The Value of AI/AN Public Health Curriculum:

Challenges and Future DirectionLarry Murillo, DrPH, MPH, MS

Assistant ProfessorSchool of Medicine

Oregon Health and Science University

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.

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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

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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

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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

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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)

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What Might AI/AN PH Curriculum Look Like?

Balance of three perspectives Professional Community

Group and individual Traditional Health Practitioners Circle

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AI/AN Public Health Issues Course

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

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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

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Levels of THP Practice

Common family knowledge Practitioners and protocol Spiritual Level

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Clinic THP Perception

Administration – Political Issue Medical – Alternative Medicine Issue Health Education

Prevention message Community Intervention

Mental Health – Intervention Issue

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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?

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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

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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

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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