Urban Indian Asthma
When we think about Native Americans, one of the stereotypic image that comes to mind is someone with tanned skin, a sun-beaten face, someone who is more wrinkled the older age he or she is, who is either travelling through the wilderness or living on one of the many reservations we grew seeing the pictures of when we were in elementary school. In the cartoon world, the same image provided to us casts quite a different spell on how we view and ultimately judge the Native American or American Indian to be, depending on how we are trained to refer to these people. Back in the 1980s, there were two types of “Indians” out there in the minds of children–the stereotype cartoon character and the real life movie character. To older people, these two types were traditional and modern in their lifestyle. Some of us non-natives even fantasized a little about such a cultural character, not necessarily wishing to be in the wilderness and such, since even to true Indians that was by then asking for just a little too much change in the modern lifestyle. Instead, we wanted to be able to take advantage of the new products they–the Americans Indians–had to offer us–the grocery stores built on local reservations. At first these places were cheaper sources for untaxed canned foods, alcoholic beverages and tobacco products, which you had to have a card for, but later became casinos. This turned these places into big money makers since both Indians and non-Indians were allowed to make use of them. But not once during this time in this country’s history did much about the real social and public health issues that Indians faced really come to light.
During the early 1990s, more of an understanding of the health of the Native American had developed. This is because their health had transformed from the traditional 1920s and 1930s images of a thin Indian wearing traditional or backwoods clothes, to the image of someone engaged in rural redneck like activities much of the time, living on the street or under the bridge in poverty, someone who was always “drunk” we felt. This “someone” had become a less active individual, due to which he or she was quickly becoming morbidly obese. Pretty soon, news about this public health issue hit the news–the now famous Pima Indian morbid obesity problem had taken form.
This drew attention to the problem of acculturation, and researchers started to ask, could a change in lifestyle have this much of an impact on the health of a Native American child or adult?
The answer to this research question was of course ‘yes.’ And so the interest in the “healthy gene theory” that Indians once bore was transformed into an interest in studying what came to be known as the “New World Syndrome”, a mixture of liver, gall bladder, pancreatic, and heart and blood vessel diseases related to the onset of morbid obesity, cholesterol problems, diabetes, gall bladder disease like stones, and ultimately hypertension , heart failure and heart attacks. By 1988, the existence of such a trait was published and this anthropological name made public for the first time.
By 2000, the concept of new world syndrome was well understood, and due to their late arrival in the discovery and research of this condition manifested by American Indians, the regular medical world transformed it again into what is now known as Metabolic Syndrome. This term was really used to refer to something more of an endocrine nature, not a lifestyle, psychological and emotional nature. Nevertheless, the regular medical profession had to somehow account for its slowness in catching up with the anthropologists’ interpretation of this change in the American Indian stereotype from someone who was thin, undernourished, but active and very healthy and therefore often gifted with an “athlete’s heart” or athletic bradycardia with hypotension, to someone who was very fat and often eating very unhealthy foods at the local gatherings and strip malls whenever they had a chance. (My own personal take on this was that this was linked as well to the older generations longevity patterns; the same situations that made them starve and live longer due to lack of hyperlipidemia, hypertension, heart disease and such, converted them as well to the “survival gene” trait (another name coined for it in the 1930s due to the bradycardia research), storing calories as fat in order to make it through the colder winter months.)
Metabolic Syndrome isn’t the only diagnosis related to being an acculturated Indian or an Indian engaged in making modern life changes. The Urban Indian concept also developed in the 1980s, something first made popular in the 1960s, but really a definition of the Indian that we added more meaning to due to the 1980s experience and its maturation during the 1990s. The 1980s Indian health problem still had some lingering problems with drugs, booze and laziness attached to it in the 1980s, especially since tuberculosis was a major infectious disease often born by these people. The 1990s facilitated the transfer of the Native American health issues to the urban-linked problems that related to proximity to fast foods and the like. You had the choice of living on a reservation, or in the urban setting depending upon federal welfare services for your low income housing, medical care and food stamps. The urban Indian that then developed due to this now resided in a place where asthma could ensue, due to “unnatural” environmental settings–the smog and pollution saturated airs common to city settings, which is how the urban Indian asthma problem developed into a late 1990s, early 200os public health issue.
Thus the following report I composed on Urban Indian Asthma. I made a brief attempt to promote this to the Pacific Northwest Native American public health npos to develop this into an actual project with active NIH grants out there to apply for, but politics within these settings had its way of preventing such progress. Diabetes and obesity were still the only topics of concern for the time. Within a year, Seattle took the lead in developing a similar type of urban Indian public health research program.
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A respiratory disease program for Native Americans
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Brian Altonen, MPH, MS 