Chasing the Dream: Dr. Donald Warne

Ashley Thornberg:

Dr. Warne, thank you so much for joining us today.

Dr. Warne:

Well thank you. Very happy to be here.

Ashley Thornberg:

I'd like to start because this entire project relates to poverty, so just your perspective as an academic, your perspective as an American Indian, what is poverty to you?

Dr. Warne:

Well, I come from a small town called Kyle, South Dakota on the Pine Ridge Indian Reservation. In many ways, Pine Ridge really could be considered the epicenter of health disparities and poverty, and other types of disparities. Poverty is more than just a lack of financial resources. It has an impact on people's sense of the future and their hope for the future. What I observe in a lot of our tribal communities, really, is a culture poverty in which people do not believe they have the opportunities that many people outside our reservation communities have. When we see less access to opportunity and people believe that their destiny does not include prosperity, that has a huge impact on behavior including whether or not people see the value of finishing school or see the value in good health behavior.

I see poverty, really, as the root cause of a number of our disparities and challenges, both in education and in health.

Ashley Thornberg:

Why do you call that reservation the "epicenter" of poverty?

Dr. Warne:

We have the most impoverished community when we look at various years of the census. It seems that what used to be called Shannon County, it's now Oglala Lakota County which is the home to the Pine Ridge Indian Reservation, we're always in the top five of the most impoverished counties in the nation. Unfortunately, it has a huge impact on health outcomes as well. In talking to the health director at Pine Ridge, the average age at death for men from Pine Ridge is now down to 48. I'm 50, so we have in many ways third world health conditions in our reservation communities. The numbers are similar in North Dakota. The most impoverished counties tend to be the reservation counties, and the average age at death for American Indians in the state of North Dakota including the cities. If we look at all American Indians, it's 20 years earlier than the white population. Poverty has in impact, like I said, on education and health but certainly even life expectancy is correlated with income.

Ashley Thornberg:

In your first answer, you said something really important: "Do not believe in opportunities." What do you mean by that and how does that have an affect going forward when it comes to getting out of poverty?

Dr. Warne:

When we think about poverty, we have to think about our own childhood experiences. If we think about the majority population and you grow up in a city or suburb, and all of your teachers are your same race or ethnicity, all of the principals are the same race and ethnicity, all of your doctors are the same race and ethnicity, essentially every professional you ever met is from your race or ethnicity, then everything seems possible for American Indian children growing up on reservations. We rarely have American Indian doctors and teachers, and principals, and professionals. Even in my own experience, it wasn't until I was in college when I had actually met an American Indian physician and I had to seek him out. It was a life-changing event for me just to meet an American Indian doctor. In truth, I knew that it was not illegal for an Indian to become a doctor, but it didn't seem real until I met one. If you're from the majority population, you don't know what that feels like.

Combine that with all of the social circumstances that poverty can generate including intergenerational abuse. We see substance abuse, we see violence, violence against women, violence against children, neglect, food insecurity, all of these challenges. For children who do not have the framework in which to process that appropriately, the future does not look bright. Unfortunately, we have one of the highest rates of suicide among our young people as well. Again, much of that comes down to poverty, and not just financial poverty but poverty of opportunity.

Ashley Thornberg:

We're visiting today with Dr. Donald Warne. I'm Ashley Thornburg with Bill Thomas Dr. Warne is the chair of the Department of Public Health at North Dakota State University. He's also a past director of the Office of Native American Health at Sanford Health. A 2015 report from the Center for Disease Control shows the suicide rate was highest in the American Indian and Alaska Native population. In fact, American Indian and Alaska Native males were more than twice as likely to commit suicide as most other gender and racial and ethnic subgroups. American Indian groups also face diabetes at more than twice the average of non-Hispanic whites. They lag behind the national average for graduating from high school at just 67% versus 80%.

Researchers link much of the chronic problems to the systematic breakdown of traditional Native life. In the 400-year history of the American Indian genocide, roughly 90% of the population was killed and many survivors forcible removed from their homes, not allowed to speak their native languages, eat their ancestral foods, or practice traditional customs.

Bill Thomas asked Dr. Warne about the collective impact of sustained abuse known as historical trauma.

Dr. Warne:

Historical drama has been studied in various populations, including future generations of people who survived the Holocaust. What we see is that people who feel culturally closely connected to cataclysmic events that occurred in history tend to have worse health status and tend to have more challenges. What we see is that there's an ongoing from generation to generation passing down of traumatic events, sometimes in a very direct way. I think if we look at American Indian experience, not just warfare and loss of land and loss of resources, and loss of self-governance in many ways. What we also see is loss of traditional parenting, loss of traditional societies. Historically, at least in my tribe, the entire family was involved in bringing up children. We had aunts and uncles who had a key role in raising children.

I think what we've seen with the boarding school experience is that a whole generation of children, who are now the grandparents of today, were taken away to boarding schools were taught a very different way of thinking and believing. They suffered abuse and neglect themselves. In the boarding schools, many of the children died. If you look at the boarding schools in the east coast, for example Carlisle, Indian school in Pennsylvania. There's a huge graveyard right next to the school. We don't know why so many children died at boarding school. We know that there were outbreaks of tuberculosis, but that doesn't explain all of the death among these children.

I think of it, also, from the perspective of the survivors. What if as a child, so many of your friends and playmates were dying at an unnatural high rate? Does that have an impact on your future? Does it have an impact on your health behavior? Does it have an impact on your future parenting skills? We can see it passed down in a very direct way from generation to generation just looking at intergenerational abuse and neglect. In addition to that, there is an emerging scientific framework to better understand this. It's through what's called epigenetics. I'm sure some of the listeners have heard of the concept of epigenetics, but essentially what we're finding is that stressful events can have an impact on gene expression. You can actually see changes in genetics occurring based on stressful events. Certainly the American Indian experience is a highly stressful experience.

Basically what genes do is make proteins. We can see that if a gene is compromised through stress and not to get too technical, but there's a methylation process in the nucleotides of DNA. When we see mutations in the gene or some other types of stress on the gene, it can have an impact on the proteins that are created and those proteins can be stress hormones, those proteins could be certain types of receptors. There's a good and emerging scientific framework to better understand this.

Bill Thomas:

When did the boarding school policy end?

Dr. Warne:

Well, there was forced removal during the late 1800s-early 1900s where children were taken away, in many cases, thousands of miles away to boarding schools.

Bill Thomas:

They took them far away partly to keep them from going back because the children would want to go back to their families.

Dr. Warne:

Yeah, exactly. In terms of forced removal, I don't know the exact date when that occurred but just thinking in my own family, my mother was taken to boarding school at Pine Ridge. The stories that she has are just remarkable. They would treat many of the children terribly. They were incredibly strict I think beyond what would be natural for a child. There were a lot of beating that occurs. She says that every Wednesday, the kids would have their hair washed with turpentine to either prevent or get rid of lice, even if there were no lice in the children's hair. That was every Wednesday that would occur. It's very dehumanizing. This isn't something that's so far in the past that we don't have memory of it. This is my mom's experience, and it's certainly had an impact on her.

Ashley Thornberg:

How long did it take your mom to open up about what happened to her at boarding school?

Dr. Warne:

She didn't start talking openly about it until maybe the last five to ten years. She's 78.

Ashley Thornberg:

How do you think that her experiences at boarding school affected her parenting specifically and her self-esteem and self-worth?

Dr. Warne:

Well my mom is very strong, extremely strong. Obviously based on that, she's had high expectations of her children which actually turned out to be very beneficial to her brother and I. She also was fortunate in that she was second oldest in her family of ten children. Her oldest sibling, unfortunately, passed away in childhood so she wound up being the oldest and kind of the leader within her family. One of their other challenges in addition to boarding school was that their family was relocated to Rapids City in the 1950s. For the first time in her life, when she was in middle school, she was a minority. She had always lived in Pine Ridge among Lakota people. If you can imagine Rapids City in the 1950s, extremely racist. Openly racist. No shame about their racism. It had a huge detrimental impact on my mom's immediate family. We saw a lot of substance abuse for self-medication for some of the depression and terrible things that were happening within those social circumstances.

I was just very fortunate. My mom is incredibly strong, so she raised my brother and I, I think, in a very good way. She was also old enough to still be connected to a lot of the cultural traditions. Unfortunately, most of her siblings have already passed away, but for the surviving siblings there have been challenges with substance abuse. They're all in recovery now which is wonderful, but I think just not having the community-based community parenting that was traditional was detrimental to a lot of my family members, both immediate and extended family. For me, I was fortunate. She's very strong and I think more strict, I'm not sure what the right term is, than some of my contemporaries' parents were. In the long run, it made my brother and I very strong as a result, but that's not the typical outcome. Quite often, we see parents who are survivors of boarding schools wind up having their own problems with addiction and subsequently future generations suffer as well.

Ashley Thornberg:

It can be really hard not to internalize a message like that. Like you said, your mom used to have her hair washed in turpentine every week as if she had a disease or a bug. It becomes easy when you live with that day in and day out to internalize that message, to just say, "I can't fight. I'm not worth it to fight this."

Dr. Warne:

Yeah, and obviously there's a lot of anger that's generated, a lot of depression and anger. If people do not have positive outlets for that type of energy, we see negative outcomes. Certainly people self-medicate with alcohol and other substances based on those experiences, but what I've seen in my own experience is that people who have a positive outlet whether it's traditional ceremonies or other types of cultural connectedness, I do see protective effects and I do see a lot of resilience among our people. I think for a lot of populations that they suffer the same things that American Indians had suffered, they wouldn't be around at all. Really the resilience and strength of my people is why we're here today.

Ashley Thornberg:

You know, there's this series of billboards in town that you sometimes see that says, "Just one thing: drink water," "Just one thing: wear sunscreen" as it refers to physical health. When we talk about problems that are related to systemic racism, a destruction of culture, language, the framework to properly raise a child and add in the chronic health and acute health conditions. I know there is no possible way to have one solution, but what are some of the ways that we can alleviate poverty among the population that does live in poverty?

Dr. Warne:

It is very complex. It's taken generations and systemic policies to lead to the high rates of poverty. You're correct; there's not going to be one magic bullet, so to speak, to fix it but there's a number of things that can be done. It starts of course at the tribal level. I think that with the tribes that we see that are more successful in terms of economic development, educational programming, health services, and other social services, they have very strong self-governance. The tribes that are more dependent on external entities and external programs tend to have more challenges. The solution there, of course, is to promote self-governance but we also I think to be honest in many of our tribes, we need better tribal leadership. Certainly in some of the communities where I've lived and worked, I've seen wonderful tribal leaders that promote sovereignty and really understand the issues. I've been in other settings where our tribal leaders don't understand the issues as well as I wish that they did. That's just the truth of it.

Just to say strong tribal leadership, there's more to it than that. We need to build the educational systems that can generate people who understand governance very well, who understand economics very well, and understand health systems and educational systems and other social systems. Education's a big part of it. We also do need to ensure that the federal government lives up to its trust responsibilities. The land and natural resources that have made this country wealthy are not European resources; these are American Indian resources, and we did not lose those resources in a war. They were exchanged through treaties in which the tribes exchanged land and natural resources for various social services like housing, education, and health care. If the federal government does not want to fully fund Indian Health Service, for example, that's fine. Just give us our land back. Of course that's not going to happen any time soon.

I think there's a role for tribes to strengthen their self-governance, but the federal government also needs to live up to its trust responsibilities and fully fund the services that are owed to tribes based on the exchange of land and natural resources. I look at the Indian Health Service as the largest prepaid health plan in history. It's not free healthcare; we gave up a lot for those basic services, but we're funded at less than 50% of our needs for health services.

Ashley Thornberg:

Dr. Warne, thank you so much for joining us today.

Dr. Warne:

Thank you.

Ashley Thornberg:

That'd Dr. Donald Warne. He's the chair of the Department of Public Health and an assistant professor at North Dakota State University. He's an Oglala Lakota man who grew up on the Pine Ridge reservation in South Dakota. He studied medicine at Stanford and earned his master's of public health from Harvard University. We've been visiting about historical trauma, the concept that the effects of collective abuse of a group can be passed on to future generations. Mostly, we've been focusing on the behavioral impacts. If someone is abused, they're more likely to become abusers. Dr. Warne also spoke about epigenetics, saying that research is pointing to the fact that stressful experiences like abuse and chronic health conditions may actually change things on a genetic level. In his paper "American Indian Health Disparities of Psycho-Social Influences," which he authored with fellow assistant professor Denise [Lashmidir 18:30], Dr. Warne says the field of epigenetics may advance research in the field of historical trauma.