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  • 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.

  • >> 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</