathering fruits and other plant life, and farming19. In addition, trading with other tribes was also an important part of their culture. Tribes near to water, such as the Warm Springs tribe near the Columbia River, enjoyed Salmon as one of their main staples.

4Tribes on the plateaus and high plains, primarily subsisting on deer and other large game, were

often forced to migrate in search of food. Some regions, such as the Southwest, were chronically dry and so underground springs were created to allow for crops to be planted and sustained20. In the South, the Native Americans used advanced farming techniques such as irrigation and crop rotation19. The traditional Native Americans were master farmers and cultivated crops referred to as “the three sisters”, which included corn, beans and squash. The most commonly consumed foods were those that could be grown such as sunflower, wild rice, potatoes, peanuts, avocado, pigweed, wild mint, wild currents, wolf berry and wild onion – and of course the three sisters, corn, beans, and squash20. In addition to food crops, Native American farmers often grew cotton, hemp, tobacco and medicinal plants19.

Food and religion are closely intertwined for Native Americans. Prayers for rainfall and good harvests were commonly made. The Warm Springs Indians observe three religious feasts of thanksgiving each year. The first is the “Root Feast” which occurs in the spring and celebrates the first appearance of many important roots. The second, also occurring in the spring, is the “First Catch/ Salmon Feast” which acknowledges the first migration of salmon. The third religious feast is the “Huckleberry Feast” which happens each fall to recognize the ripening of the first berries21.

The Navajos believed that sheep were given to them by the sun and were a blessing to their lives. When a sheep was butchered, every part was consumed or used as clothing. Even the blood was used for blood sausage (blood mixed with cornmeal, chili and potatoes) – and was considered a delicacy. Today, mutton is still expected to be available for ceremonial events and social gatherings. The use of

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Juniper Ash in food recipes was also important to the Navajo tradition. The branches of the Juniper tree were burned, the ash was sifted and then added to bread, dumplings, and blue cornmeal mush.

Prior to 1960, malnutrition was a common issue on Indian reservations in the United States. After the 1960s, the biggest issue became over-nutrition, which soon led to high rates of obesity among this population. The primary nutrition issues of the 21st century are excessive energy intake, high fat intake, low fiber intake, and low intake of several important nutrients such as iron, calcium, vitamin A and vitamin C. The health concerns created by the energy-dense, nutrient-poor food choices of the Native Americans are further aggravated by the excessive consumption of alcohol20.

During the 1960s, struggling with unemployment and poverty, many Native American family members were forced to leave the reservation in search of employment. Consequently, the foods they used to gather and garden slowly disappeared and have been largely replaced by foods purchased from grocery stores, trading posts, fast food restaurants, and of course foods provided by the federal programs such as the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Food Program for Woman, Infants, and Children (WIC), or food distribution program20.

A typical Native American diet today is very different than that of the traditional diet. Today it is high in energy, fat, cholesterol, sodium and refined sugars – often including processed foods, lard, soda, and sweet/salty snacks. Fresh fruits and vegetables are not consumed often. The concern with poor nutrition is compounded by the fact that many Native Americans living on reservations do not have refrigeration, electricity, or running water20. This means that perishable foods must be consumed quickly. Transportation concerns such as unpaved roads, poor weather conditions, and long distances to stores make grocery shopping difficult for some to do on a regular basis. Today, many tribes consume non-traditional foods obtained through government programs and grocery stores. Convenience is a major factor in the decision to decrease the use of indigenous foods20.

Chapter 5: Analysis of health education materials and projects relevant to the Native American population

The increasing prevalence of overweight and obesity-related diseases, especially diabetes, among American Indians has created a critical need for intervention.

In 1993, Pathways, a culturally appropriate school-based health promotion and obesity prevention study for American Indian Schoolchildren was initiated. Its purpose was to test theory-based school interventions22. Social Learning Theory (SLT) has been used for over 30 years for school-based interventions that promote healthy eating and physical activity behaviors.

The idea behind SLT is that people learn by observing the behaviors, attitudes and emotional reactions of others. “Most human behavior is learned observationally through modeling: from observing others, one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action”24. The hope was that by facilitating the SLT interventions in the Pathways study, the children’s knowledge, values, sense of personal control, and behaviors related to food and physical activity would be enhanced. The interventions promoted changes in behavioral attitudes by providing opportunities and experience in goal-setting, developing skills in food selection and preparation, physical activity and self-monitoring.

An important element of the Pathways study was that the materials and approaches utilized were culturally appropriate. Members of the tribes contributed games, music, artwork and cultural stories for use in the classroom and approved all educational material. The concept of cultural sharing was integrated throughout the curricula to reinforce the students’ cultural identity23 and included an appreciation of healthy eating habits and active lifestyles.

The Pathways intervention was successful in impacting the participant’s knowledge and understanding of healthy behaviors as well as improving school food service. The study was not successful in actually reducing the percentage of body fat of its participants. Obesity prevention and intervention efforts need to continue; and additional approaches and increased program durations may be necessary.

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Numerous educational materials are available to use in the classroom environment to teach children about Native American histories and cultures. Many of the materials are interactive or based on story-telling, which serve to support the Native American traditions of teaching their young. One such resource is the National Museum of the American Indian website http://www.nmai.si.edu/. This site features educational materials that focus on various tribes, teach about visual arts and highlight a specific American Indian artist, Fritz Scholder25, discuss the meaning of Thanksgiving from the Native American perspective and touch upon other important cultural realities. The materials that are available to order are classy and colorful.

Additional educational resources can be found at the Smithsonian Education website at www.smithsonianeducation.org which features a variety of American Indian Heritage teaching resources26, the National Heart Lung and Blood Institute from the National Institutes of Health which offers a booklet on heart-healthy living for American Indians27, and many more. The challenge for educators in obtaining materials is that typically school districts have existing policies about the curriculum that is utilized. Teachers may not be reimbursed for purchasing materials outside of the pre-established curriculum, or worse yet, they may not be allowed to use them.

The Native American culture has a lengthy, diverse and magnificent history. Unfortunately they are also a population that is experiencing significant health disparities. There are no quick solutions, but by continuing to embrace their culture and find solutions that respect their beliefs and their history, progress can be made.

Chapter 6: Limitations of the project and future directions of resource developmentThe limitations of this project center on trying to address the population of the Native Americans

as a whole, yet realizing that they are regionally extremely diverse in their language, religion, food habits, and lifestyles. The idea of honing in on one specific American Indian population (Warm Springs) was inviting, yet challenging in that the number of resources that specifically cater to the history of this population are limited.

Future directions of this project involve continuing to gather specific and general details about the Native American culture that will add additional substance and life to this subject.

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Fritz Scholder,

Heart Indian, 2004

Chapter 7: Bibliography

1. Goody CM, Drago L. Cultural Food Practices. Diabetes Care and Education Dietetic Practice Group; American Dietetic Association. 2010. Published by Diana Faulhaber.

2. Columbia River Inter-Tribal Fish Commission; The Confederated Tribes of the Warm Springs Reservation of Oregon; http://www.critfc.org/text/warmsprings.html; Accessed on 2/21/10.

3. Warm Springs: The Confederated Tribes of Warm Springs; www.warmsprings.com; Accessed on 2/15/10.

4. Wikipedia Indian Reorganization Act: http://en.wikipedia.org/wiki/Indian_Reorganization_Act; Accessed on 2/21/10.

5. Kennedy. Minority health and health disparities research and education act of 2000. The National Academies: 2000; Public Law 106-525. Available from: www.nationalacademies.org. Accessed 2/20/10.

6. Satia JA. Diet-related disparities: Understanding the problem and accelerating solutions. Journal of the American Dietetic Association. 2009:610-615.

7. Health of American Indian or Alaska Native Population. Available at: http://www.cdc.gov/nchs/fastats/indfacts.htm. Accessed 2/20/10.

8. Health of White Population. Available at: http://www.cdc.gov/nchs/fastats/white_health.htm. Accessed 2/20/10.

9. Compher C. The nutrition transition in American Indians. Journal of Transcultural Nursing. 2006;17:217-223.

10. Obesity and American Indians/Alaska Natives. Available at: http://raceandhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=537&ID=6457. Accessed 2/20, 2010.

11. National Center for Chronic Disease. Number of people with diabetes increases to 24 million. Center for Disease Control and Prevention; 2007.

12. Indian Health Disparities. Available at: http://info.ihs.gov/Disparities.asp. Accessed 2/20/10.

13. Jones DS. The persistence of American Indian health disparities. American Journal of Public Health. 1996;96:2122-2134.

14. Indian Health Service Introduction. Available at: http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/IHSintro.asp. Accessed 2/20/10.

15. Native American Elderly. Available at: https://sakai.ohsu.edu/xsl-portal. Accessed 2/21/10.

16. Traditional Native American Values and Behaviors. Available at: http://nwindian.evergreen.edu/curriculum/ValuesBehaviors.pdf. Accessed 2/21/10.

17. Marbella AM, Harris MC, Diehr S, Ignace G. Use of Native American healers among Native American patients in an urban Native American health center. Archives of Family Medicine. 1998;7:182-185.

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18. Brown TL, Zephier E, Johnson ML. American Indian food practices. In: Goody CM, Drago L, eds. Cultural Food Practices. Diana Faulhaber; 2009:1-19.

19. Facts for Kids: Native American Food; http://www.native-languages.org/food.htm; Accessed 2/21/10.

20. American Dietetic Association Nutrition Care Manual Cultural Food Practices; http://nutritioncaremanual.org/content.cfm?ncm_content_id=80449; Accessed 2/21/10.

21. US History – The Warm Springs Indian Tribe; http://www.u-s-history.com/pages/h1539.html; Accessed 2/21/10.

22. Warm Springs: http://www.warmsprings.com/warmsprings/Tribal_Community/History__Culture/Culture/; Accessed 2/21/10.

23. Davis SM, Clay T, Smyth M et al; Pathways curriculum and family interventions to promote healthful eating and physical activity in American Indian schoolchildren. 2003. Available on Sakai.

24. Bandura, A. Self-efficacy: The exercise of control. New York: W.H. Freeman.1997.

25. National Museum of the American Indian; http://www.nmai.si.edu/subpage.cfm?subpage=education&second=dc&third=general; Accessed 2/21/10.

26. Smithsonian Education; http://www.smithsonianeducation.org/educators/resource_library/american_indian_resources.html Accessed 2/21/10.

27. National Heart Lung and Blood Institute; http://www.nhlbi.nih.gov/health/healthdisp/an.htm; Accessed 2/21/10.

28. eMapstore.com; Map of the US; Accessed 2/28/10.

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