Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
JOYCE NASEYOWMA-CHALAN: Good morning everyone. There must have been a short person here. I want to say thank you to Tishia. I can say Tishia and I remember Tishia because my daughter’s name is LaTisha and we call her Tishia, so I was expressing to her this morning that that’s such a beautiful name. So thank you for the very warm welcome. I appreciate that. Before I begin this, as I was introduced, I’m an Indian person actually born and raised, I guess, I don’t know when you say “raise,” seems like we’re always growing, every day we’re being raised, so. I lived about 18 years of my first part of my life in this state because I’m Hopi and I was born in Tuba City, Arizona. So if any of you know how Arizona is situated, that’s north of Phoenix. But part of our way of acknowledging everyone’s existence are the fact that we come together any time is always considered an opportunity, and in fact, sort of some element of sacredness, and I want to honor your physical, your emotional, your spiritual, and your mental presence here at this time.
So welcome and I hope you recognize that you’re not only here physically, but you have brought all of these different energies and your spirit is here with us too. I have to get used to this. I forgot to press. We’ve got several gadgets up here, so if I seem like I’m not quite coordinated here, I’ll get it together. Anyway, for the sake of my presentation or what I’m going to speak to, I wanted to talk primarily about New Mexico and Arizona, but since I’m representing New Mexico, I’m going to present more information regarding New Mexico. I have some slides here because I think it’s so important for us to remember that we’re here on this earth as guests to Mother Earth and she deserves the respect as indeed she is the elder, and as I was driving down here, I drove from Cochiti, down here with my family, and even though it was dark, I could just feel the beauty in the country and the landscape as I was coming through here, and I just, you know, am in awe every day about what we’re surrounded with and we always have to be reminded that we’re here surrounded by all of this massive land base.
I want to introduce myself properly. Since I’m Hopi and my primary language is Hopi, I want to say to you that Joyce Naseyowma-Chalan [speaking foreign language]. What I said to you is that my English name, or my white man name, is Joyce Naseyowma-Chalan. Though I will always be known as my Hopi name, I’m from the Sun Klan and I make my home in Cochiti Pueblo. I’m part Taos and this is my family. I actually have another child who is 28 years old, who has blessed our family with a five-year-old grandchild. We are here in this vast area and the unique piece of this all is that we’re in this region where one of the largest land bases is connected with the Navajo nation and I think that creates--that’s just an example of some of the challenges we’re faced with here. In New Mexico, we have about 1.8 million residents. The population is about 1.8 million compared to Arizona, which is 1.5 million. This is a demonstration of the racial and ethnic diversity with children under the ages of 18. As you can see, a large majority of the populations--for Native American people--they’ve got quite a huge young population. But primarily for New Mexico, Hispanic makes up the larger majorities, as is in Arizona. The greatest challenge that New Mexico faces is access to healthcare.
Right now, one of our situations that we are faced with in New Mexico is that we’re considered one of the poorest states. We’re ranked 49th in the country, which basically adds to our challenges in health status, which since we’re a poor state, you can imagine that we’re also probably one of the lowest wage earning states. So it makes it very difficult to recruit the health professionals that are needed to be able to address the different health challenges that we’re faced with in New Mexico. This just gives you a general idea of where we stand in terms of health shortage areas in New Mexico. We have 55 counties, and of our 55, 32 are considered the health professional shortage areas. So we’re constantly searching for those individuals to recruit to the state, to be able to--gosh, I only have five minutes left.
NAOMI KISTIN: No, no.
JOYCE NASEYOWMA-CHALAN: Okay. So anyway--
NAOMI KISTIN You have 10.
JOYCE NASEYOWMA-CHALAN: --we’re constantly faced with this shortage. And the other is that both states definitely are faced with rural areas. I mean there’s so much space from one town, one major city to another major city. It becomes quite challenging and makes it difficult to access healthcare. And when you have a state that has a diversity of situations, for instance, in both Arizona and New Mexico, we have many tribes. In Mexico, we have 22, and I’m not quite sure how many we have in Arizona. All I know right now, for a fact, is we have Hopis and Navajos. Of course I know the other tribes, but I don’t know how many. But primarily, as a result of this, we have many health systems that serve to create this opportunity for healthcare: the Indian Health Service, the federally qualified health centers, the state and tribal WIC programs, and, of course, your local health departments. In New Mexico, our local health department serves primarily as a safety net. What I’m going to show to you is some information that is taken from the Kids Count 2003, which primarily speaks about the 10 indicators of Maternal and Child Health well-being and just demonstrate to you what each state is challenged with.
Our first slide here shows the overall ranking. I don’t know how well you can see this. But basically, it shows that overall, there are some differences that have occurred from 1995 on to about 2000 between New Mexico and Arizona, but primarily, there’s a lot of similarities in the overall ranking of health. But if we go to the children living in poverty, we can see, again, New Mexico almost three times the national average, while Arizona might be twice, or maybe not so much there. But primarily, poverty is a real issue in our state. We look at the families with children living with a single parent, we can see in New Mexico, this is escalated, has just practically jumped from one point to another and it’s become an extremely challenging situation in our state where we’ve seen a gradual increase throughout the country, New Mexico has had more of this happening, which certainly brings a lot of need for greater Maternal and Child Health services. I can’t read this. Oh, children living at home whose parents are unemployed, we can also see naturally New Mexico would be ranked very high, but we see a deep decrease in the later years, towards 1999.
In terms of teens who are high school dropouts, this is an interesting slide because Arizona outranks us. Not that this is good, but it’s at least one of the things that New Mexico is not worst of, you might say. They’re bad, but primarily, what we see here is this real concern. The fact that we’re ranked high about the national average, and so, again, keeping children in school. We know that when children aren’t in school or when they drop out, there’s other situations that they’re faced with. This is a slide showing those children who are not attending school, but also not working. Basically, in our definition, not being very productive and possibly, as a result, engaging in other types of behaviors that could create some unhealthy behaviors, and so forth. So New Mexico has had this where they were having extreme situations related to that and looking at--there’s some decreases in that right. This is a slide showing the percentage of low birth weight babies. Primarily, we’re seeing a gradual increase and maybe that’s related to the fact that we’re having more and more teens having children. You probably know that answer better than I do because you’re the epidemiologists. You guys study this all the time. I just look at the data. Here we have the teen deaths due to accidents.
You know, people refer to these as deaths before their time, in a sense, and in New Mexico, right now, we’re seeing an increase in that, which is a real concern. On a personal note, I had a 19-year-old nephew pass away in this. I was one week at my job when he got into an auto accident, and you know, naturally when things like that happen to your family, it just tears your family apart. So I’ve experienced and seen how this can affect the family. Well, let’s talk about some successes. Everything can’t be so doom and gloom. But you know, as a result of all the hard work of our epidemiologists and our providers and so forth, we know this is a situation: what have we done to begin to address some of them and what have we been successful with? And this is showing what we’re trying to achieve is these happy, beautiful babies, you know. They’re going to grow up to be happy and productive people in our society.
Here we have the infant mortality rate. We see that gradually with a lot of work through Maternal and Child Health services, we’re seeing a decrease in that rate. It’s happening overall. Here is teen birth rates. There is a decrease there, so I think that’s probably a good sign. But still, in New Mexico and in Arizona, we’re probably almost three times greater than the national average, which creates a challenge. Then one of the positive things is bringing, you know, creating this opportunity, safety for your children. These are my children. Well, the taller one is my daughter and the two little ones are my nieces. And we talked about what we’re doing in New Mexico to promote--ensuring that they’re going to continue to be in this world for a long time and that’s primarily working at reducing child death rate and this is related to our real intensive campaign around seatbelt usage.
In New Mexico, one of the things that’s happened is we have a new Governor and he’s primarily made healthcare his priority, and one of the pieces that came to his attention is the rate--where New Mexico ranked in terms of immunizations, and we ranked 49th, and he was not happy with that, so his wife, Barbara Richardson, the lady in the green, took on this initiative as her own as one subject she wanted to address. As a result, the state right now is involved in an intensive campaign to increase our immunization rates. All of you are familiar with PRAMS, I’m sure. Thirty-three states are currently engaged in that, but primarily what we’re doing here is, with the help of and absolute dedication of Susan Nalder and other epidemiologists, is we’re looking at PRAMS as a means of reducing the gaps in our tribal communities. Many of what health status statistics are being driven by tribal--some of the situations in our tribes, so primarily what we’re doing is taking this data and presenting it to the tribes and to other communities so that they can understand how to use this and be able to provide better planning at the local level. So what’s happened is that the data has been helpful by influencing policymakers in managed care organizations.
The Board of Health issues are now a big issue in New Mexico, so they’ve been helpful there, and so forth, to other programs, Healthy Start, and primarily are a big influence in our state Department of Health strategic plan. Challenges. And I’ll try to go through this a little bit faster. What happens with health? And right now, in New Mexico, we’re in a political atmosphere where it is a priority; healthcare, not health services. It’s healthcare. So what we’re talking about is how are we going to manage the cost. Is that really achieving what we want to achieve here? The other piece is the style of leadership. We have a Governor who’s saying, “I want this done,” you know, “this is a problem. We have problem DWIs in our state. I want it fixed by three months.” You know, most of us know that’s not possible, but it’s really creating a frenzy. I mean I think it’s great he’s made health one of his leadership goals, but it’s also important to know that getting it done is going to take some time. Partnerships are important.
You know, when you’re in states where there’s a lot of diversity, you really have to respect the fact that there’s people that know and what their needs are at the local level and have a general idea of what will work. We have a situation, I think, across the country with diminishing resources. How are we going to use the data to be able to make good decisions? How are we going to prioritize what is it that we’re going to put our efforts towards? Issues around gaps and disparities in accessing healthcare--I mean, Board of Health, I think, is one of the primary concerns in New Mexico around immigrant populations. How are we going to ensure that we can reduce that disparity in terms of access? These are some of the successes.
Just real quickly, the alphabet soup group; this is the managed care organization and private healthcare providers that have come together and use some of the data to be able to determine how they’re going to prioritize and create policy. Naomi mentioned the Rocky Mountain MCH Training Partnership. Primarily, New Mexico has been very, very involved in developing culturally appropriate models, and I brought this to put this up here because the concept is that we are focused, you know, on the children, and primarily they’re viewed as the holy people, so we’re really looking at finding a way to give them lifelong happiness. I think that’s our goal. And real briefly, I just want to say, and then I’ll end this, is that my whole life--I said this on several occasions, and that is that--by the way, this is in my backyard, so, you know. I live in Cochiti Pueblo and we’re given this opportunity. We’re granted this thing from Mother Nature to have 10 rocks. I don’t know if you know about 10 rocks, but it’s in our backyard and it’s just a beautiful place. And Susan provided this picture for me and I was just so happy. Anyway, what I wanted to say is that I grew up in Arizona.
I was a teen mom at 17, and lived in this--what you all are trying to address in terms of family dynamics. You know, my father was an alcoholic. My mother, primarily, was a single parent because my father wasn’t available. I became a teen mom, as I indicated, and as a result of that, I feel like, you know, probably wasn’t quite prepared to parent my child in a manner that would give her the stable foundation that she could use later on in life and make good decisions for herself, and somewhat, you know, credit myself--I say credit for the fact that she also became--well, a single mom at a--what I would consider--a young age, 24. She wasn’t quite prepared for that. But with my experience, I not only talk about--I think it’s important to know the data. What’s more important is to know what’s the story behind that situation? What is it that this person knows and what can this person offer in terms of their experience, and so forth? So I would ask, as you’re doing your work and doing your studies, and so forth, that you always use that qualitative information to support and link with your quantitative information. So with that, I’ll go ahead and end here, and I’m sorry if I took a little bit more time than I should. Thank you.