SIOUX FALLS, S.D. — Specialists in American Indian health are turning to art to correct a problem in medicine.
The problem is cancer, the leading cause of death among all South Dakotans and a greater menace to Indians in particular.
A project called Circle of Life will take root this fall as an attempt to close that gap in cancer care. Sponsors will use Native art, stories from survivors and lessons on nutrition, exercise and screenings as online tool kits to encourage healthier living among tribes. The larger society has been saturated with anti-cancer messages since the 1960s, but the voices in this project are new and exclusively American Indian.
“This is cancer education for Native Americans by Native Americans,” said Charlotte Hofer, spokeswoman for the American Cancer Society, which is sponsoring the project.
The curriculum will be available at cancer.org as a resource for what Hofer calls “a positive, holistic message based on common tribal values of spirituality and respect for the natural world.” She expects community leaders and school teachers to use it in seminars and classrooms and for individuals to do the same online.
The effort rises out of a knotty health challenge. Half of South Dakota’s Indians smoke, a rate three times worse than the full population and a leading indicator of cancer. Indians are more obese, eat less nutritiously, get less exercise and see doctors less often, all factors in causing cancer or failing to catch it before it grows out of control. They develop the disease more often, and they have a death rate, at 252 per 100,000, that is 37 percent higher than cancer mortality for whites. On top of that, they’ve had to deal with a reluctance to face the problem in their own tribes and external challenges that keep rural Indians at a medical disadvantage.
“We do less cancer screening because we’re underfunded, and the result is we do not have the services that are considered standard for others. When you diagnose it later, people die,” said Dr. Donald Warne, a senior policy adviser to the Great Plains Tribal Chairmen’s Health Board and a consultant to Sanford Health.
Cancer is becoming a more visible problem, ironically, at a time tribes are seeing a gain in life expectancy. Average lifespan moved from 78 to 80 overall for South Dakota in a decade ending in 2007, and tribal people specifically jumped from the 50s to the mid-60s. Efforts to cut drinking on reservations had a hand in that, as did progress in reducing deaths to pneumonia and influenza.
But living longer has its side effects, and one of them is cancer.
“One of the biggest risk factors for cancer is getting older. Decades back, Native folks never lived long enough to get cancer,” said Kris Rhodes, executive director of the American Indian Cancer Foundation in Minneapolis.
The power of imaging is central to the Circle of Life, with the color illustrations, photography and text from and for Indians. It is to be a work of art with personal impact, no small matter for minorities often left at the margins of health messages.
“If you’re from the majority society, and people all look like you, you don’t even think about that,” said Warne a South Dakota native and member of the Oglala Lakota tribe. “But if you’re not from the majority society, you start to wonder if this is for me. Health messaging is more effective when it’s culturally tailored and culturally appropriate and when the messenger is from the same cultural group as the person receiving the messages.”
Success in this case will require a shift of opinion on smoking, a greater openness to health screening and a willingness to get past a barrier to acknowledge a problem. Roberta Cahill, director of community partnerships for the American Cancer Society in Pierre and a Yankton Sioux member in her 60s, said tribal people for years have had trouble owning the problem.
“People did not talk about cancer much,” Cahill said. “A lot of time people were unaware of others who had survived cancer. In other instances, there’s a belief if you talk about something it’s going to happen. It’s been a very difficult topic to bring up in communities.”
Smoking complicates the challenge. Indians use traditional tobacco in spiritual ceremonies, which is distinct from the addictive commercial tobacco people smoke for periodic pleasure. It’s the commercial tobacco that now plagues Indian country with a 49.9 percent smoking rate, in contrast to the steadily falling 15.3 percent rate for whites in South Dakota. The government might have had a hand in this disparity by sending surplus smokes to the tribes after World War II and thus fostering an addiction for huge numbers of Indians.
“It is definitely the social norm to smoke. It’s the affordable luxury when there are high rates of poverty. The cultural context is huge,” said Rhodes from the cancer foundation. Rhodes, 43, from the Anishinaabe tribe in northern Minnesota, experienced it herself. “I smoked as the thing to do in high school and college. Then I just quit. I was one of the lucky people,” she said. She later taught tobacco control classes in Indian country and found the social connection to other smokers the hardest link to break. The new curriculum will need to finesse the point.
“Messages around tobacco need to be sensitive to separate out the spiritual use. When it’s our most sacred medicine, you can’t just say ‘tobacco kills.’ It takes a bit more messaging than that.”
The effort comes alongside state health department efforts to make breast, cervical and colon cancer screening accessible to all residents and as the major health system try to cover more rural areas.
“There’s a lot to be learned,” Rhodes said. “For too long Native folks weren’t at the table. Now with Circle of Life we are engaging communities to ask the question, what’s not working and what needs to be changed.”
Information from: Argus Leader, http://www.argusleader.com