2006 SUMMER SCHOOL
OF
GERONTOLOGY
The Invisible Population
Native Americans in South Carolina
August 23, 2006
Barbara MorningStar Paul
Program Coordinator, Native American Affairs
SC Commission for Minority Affairs
6904 N. Main St., Suite 107
Columbia, SC 29203
803.333.9621 extension 23
bpaul@cfma.state.sc.us
WHAT ARE THE MAJOR ISSUES
TODAY?
How to Relate to Native people
Cultural differences
Addiction issues
Physical Health/Mental Health Issues
Criminal Justice issues
Family structure
Indian Child Welfare Act
Spiritual beliefs
SERIOUS Lack of Accurate Statistics in South Carolina
Barriers to Treatment
MORE ISSUES TO CONSIDER






Education/Literacy
Healthcare
Economic Status
Poverty Rates
Addiction to Alcohol and Other Drugs
Criminal Justice – Adult and Juvenile…



Crimes Against Women/Domestic Violence
Family Structure
Infant Mortality
Overview of Native American
Population

Federal vs. State Recognition – What it means…..

The Native American Population is growing at a rapid pace

Current Native American population in South Carolina:



Claiming Native American race only – 13,718
Claiming Native American and another race – 27,623
Of those:


1,441 claim Native American of Hispanic descent as one race only
2,107 claim Native American of Hispanic descent as more than
once race
Comparison report
Population Growth
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1990
2000
Native Americans
A BRIEF HISTORY LESSON
 First
contacts between Europeans and
Indians in South Carolina.
 Colonization
 Treaties

The Trail of Tears (Indian Removal Act)

What did it do??
"Even
the seasons form a great circle in their changing, and always
come back again to where they were. The life of a man is a circle
from childhood to childhood and so it is everything where power
moves." --Black Elk (Hehaka sapa), OGLALA SIOUX
MORE HISTORY…




In all, Southeastern Indians (not
just Cherokee) gave up about 100
million acres of land for about 32
million acres in West
Indian Appropriations Act of 1871
The General Allotment Act in 1887
How did all of this affect Indian
health??
PERCEPTIONS BY OTHERS
Pan-Indianism
Heathenism
Presence or lack of presence in the State – “NATIVE AMERICANS
DO NOT REPORT THEIR RACE ACCURATELY”

REASONS FOR NOT REPORTING RACE AS NATIVE AMERICAN







MISCEGENATION LAWS
CENSUS
TRAIL OF TEARS
PREJUDICE/REPRISAL PRE AND POST CIVIL WAR/SEGREGATION SOUTH
CIVIL RIGHTS??? FOR WHO???
RELIGIOUS FREEDOM ISSUES
FEAR, FEAR, FEAR

How they look…..

Stereotypes

INACCURACIES ARE DOCUMENTED AND OBVIOUS
SO WHAT?? WHY ARE YOU
TELLING US ALL THIS?
IS THERE A CONNECTION BETWEEN SELF
IMAGE/SELF RESPECT AND:
 MENTAL HEALTH
 PHYSICAL HEALTH
 BEHAVIORS – HEALTHY AND UNHEALTHY
IS THERE A CONNECTION BETWEEN
POVERTY/ILLITERACY AND:
MENTAL HEALTH
 PHYSICAL HEALTH
 BEHAVIORS – HEALTHY AND UNHEALTHY

NATIVE AMERICANS IN SOUTH CAROLINA
How many tribes and groups are in
South Carolina?
“First Contact”
Archaeology
“Invisible”
Statistics.
Are seriously underserved.
The good, the bad and the
ugly…..







Smallpox
Alcoholism/Addiction
Lack of education
High drop out rates
Low economic and income levels
Miscommunications
Fears
So you think you can relate to Native
People?
My grandmother was a Cherokee princess……”
“
Exercise: "What you see with your eyes shut is what counts." --Lame Deer,
LAKOTA

“The Santee Indians came together and built their won school. It was
called Crane Pond School and it was an all-Indian school. This was set
up by the government. We also weren’t allowed to mix with the white
people. This took place back in the early 1900’s. I was only allowed to
go to the seventh grade and only the whites and blacks could finish
high school. We could not ride the bus or go into establishments. If
we went to town for anything we had to go to the window and wait for
whatever service was needed by the established. We were finally
allowed to ride the bus but could only sit in the very back, quietly.”
(Voncile Pratt-Platt Todd, August 25, 2005”).
Educational/Language Barriers
i.e. medical-speak
i.e. government speak
Literacy issue and sensitivity
The Old Ones have always said that no matter who despises or ignores you, no matter
who keeps you from entering their circles, it is right to pray for them because the are
like us, too." --Larry P. Aitken, CHIPPEWA
Cultural Issues

Resentments and Why:




Euro-culture
African American Culture
Hispanic/Latino Culture
How to avoid triggering resentments
Addiction Issues

AI/ANs are the most impoverished of today’s minority groups.
Over one quarter live in poverty, compared to 8 percent of whites.
A heterogeneous grouping of more than 500 Federally recognized tribes,
the AI/AN population experiences a range of health and mental health
outcomes.


While AI/ANs are, on average, five times more likely to die of
alcohol-related causes than are whites, they are less likely to die
from cancer and heart disease.
According to the S.C. Budget and Control Board Office of Research and
Statistics (9/19/2005), DAODAS reported serving ONLY 127 Native
American people.

WHAT IS WRONG WITH THIS PICTURE???

MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 1999
PHYSICAL HEALTH/
MENTAL HEALTH
“…… more than half of the AI/AN population does not
permanently reside on a reservation,3 and therefore have limited
or no access to IHS services. Geographic isolation, economic
factors, and suspicion toward traditional spiritual beliefs are some
of the reasons why health among AI/ANs is poorer than other
groups. Other factors that contribute to poorer health outcomes
for AI/ANs include cultural barriers, geographic isolation,
inadequate sewage disposal, and economic factors.4 “
American Indians born today have a life expectancy 5 years less than non-Indians
(NATIVE AMERICAN RESEARCH CENTERS FOR HEALTH Release Date: August 21, 2000)
HOW MANY FEDERALLY RECOGNIZED TRIBES ARE IN SOUTH
CAROLINA?????
WHAT HAPPENS TO THE REST OF THEM???
3 Statistical Handbook on Racial Groups in the United States by T.B. Heaton, B.A. Chadwick, and C.K. Jacobson; Phoenix: Oryx
Press, 2000; Table A3.5.
4 The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality. United States
Commission on Civil Rights, Sept. 1999.
5 American Indian & Alaska Native (AI/AN) Populations;CDC; Office of Minority Health
PHYSICAL HEALTH/MENTAL HEALTH – Continued
According to a 2001 study by the U.S. Department of Health and
Human Services , among AI/AN youth aged 12 to 17 years in
1999-2000:

Illicit drug use was more than twice as high (22.2%) as the
national average (9.7%).

Binge alcohol use was higher (13.8%) than the national
average (10.3%).

Heavy alcohol use was higher (3.8%) than the national
average (2.5%).



Driving under the influence of illicit drugs or alcohol in the
past year was slightly lower (10%) than the national
average (11.2%).
Use of cigarettes was more than twice as high (27.2%) as
the national average (13.4%).
Getting into at least one serious fight at school or work in
the past year was higher (22.1%) than the national average
(19.9%).
PHYSICAL HEALTH/MENTAL HEALTH – Continued





Taking part in at least one group-against-group
fight in the past year was higher (22.4%) than the
national average (16.1%).
Carrying a handgun at least once in the past year
was about the same (3.3%) as the national average
(3.2%).
Data also indicate the presence of despair.
Suicide is the second leading cause of death for
AI/AN youth in the 15-24 age group
The suicide rate is 2.5 times higher for AI/AN
people than the combined rate for all races in the
United States (USDHHS, 1999).
PHYSICAL HEALTH/MENTAL HEALTH – Continued

In the BIA study, 19% of AI/AN high school youth had seriously considered
suicide during the preceding year. Although still a strong cause for concern,
this statistic does represent an improvement over the 29% reported in the 1994
survey (Shaughnessy, Branum, & Everett-Jones, 2001).

Native males ages 15 to 24 account for two-thirds of all Native suicides.

Violent deaths – unintentional injuries, homicide, and suicide – account for
75% of all mortality in the second decade of life for AIANs. (Source: Fact
Sheet, Surgeon General’s Report; U.S. Department of Health and Human
Services, Office of the Surgeon General, SAMHSA, 1999.)

Homicide and legal intervention are the third leading cause of death for Indian
youth (ages 15-24); the homicide rate among American Indians is 1.2 times
that of the general U.S. population (USDHHS, 1999).
Social and Emotional Distress Among American Indian and Alaska Native students: Research Findings
by Ardy SixKiller Clarke; EDO-RC-01-11 (January 2002)
PHYSICAL HEALTH/MENTAL HEALTH – Continued
AI/ANs are over-represented among high need populations:

People who are homeless.

People who are homeless. While representing less than 2% of the U.S.
population, it is estimated that AI/ANs constitute 8% of Americans
who are homeless.

People with alcohol and drug problems.

People who are incarcerated – see “Criminal Justice” slide

People who are victims of trauma – see “Criminal Justice” slide

“Need for Services: Research on AI/ANs is limited by the small size
of this population and by its heterogeneity. “
MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 1999
*****"Silence is the absolute poise or balance of body, mind and spirit." -Charles A. Eastman (Ohiyesa), SANTEE SIOUX
AND MORE INFO……



Access to Services: About 20 percent of
AI/ANs do not have health insurance,
compared to 14 percent of whites.
Traditional healing is used by a majority of
AI/ANs.
Appropriateness and Outcomes of
Services: The appropriateness and
outcomes of mental health care for AI/ANs
have yet to be examined, but are critical
for planning treatment and prevention
programs.
MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 1999
SO DO INDIAN PEOPLE TRUST YOU??
A government prohibition on participation in traditional spiritual
ceremonies continued until the American Indian Religious
Freedom Act of (1978).
…….traditional cultural views still heavily influence the way in
which Native people understand life, health, illness, and healing
(Todd-Bazemore, 1999).
American Indian adolescents were much more likely to be
diagnosed with AD/HD and substance abuse or substance
dependence disorders. The rates of conduct disorder and
oppositional defiant disorder were also elevated in the American
Indian sample.
MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 1999
Everything's so simple, and we make everything so complicated.
That's why we're confused." --Vickie Downey, TEWA/Tesuque Pueblo
Criminal Justice – Victimization;Crimes
Against Women/Domestic Violence




People who are incarcerated.
People exposed to trauma. The rate of violent
victimization of AI/ANs is more than twice the
national average.
The higher rate of traumatic exposure results in a
22% rate of PTSD for AI/ANs, compared to 8% in
the general U.S. population.
The American Indian Vietnam Veterans Project
found lifetime prevalence of PTSD to be 45 to 57%
among AI veterans, rates significantly higher than
among other Vietnam veterans.
Source: Fact Sheet, Surgeon General’s Report; U.S. Department of Health and Human Services, Office of the Surgeon General, SAMHSA, 1999

Catawba Indians 1910
Criminal Justice and Incarceration
THE FASTEST GROWING INDIAN RESERVATIONS??
Family
Structure
American Indian families maintained by a single female
increased between 1980 and 1990. However, the Native
American increase of 27 percent was considerably larger than
the national figure of 17 percent. *
High incidence of Indian households headed by women (45%),
42% of whom were younger than 20 when they had their first
child (LaFromboise, Choney, James, & Running Wolf, 1995).
American Indian families were slightly larger than the average size of
all U.S. families (3.6 versus 3.2 persons per family) (U.S. Census
Bureau, 1993). *
……..households in many American Indian communities exhibit
much higher dependency indices than other segments of the
U.S. population and are more comparable to impoverished Third
World countries (Manson & Callaway, 1988).
Families continue to feel alienated from mainstream
educational purposes and institutions, which reduces their
involvement in their children's educations (Cummins, 1989).
* MENTAL HEALTH: A REPORT OF THE SURGEON GENERAL 1999
"Even the seasons form a great circle in their changing, and always come back again to where they were. The life of a man is a circle from childhood to childhood and
so it is everything where power moves." --Black Elk (Hehaka sapa), OGLALA SIOUX
SPIRITUAL BELIEFS


Many Christian Native Americans, but with
remnants of their own cultures infiltrated
Some Native Americans maintain spiritual
practices from their ancestors




Smudging
Sweat lodges
Feathers….
Pow wows and blessing of the circle
WHAT IS HAPPENING TO OUR CHILDREN?
•Multiple studies have shown the adverse effects of
chronic exposure to violence on a child's ability to
learn
• Many AI/AN youth live in communities that
continue to experience long-term economic and
social distress. High rates of alcoholism, drug
abuse, domestic abuse, child neglect, substandard
housing, and lack of job opportunities are common
conditions in Indian communities.
"We
know that in all creation/Only the human family/Has
strayed from the Sacred Way." --OJIBWA Prayer
INDIAN CHILD WELFARE ACT
AND WHAT DOES THAT HAVE TO DO WITH YOU?




MULTI-PURPOSE ACT
US Government recognizes that a disproportionate number
of Native children have been removed from their homes and
placed in white homes
Protects children from losing their culture
Prevents breakup of Native American families while
protecting children from
“In any adoptive placement of an Indian child under State law,
a preference shall be given, in the absence of good
cause to the contrary, to a placement with (1) a member of
the child's extended family; (2) other members of the
Indian child's tribe; or (3) other Indian families.”
SC American Indian Birth Data

In 2004, there were 328 births to Native American mothers in SC.
This represents less than 1% of total live births.
•
There were 5 infant deaths from 1999-2004.
•
The US infant mortality rate for 2002 was 8.6 deaths per 1,000 live births.

Data Source: SC DHEC Vital Records
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
CURRENT SITUATION
Most current statistics from IHS demonstrate: SIDS death rate declines 58% in
IHS areas.
Infant mortality rate in IHS areas 94-96 was 9.3 vs. US all races rate of 7.6 (22% higher)
Aberdeen, Tucson, and Nashville areas exceeded US rate by over
50%
Indian Healthcare Reauthorization Act
R. Mona Rosenman
DIRECTOR STRATEGIC COMMUNICATIONS & POLICY
CJ Foundation For SIDS
LACK OF STATISTICS IN SOUTH
CAROLINA

What DO we know?



According to SC Department of Education, in their
2004 “Quick Facts” publication, the drop out rate
for American Indian/Alaskan children grades 9-12
was a staggering 6.3 – the HIGHEST in the State,
followed by 3.8 for African American children.
Does lack of education help/hurt this population?
Older American Act (Aging Services) have been
provided to only 31 Native Americans in the last
year!
“
MORE THAT WE DO KNOW…
Diabetes has risen to epidemic proportions in some populations, and many others are fighting the
battle against obesity and high blood pressure. Because native people generally earn less than the
average American and tend to live in remote, rural locations, some may have limited access to
clinical preventive services, health education, and prevention efforts. All these factors act
synergistically to place native people at very high risk for chronic diseases.” (NIH Study 1998.)
heraldonline.com
By Denyse C. Middleton · The Herald - Updated
08/21/06 - 12:40 AM
“…But the elimination of federal grants for health care to
the only federally recognized American Indian tribe in the
state has resulted in transportation and medication
problems at the reservation's health clinic. The clinic is
operated by Indian Health Services and offers free health
checks and generic medications to the elders, said tribal
executive committee member Claude Ayers…..”
Catawba master potter Evelyn George, 92, polishes a piece
of pottery with a smooth stone to prepare it for firing Thursday
at the Catawba Senior Center on the reservation.
Andy Burriss · The Herald
"Just about everyone down here on the reservation has heart trouble and
diabetes," Plyler said. "We need someone to go out and check on the
seniors at home. We need a home health service."
Interesting information…
STATISTICS (OR LACK OF) IN SOUTH CAROLINA
According to the 2000
Census, there were only
1,180 Native American
Indians age 65+ in the entire
state!
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
Census 2000


“According to the 2000 census, the median age
of 29 years for American Indians and Alaska
Natives was about 6 years younger than the
national median of 35 years”.
“Less than 10 per cent of all American Indian
tribal groupings were 65 years of age and older”
American Indian Leading Causes of
Death for US
US
Cause of Death
2002
Number
All Causes
12,415
1. Disease of Heart
2,467
2. Malignant Neoplasms (Cancer)
2,175
3. Accidents
1,488
4. Diabetes
744
5. Cerebrovascular Disease (Stroke)
567
6. Chronic Liver Disease and Cirrhosis
547
*Age adjusted to 2000 population
American Indian Leading Causes of Death for SC
Cause of Death
SC
1999-2004
Number
All Causes
204
1. Disease of Heart
55
2. Malignant Neoplasms (Cancer)
41
3. Accidents
12
4. Chronic Lower Respiratory Disease
(Asthma, COPD, etc)
11
5. Cerebrovascular Disease (Stroke)
10
5. Diabetes
10
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
Data Source: SC DHEC Vital Records
Rate not available for SC
Aging Population
PROGRAMS AND SERVICES AVAILABLE TO SENIORS IN S.C.















Information, Assistance, and Referral
Insurance Counseling
Legal Assistance Services
Living Will Witness Program
Long Term Care Ombudsman Program
Adult Day Services
Group Dining
Disease Prevention and Health Promotion
Elder Abuse Prevention
Employment Services
Homebound Support
Home Care Services
Home-Delivered Meals
Respite and Caregiver help
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
availability of limited state and federal resources; therefore,
the percentage of persons served declined
Figure III.7.2.5
Source: US Census current population and National Aging Program Information System Federal Report
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
Native American Information Across
Agencies and Systems for 2004
Service Entity Number of Native Americans
Hospital
2,551
Inpatient
575
Outpatient
1, 351
Medicaid
Inpatient
540
Outpatient
416
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005

"It
is well to be good to women in the strength of our manhood
because we must sit under their hands at both ends of our lives." -He Dog, OGLALA LAKOTA
Office of Research and Statistics,
State Budget and Control Board









DemographicNumberNative Indian/Alaska Native
Age:
60-64 390
64-69 360
70-74 190
75-84 180
85+
60
Total 1,180
Median Income: $30,568
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
A Portrait of Older Minorities
Research Report
AARP Minority Affairs
November 1995
“Indian Health Service figures for 1990 show average life expectancy at
birth for Native Americans to be only 67 years, eight years less than
that of whites.
American Indians and Alaskan Natives are 10 times more likely to
develop diabetes than whites. In addition, alcohol abuse is a leading
cause of health problems including accidents, cirrhosis of the liver,
suicide, and homicide.
The other major health problems of older Native Americans are
tuberculosis, liver and kidney disease, high blood pressure,
pneumonia, and malnutrition.
The majority of older Native Americans rarely see a physician, primarily
because those needing medical assistance often live in isolated
areas and lack transportation. Native American traditions of ritual
folk healing and the spiritual aspect of disease have also deterred
reliance on a strictly scientific medical community. These factors are
often neglected or overlooked by health care professionals and
planners.
A Portrait of Older Minorities
Research Report
AARP Minority Affairs
November 1995
(CONTINUED)
“The status of the older minority members is
not likely to improve greatly in the
immediate future. The factors which largely
determine their quality of life (education,
employment, income, and health) will not
vary much among the minority populations
now approaching retirement age. “
Native American Information Across
Agencies and Systems for 2004
Service Entity Number of Native Americans
Hospital
2,551
Inpatient 575
Outpatient
1, 351
Medicaid
Inpatient
540
Outpatient
416
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
Native American and Alaskan
Native alone or in combination
with one or more other races

Age:

60+ 2,834
65+ 1,983
75+ 783

Median Income: $33,750


Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
AND MORE NUMBERS…….
Service Entity Number of Native Am.
DSS
TANF
349
Foodstamps
2,438
Foster Care
15
Child Prot. Serv.
19
Dept. of Ed.
2,869
DAODAS
127
DMH
281
Total Undup.
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
8,113
SO WHAT’S UP WITH THESE
NUMBERS???



Native American population demographic
information is sketchy at best!
Aging service providers need to find better ways
to reach out to older Native Americans.
There is a need for Native Americans to claim
their heritage so that services can be made
available to them.
Terri Whirrett
Lt. Governor’s Office on Aging
Presented at the Native American Conference
November 18, 2005
Alternative Views within the Native
American Population

Medicines


Disease





“Proof” of Indianness pro’s and con’s
History, genealogy


Diabetes
Heart Disease/Cardiovascular Disease
Cancer
Alcoholism/Addiction
DNA Typing


Use ancient remedies and spiritual methods
Understanding of culture
Reproduction

Spiritual/Religious beliefs
BARRIERS TO TREATMENT OF
NATIVE AMERICANS IN S.C.








Geographic isolation
Economic factors
Suspicion towards government agencies
Fear of reprisal
Serious cultural barriers; lack of
understanding by care providers
Reliance on traditional healing
Lack of respect from care providers to
Native American people
Honor is extremely important
How do we REACH this
population?








Children:
Seniors/Elders:
How will this affect their self-image?
How will this affect their health?
How does this affect their personal
beliefs?
What will they gain?
What can they lose?
How will it affect their spirituality?
How do we do OUTREACH to
this population?








Meet with Native American Leaders to “demystify” community
services
Do not practice “pan-Indianism”
Go into communities to gain understanding of cultures
Develop an education component that is culturally sensitive to
Native American history
Incorporate Native People and ask them to give input into their
needs
What will they gain?
What can they lose?
How will it affect their spirituality
So WHAT DOES THIS ALL MEAN?

How many other racial/ethnic groups have to PROVE their
heritage to receive services?

Disproportionate levels in many problem areas

Native people do not trust government agencies



NO special programs have been initiated to met the needs
of Native Americans. WHY?
Cultural awareness is essential in order to provide effective
services to this population
This population is in desperate need of early interventions
WHAT CAN YOU DO???







Research on resiliency has shown the importance of individuals and organizations in providing protection and hope to
young people, while helping them to "find the good path" and lead fulfilling lives (Benard, 1997; Bergstrom, Cleary, &
Peacock, 2002).
HONOR
RESPECT
DIGNITY
KINDNESS………………………………
COMPASSION
EMPATHY
"If I destroy you, I destroy myself. If I honor you, I honor myself." --Hunbatz
Men, MAYAN
HOW CAN YOU HELP?
WATCH WHAT YOU SAY!!!!!!!!!!!!!!!!!!

Do not demean

Do not compare

Do not question why they haven’t done something (i.e.
education, work.)



Don’t talk about Indians as though they belong to the
past. There are about 800,000 Native Americans living
in the United States on reservations, in cities and in
rural areas. - many in conditions of poverty and
powerlessness, but they are very much alive today.
Don’t lump all Native Americans together. There were
no “Indians” before the Europeans came to America-that is, no peoples called themselves, “Indians.” We
were Tsalagi, or Dine, or Lakota…….
DON’T ASSUME!!!!!!!!!!!!!!!!!!!! Ask questions with
respect.
Resources




Indian Health Service
http://www.ihs.gov/nonmedicalprograms/research/irb.htm
Native American Cancer Research
http://natamcancer.org/page3.html
The Pew Forum on Religion & Public Life
http://pewforum.org/news/display.php?NewsID=2913
U.S. Census Bureau http://www.census.gov/population/www/popprofile/amerind.html