ALASKA NATIVES COMMISSION
JOINT FEDERAL-STATE COMMISSION
ON
POLICIES AND PROGRAMS AFFECTING
ALASKA NATIVES
4000 Old Seward Highway, Suite 100
Anchorage,
Alaska 99503
TABLE OF CONTENTS
Witness List | Exhibit
List
| PDF Version
Deposition Exhibit #9 - Testimony
of Margaret Wilson
TESTIMONY TO ALASKA NATIVE COMMISSION
July 18, 1992
This testimony was prepared in response to identified
health needs of Alaska Natives residing in the Alaskan Interior.
WHY
THIS POPULATION IS AT RISK
Prior to the presence of non-Natives
in Alaska, aboriginal peoples congregated in non-competitive
extended family groups.
The family
was both the chief socializing agent and the economic unit. This
social organization relied upon informal response systems for
decision making and for social control while Elders made known
the cultural values.
Within a relatively short period of time,
cultures which allowed Natives to survive in one of the earth's
harshest environments
have been nearly destroyed, leaving many Alaskan Natives in a
state of cultural limbo. The problems that besiege us have not
been historically prevalent in Athabascan culture; we know that
this current solution is both tragic and unacceptable.
BEHAVIORAL
HEALTH
A study by Dr. Bernard Segal, of the University
of Alaska Anchorage, outlines prevalence and incidence rates
and substance
abuse patterns
among Alaskan youth. Segal's 1988 study suggests that several
noteworthy changes in drug taking behavior have occurred among
Alaskan youth since an initial study reported in 1983. Overall,
the lifetime experience of youth with one or more chemical substances
has increased, especially experiences with marijuana, hallucinogens,
and inhalants. Lifetime experience with marijuana is up 7.7%,
while hallucinogen and inhalant experiences are up 9.4% and 9.1%
respectively. Crack use was not reported in the initial (1983)
study, however, a 4.7% lifetime experience was reported in 1988
(all are reported at 95% confidence intervals). Segal also reports
that 5.8% of the students polled drink alcoholic beverages five
or more times per week. In a more recent study Alaska Adolescent
Health Survey 1990 in which over 5000 students were assessed
the rates have increased dramatically. Marijuana usage was reported
in 45.9%of males and 45.8% of females in grades 10-12 or ages
15 to 18. 22.2% of males and 20.5% of females in the 7th-9th
grades or ages 12 to 14 admitted to marijuana use. While most
teens have tried alcohol, 25% of 12th graders in larger communities
(population over 2500) and 16% of smaller communities (population
under 2500) drank either daily or weekly. Many start their drinking
patterns early on. And many of these youth already have problems
as a result of alcohol use and abuse. Although the use of inhalants
(sniffing glue, gas or paint) is not as common in our region
it is a problem and the population using it is much younger.
The use of cocaine in rural areas is increasing but because of
the cost is usually not the drug of choice in the rural setting.
The
above information suggests that substance abuse is epidemic among
youth in the Interior region. Our observations suggest
that, as they are elsewhere, drug use incidence and prevalence
rates are even higher among high school drop-outs. While drop-out
rates are not offically calculated in Alaska, it is known that
rural Native students drop out at a higher rats than do their
non-Native urban counterparts. This suggests that rural Native
drop-outs are even more likely, than those polled by Segal, to
have or to develop a substance abuse problem.
In 1987 alone there
were 641 youth age 17 and under who were treated for substance
abuse in programs supported by the Alaska
State Division of Alcoholism and Drug Abuse (ADA). This figure
does not include adolescents who were treated at private for
profit inpatient facilities such as Charter North.
A variety of other factors contribute to, and are associated
with, adolescent alcohol and drug abuse. The following social
conditions and problems have been identified as significant indicators
which suggest that Alaskan Native youth represent a vulnerable,
multi-risk population.
SUICIDE - A 1986 study of suicide
rates among Alaskans reported by Hlady and Middaugh reconfirmed
the
established finding that
suicide in epidemic in Alaska, especially among young Native
males. During 1984-1985, the proportion of Alaskans committing
suicide that were Natives (33%) was significantly larger than
the proportion (14%) of Natives among the population. For all
races, the average annual age-adjusted rate was 21.0 per 100,000
population per year. Among Natives it was 42.9 suicides per 100,000
population per year, 2.2 times the White age-adjusted rate of
19.1 suicides per 100,000 population per year, (pg.14). Of 57
Alaskan Native suicides in which the blood alcohol level was
tested, 79% had detectable levels of blood alcohol compared to
48% of the 110 White suicides tested, (pg.16). Clearly, the risk
of suicide increases when alcohol use is involved.
This year,
the Interior Native population has experienced an explosive increase
in the number of suicides completed, a number
of which were carried out in public. Within the TCC region in
the past year, we have experienced 12 completed suicides, ranging
in ages from 16 to 72. We are gravely in need of effective intervention
measures but limited resources constrain our efforts to a limited
response. Limited staffing precludes a simultaneous response
to crisis calls from the villages, continuation of full service
levels to urban beneficiaries, and the provision of routine itinerant
clinical and prevention services. Our ability to do more with
less has reached a critical point. The TCC Community Health Services
has established a Suicide Task Force in the past year and have
come up with a prevention plan that consists of three elements
that combine both short-term, suicide crisis intervention and
long term community development and educational efforts. We know
that this will require major effort and more funding.
HOMICIDE - According
to the Alaska Office of Alcoholism and Drug Abuse,
over 80% of all homicides in the state are alcohol related. The
homicide rate in Northern Alaska is even higher than that seen
statewide. In 1987, homicide was the seventh leading cause
of death. Homicide rates in the rural areas of the TCC region
are 50% higher than those in the urbanized Fairbanks North Star
Borough and nearly 50% higher than the statewide average.
ACCIDENTAL
DEATH - Alaskans from rural communities are also at
great risk of accidental death. Accidents are the number one
killer of Northern Alaskans, accounting for 24.7% of all deaths
for the five year period 1979-1983. Motor vehicle accidents were
the most frequent cause of accidental death each year from 1979-1983,
followed by water-related accidents, aircraft accidents, and
firearms. Accidents claimed 424 lives in Northern Alaska during
this period.
In Alaska, alcohol involvement in motor vehicle
fatal accidents for 1987 was 58%. Juveniles, ages 16-20
made up only 6.8% of
Alaska Drivers in FY-87, but were involved in 21% of alcohol-related
traffic deaths and 13% of all alcohol related accidents (Alaska
State Office of Alcoholism and Drug Abuse). With the arrival
of ATVs and snowmachines the accident rates are higher because
of alcohol involvement.
Water related accidents are the second
most frequent cause of accidental death. In the northern region,
outside the Fairbanks
North Star Borough and the highway corridors, water related mishaps
are the leading cause of accidental death. Most of the victims
of drowning and boating accidents are Native males. No hard data
exists to show a relationship between alcohol use and water-related
accidents but we are confident such a pattern exists.
Overall,
Natives account for a much larger percentage of accidental fatalities
than their proportion of the population would suggest.
In 1981, accidental deaths am Alaska Natives accounted for 38.8%
of all such deaths in the Nothern region, while Natives at that
time represented only about 20% of the population (Alaska Department
of Health and Social Services, 1982b).
TEENAGE PREGNANCY - Early
pregnancy is also identified as a potential factor in adolescent
substance abuse. Of the 345 children born
to rural Interior Native mothers, 14.8% were born to mothers
age 19 and under. In one of our interior villages this year alone
we had 4 teenage pregnancies, all these girls were still in high-school.
For the years 1980-1984, the average annual birth
rate for rural Interior mothers under age 19 was 12.1% (Alaska
Department of
Health and Social Services, Vital Statistics Annual report, 1981,
1982, 1983, 1984. Juneau, Alaska. 1983, 1985, 1987).
While Native
teens (15-19) comprise only 18 percent of the population in this
age group, they represent 43 percent of the teen births.
It is well established that children born to young mothers have
greater risk of developing health problems, of being physically
abused or neglected and of becoming substance abusers later in
life.
Poverty and unemployment contribute greatly to
substance abuse problems. In the Northern region, most of the
communities
outside
the Fairbanks North Star Borough are considered to be "poverty
areas" by federal designation (U.S. Dept. of Health, Education
and Welfare, 1978). Because of the extremely high costs of food,
shelter and utilities; the federal guidelines for poverty are
much too low. In many rural Alaskan communities, upper income
bracket families have actual purchasing powers below those of
urban "poverty level" families. These vast differences
in living costs cause real impoverishment far in excess of "on
paper" poverty. Year around paid employment is extremely
limited and a significant proportion of rural Alaskans live in
poverty.
As illustrated above, substance abuse and other
conditions are clearly an overwhelming problem in rural Alaska.
The implication
for continued social problems, loss of traditional values and
lifestyles, family breakdown, and decreased quality of life for
Alaskan Natives is obvious.
SEXUAL ABUSE/PHYSICAL ABUSE -
According to the Adolescent Health Survey 1 in 4 females report
being sexualy
abused and nearly
the same amount 23% report physical abuse. Who do these abused
youth tell? NO ONE. The magnitude of abuse is vast as it is in
other places.
MATERNAL AKD CHILD HEALTH
The Tanana Chiefs Conference
leaders and member village show a grave concern about FAS and
its effect on the future of Alaska
Native people. Every village in the region (43) participated
in voluntary toxic fetal effects information and planning meetings
in 1990. These meetings served to inform community members about
toxic fetal effects and to gather ideas on how best to prevent
FAS in the Interior communities. The proposed program represents
an important part of this region-wide toxic fetal effects prevention
effort.
The problems cited below suggest an urgent need
for FAS, Alcohol Related Birth Defect (ARBD), and other toxic
fetal effects
prevention
education services for the rural Interior population.
FETAL ALCOHOL
SYNDROME - Alaska Natives suffer the highest rates of
FAS of any studied population in the world. The statewide
FAS rate for Alaska Natives is 4.3 per 1,000 live births as reported
in 1989 by the Alaska Area Native Health Services, Community
Health Services, statewide screening program. FAS rates among
the Tanana Chiefs Conference region population are higher still
at 4.6 per 1,000 live births. The FAS incidence rate of 4.6 per
1,000 live births reflects only cases which meet all three FAS
diagnostic critiria: growth deficiency, altered morphogenesis,
and mental retardation. In the Interior, this rate means one
to two Native babies are born with FAS annually. This does not
address the needs that these children born, with FAS face in
the future.
ALCOHOL RELATED BIRTH DEFECTS -
Maternal drinking is linked to Alcohol Related Birth Defects
(ARBD), which range
from moderate
to severe. These include growth retardation, increased risk of
anomalies, behavioral effects, mental retardation, and increased
mortality. It is estimated that for every child born with FAS,
10 are born with ARBD. The estimate rate for Interior Alaska
would be 46.0 per 1,000 live births. Other factors contribute
to the high incidence of FAS and ARBD in the Interior region
and suggest an urgent need for FAS/ARBD prevention and early
intervention services.
AT-RISK-MOTHERS - For the calendar
year 1987, 19% of the prenatal patients at the Alaska Area IHS
were
identified as "at-risk" from
substance abuse. In the TCC region, that translated to 60 per
year.
YOUNG POPULATION - The Alaskan population in general
is very young, with about 29% under 15 years of age. Among Alaska
Natives,
about 4,000 or 33% are under 19 years. In general, mothers who
are 19 or younger or over 35 are
more likely to have complicated pregnancies and to deliver children
with physical problems than are women aged 20-34. In the Interior,
19.4% of Native children were at high-risk due to their mother's
age (19 and under), while 8.7% of non-Native children were at
such risk.
HIGH BIRTH RATE - For the Interior region, the
Native Alaskan birth rates of 26.7 births per 1,000 population
exceeds
the statewide
five-year annual average of 24.2 per 1,000 population by 10.8%
and the national average of
15.7 births per 1,000 population by 70.1%. The Native birth rate
in the Interior is very similar to that of the Interior population
as a whole.
LOW BIRTH WEIGHT - The number
of babies born weighing less than 5.5 pounds is an indicator
of high-risk pregnancies.
Natives
experienced considerably higher low-birth weight rates both in
the Interior (61.2%) and in the state (59.6%) than did non-Natives
(48.4%, 45.5%) in 1984.
INFANT MORTALITY - Native infant
death rates in Alaska and the United States have been declining
for
the past several years.
From 1955 through 1982, the death rate for Indian infants in
the U.S. fell by 82%. The rate is now similar to the U.S. population
as a whole, although in Interior Alaska the experience has been
more variable. Because of the small population size, cosiderable
fluctuation in annual rates can occur randomly. Six-year average
rates are more appropriate when studying occurrences in small
communities.
The six-year (1979-84) annual average rate gives
che Interior's non-Natives an infant mortality rate of 10.41
compared with a
national rate 11.76. The rate for Native infants is different
from non-Native infants with a rate of 19.74 for Interior Alaska
Natives. The difference between the Interior Alaska Native and
the national rate is 68%. The Interior's Native infants are more
than half again as likely to die during infancy than were their
counterparts nationwide.
SUDDEN INFANT DEATH SYNDROME (SIDS) -
is the single greatest cause of death in the post neonatal infancy
period. Recent research
reports have linked SIDS deaths to prematernal cocaine use. One
study reported a nearly 4,000% increase in SIDS incidence among
infants born to cocaine-using mothers. (American Journal
of Diseases of Children, May 89, Vol. 143, pg. 583). The Native
mortality
rate for SIDS (4 per 1,000 live births) exceeds the total national
rate for all infant deaths.
PRENATAL CARE - In 1981, over
25% of pregnant women in the Northern region in Alaska did not
receive
prenatal care in their first
trimester. The majority of women delaying care until the third
trimester were Native. According to Northern Alaska Health Resources
Association's Health System Plan for 1985-1989, prenatal service
delivery in the Interior is not comprehensive enough and needs
better coordination among service providers.
SEXUAL RELATIONSHIPS -
Because of known high rates of sexually transmitted diseases
and high incidence of substance abuse in
rural Alaska there is great concern that HIV/AIDS will take hold
and spread quickly. At the present time the diagnosed cases of
AIDS is relatively low as is the number of HIV positive people.
Again, according to Adolescent Health Survey, the average age
of first sexual intercourse for females is 14 years of age and
for males is 13.2 years. The first choice of contraception for
both females and males is condoms; the second choice for females
is birth control pills. Typically, as everywhere else, many teens
get more misinformation than information and mostly from their
peers.
PRESENT SERVICE - We have several
rural alcohol and mental health programs in our subregions. We
have hired more
village based para-professional
counselors and emphasized training for all our counselors. We
have 4 alcohol recovery camps, one of which is open year round
and staffed by Native people. We have emphasized family treatment
as a unit and focused on traditional values. We are holding more
workshops in the villages which focus on alcohol and alcohol-related
problems. This year we have held 4 workshops in different villages
and some of the subjects addressed are suicide, FAS, HIV/AIDS/SIDS,
self-esteem, parenting, forgiving, children of alcoholics. We
publish HUNK ZOO monthly, which addresses substance abuse prevention
for our school age children. We have a substance abuse prevention
trainer, an PAS prevention coordinator, and an HIV/AIDS prevention
educator, all of whom travel constantly during the school year
to reach our school age population.
We have health and safety
educators in each of our subregions and we do a variety of health
promotion and injury prevention
activities. Yet we fall short because of lack of adequate travel
funds and lack of current material. We have attempted to work
with the 7 school districts within our region trying to supplement
their health education.
Our youth program has been active without
adequate funding. We have been able to sponsor some of our youth
for our TCC Conference
and we have never been sorry. These young people have already
impressed us with their abilities to move ahead and address and
identify issues that are significant to them.
Since the late
1800's, the influence of religious groups, traders and American
government policy has contributed greatly to the
breakdown of village social organization. Moreover, changes in
the economic life of Native communities, from subsistence to
a cash economy, have resulted in further social disruption. Poverty
has also resulted in increasingly limited or resisted subsistence
resources. Torn between two cultures many Natives have turned
to alcohol, suicide and violence as a way of alleviating the
anger and confusion of losing the old ways and of not belonging
to the modern world. These trends are more pronounced among the
youth.
Many in our population suffer from low self-esteem
and are poor decision makers. Unfortunately because of inadequacies
with school
funding many of our youth are not prepared for higher education.
We need to start focusing on teaching the Athabascan language
in our schools along with cultural activities; we need to prepare
our youth for professional and vocational training; we need more
positive role models. We need to start strengthening our family
unit so that the provision of spirituality and culture can be
met. We need to acknowledge domestic violence, sexual/physical
abuse and depression as problems and stop denying that these
problems exist. We need to nurture our youth because that is
where our future lies, and we need to encourage them to take
an active part in their well-being and we need to address the
problems and difficulties that face our male population.
SOURCES:
Alaska Dept. of Health & Social Services.
Alaska Vital Statistics
Annual Report, 1984
Juneau, Alaska. 1987.
Northern Alaska Health
Resources Assn.
Health Systems Plan, 1985-1989.
Fairbanks, Alaska. 1985.
The State of Adolescent Health in Alaska
Dept. of Health & Social Services
Office of Prevention
Juneau, Alaska 1989-90.
Prepared by Margaret Wilson
Community Health Services Director
Tanana Chiefs Conference
122 First Avenue Fairbanks AK 99701
This document was ocr scanned. We have made every attempt to
keep the online document the same as the original, including
the recorder's original misspellings or typos.
