Cherokee Nation monitoring death causes among its citizens
Amy DeVore, Cherokee Nation Public Health educator, speaks with Regina Sumler, left, and Mettie Detherage during a smoking cessation class at the CN Vinita Health Center. Tobacco use is the No. 1 cause of death in the CN, according to the tribe’s Public Health department. ARCHIVE
TAHLEQUAH – When considering the leading causes of mortality among Cherokee Nation citizens, there are considerations and even anomalies to absorb when perusing the data, officials say.
Firstly, it can take a few years to get mortality data that accurately identifies the deceased by ethnicity.
“The first thing to know about death certificate data is racial misclassification,” Dr. David Gahn, CN Public Health medical director, said. “Native Americans might be listed as white by whoever filled out the death certificate. So (the U.S. Centers for Disease Control and Prevention) has worked with the Indian Health Service and the (Oklahoma State Department of Health) to connect the mortality records with the Indian Health Service health care database to reclassify race. That has been done through 2015.”
Gahn said mortality data is available through 2018, but should not yet be compared with earlier years.
“We find up to a 30 percent difference if you use reclassified data versus the original data,” Gahn said. “We can still do relative causes of death, but the numbers– if we go past 2015 – aren’t as reliable.”
Public Health officials have filed reports on causes of death within the CN, and more recently a report on cardiovascular disease. Gahn said the figures he finds fascinating and disturbing are the potential years of life lost.
“We usually use the age of 75, and the numbers are staggering,” he said. “If you are a nation of people, and it is your culture you are preserving, you’re losing that much of your culture. The elders, the grandma who is teaching her granddaughter the names of plants and how to grow a garden, the grandpa taking his grandson fishing – it is thousands of years per year of potential life lost.”
Gahn said it hasn’t been difficult to identify the biggest health dangers to American Indians within the Nation’s jurisdiction. He called it a “simple message.”
“There are three risk factors that cause four conditions that account for 63 percent of the deaths of Native Americans in the Cherokee Nation,” Gahn said. “Tobacco is the No. 1 cause of preventable death, hands down, in the U.S., Oklahoma and the Cherokee Nation. That is followed by poor nutrition and lack of physical activity.”
The CN is in an advantageous situation with health facilities and a public health service, he said. “It is powerful and somewhat unique. The state doesn’t have hospitals everywhere, and Hillcrest Hospital in Tulsa doesn’t have a public health department.”
Gahn said patients are provided “clinical medicine” at the clinics and W.W. Hastings Hospital, while Public Health focuses on improving health outcomes for populations and communities, including smoking cessation, nutrition, education and other programs. Public Health policies may be encouraged.
“The power of policy is when we ban smoking in our government facilities, we are sending a message that smoking is bad for you, we don’t want you to do it, and we want to help you not do it,” he said. “Secondhand smoke is also bad, so we aren’t going to let you harm others. You try to match policy to the right situations. When a school says no more soda machines, that’s a huge policy. Those are policies where we are trying to change the environment.”
Public Health also sharpens its focus on populations that may not be living as long as expected, or if an unusually large number of people within an age group are dying of a specific cause.
“We are able to monitor mortality,” Gahn said. “We have strong partnerships with the state health department. We have our own cancer registry. The state has that data as well. We use both to monitor cancer incidence rates and mortality – the diagnosis, the stage of diagnosis which affects mortality and the actual mortality rates. We also focus on discovering the barriers to care.”