What’s Really Behind the Native American Health Gap?

Growing up as a member of the Ojibwe tribe, Melissa Walls knew that that diabetes ran in her maternal family. “I’ve lost two very close family members, my great grandfather and an uncle, to complications related to type 2 diabetes,” she says. But it wasn’t until she began studying American Indian health in graduate school, at the suggestion of another uncle who served as a liaison between academics and local tribal communities, that she understood that her family’s plight was part of a much larger problem.

American Indian adults are more than twice as likely as white adults to be diagnosed with type 2 diabetes, according to the Office of Minority Health at the U.S. Department of Health and Human Services. Native American youth experience the highest and fastest-growing rate of the disease of any racial or ethnic group. But those statistics only scratch the surface of the kinds of health disparities that indigenous people face.

Nationally, the average life expectancy for a Native American person born today is 73 years—5.5 years below that for all other races. Members of this community, adolescents in particular, also experience much higher rates of depression, substance abuse, and suicide and suicidal behaviors. In fact, while the national suicide rate has gone up 33 percent since 1999, the rates for Native American women and men have jumped by an alarming 139 percent and 71 precent, respectively, according to a recent report from the Centers for Disease Control and Prevention.

“You could take almost any health outcome and find health inequity for tribes,” Walls says. “I mean, take your pick.”

The health statistics reflect a dire economic reality—1 in 4 Native Americans live in poverty, the highest rate compared to all other races—and the massive gap in medical resources available to this population. The Indian Health Service, which runs clinics and hospitals for Native Americans, spent $3,332 per person in 2017, compared to $9,207 spent on each person in the national health care system, according to a 2018 report on funding shortfalls by the U.S. Commission on Civil Rights.

Walls knows from experience: Like the majority of American Indians, she grew up outside a reservation. Her family lived in International Falls, Minnesota, a town of about 6,000 people—mostly white—near the Canadian border. But to access health services, her family had to go to the nearest reservation. “We drove an hour literally to go to the doctor, to go to the dentist, to get our eyes checked,” she says. “But when you grow up in that context, you don’t label it as an inequity or disparity. It’s just sort of your reality.”

More than two-thirds of Native Americans now live in urban areas, not reservations. That reflects 1950s-era federal policy designed to encourage American Indians living on reservations to urbanize, in the name of speeding “assimilation” (and freeing up tribal lands for federal exploitation). The Bureau of Indian Affairs’ Urban Relocation Program of 1952 and the federal Indian Relocation Act of 1956 offered promises of job training and housing for the new arrivals; the hope was that moving to cities like Chicago, Los Angeles, and Minneapolis would allow more Native Americans to participate in the postwar economic boom. But in practice the relocation policy was “essentially a one-way bus ticket from rural to urban poverty,” as former Indian Affairs Commissioner Philleo Nash admitted in the 1960s.

Walls is now the head of the new Great Lakes hub of Johns Hopkins University’s Center for American Indian Health in Duluth, Minnesota, the city of 86,000 located three hours south of where she grew up. Her team currently works with 11 different tribal communities to better understand the health inequities that Native Americans experience, and try to correct them. The hub is just a 15-minute drive from the Fond du Lac band of Ojibwe tribe, with whom Walls has been working closely on diabetes prevention. Among her research interests: how stress impacts can affect type 2 diabetes, and how culture and community can help to buffer the negative effects of modern lifestyles among Native Americans.

CityLab recently caught up with Walls to talk about possible solutions to health inequities among American Indians, and why the damage that government policies inflicted on this population has been so far-reaching. Our conversation has been edited and condensed.

Can you explain how government policy induced historical trauma in the indigenous population?

The historical trauma encompasses a lot of government actions like setting up reservations and marching people across the country. Then in the the 1950s and ’60s, the government started a relocation program to get [Native Americans] into urban areas, and give them job training programs. It failed miserably, like most of these things did, in part because the job training was woefully inadequate, and often [the jobs available] were temp work or summer employment, if anything.

People were taken out of their family support systems or cultural safety nets, thrown into these urban environments, and expected to survive. Certainly in some cities, native people have worked to try build those kinds of networks. But you are very much a minority in the urban context. I think the idea of not having access to not just your friends and your family, which we all need, but those particular aspects of cultural teachings of ceremony that creates a sense of spirituality, purpose, and belonging would be scary to anybody.

[The relocation policy] was rooted in this flawed idea that all people need to look and act like European Americans, and live the way they do. It’s shocking, if you go into some of these government records, just how blatantly plain the language is about how the goal was really to exterminate or assimilate.

That has impact on communities, and we see it play out in terms of mental health, substance abuse, suicide, and other chronic diseases.

You’ve been largely looking at diabetes—how does historical trauma fit into that story?

In the case of diabetes, one really tangible thing is what we call nutrition transition. In the Midwestern U.S., Ojibwe people once had a thing called a seasonal round, where with each season came new sources of food. In the springtime, you tap trees to get maple syrup. In the fall, you gather wild rice off the lake and you hunt deer. Every season had ways of getting [food] that burned a lot of calories.

Moving away from these ways of eating and getting your food, and suddenly relying on government-sponsored commodity programs [that included] flour, sugar, lard, butter, we start to see rates of obesity kind of going off the charts. And we continue to suffer the consequences.

And this trauma has affected multiple generations?

Some of the research we’ve done is really trying to link up negative health outcomes with specific policies. We’ve published a paper that demonstrates how families who’ve gone through those relocation programs have the worst health outcomes that we can track across three generations.

It’s based on survey data from members of eight tribal communities. We were able to track parents’ reports of their parents going through relocation. If they did, we saw a significant pathway where those [first-generation] parents might have had substance abuse issues, which led to substance abuse and depression in the [second-generation] parents. That led to them being not very good parents of their own kids—the third generation—who at the time were in adolescence. They had bad outcomes like delinquency and depression.

The article was published in 2012, but we continue to collect new data every year from that same cohort, so it’s an ongoing study.

Your research is mostly on communities that live within reservations, but what can you tell us about the current urban Native American population so far?

In our cohort study, the kids who grew up on the reservation, a good chunk of them now have moved on to cities, which is another thing that happens. People tend to migrate between cities and reservations. With our new data that’s being collected from that cohort, we’re going to be able to examine urban-rural differences.

What I do know is that the health issues that hit tribal people on reservations, some reports say they’re actually compounded and worse for people in the cities, for reasons like the lack of access to cultural protective factors and social networks. People are more likely to experience discrimination when they’re in an urban area. And there’s tons of research talking about how that hurts health.

What’s a common misconception about the indigenous community that you hope to dispel?

One of the big stories I’ve helped to push forward is that yes, we have these health inequities, but people on reservations and in urban areas also have really amazing positive stories. Like with positive mental health, when we started measuring it, our communities were off the charts compared to non-native people.

We found this measure created by a sociologist called Corey Keyes [that] assesses emotional well-being, psychological well-being, and social well-being across three domains using 14 different indicators. These items assess basically how much you’re flourishing or languishing in those domains. And the outcome was that the percentage of people in our sample who [reported] flourishing was much higher than what we had seen in other studies with non-Native samples.

So you can have these [inequity] issues, but also have vibrant and cultural richness, family centric [communities] with communal, take-care-of-one-another thinking.

And that has implications for all humans: that being embedded in your community is good for you, that being tied culturally to other people is good for you. It’s not just a dismal doom-and-gloom kind of story.

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Berlin Wants to Freeze Rents for 5 Years. Can It Really Do That?

Berlin’s planned five-year rent freeze might be popular among locals, but the city may have trouble navigating a legal minefield to protect the law when it takes effect in January.

That much was confirmed Saturday when newspaper Berliner Morgenpost dropped a bombshell by publishing emails from Germany’s interior ministry to the Berlin head of Angela Merkel’s CDU party. In those emails, German Interior Minister Horst Seehofer expressed his belief that the rent freeze is illegal, as it would “distort” national laws.

In a relatively inexpensive city whose housing sector is dominated by rental units— 80 percent of residents rent their homes—the plan has found broad support. The law, approved in October, caps rent increases at 1.3 percent per year (to account for inflation) for all homes built before 2013, while owners of newer homes, including those recently built and buildings planned for the future, are able to raise rents as they see fit.

The minister’s objections paint the issue as a turf war between national and regional powers. The rent freeze won’t fly, Seehofer says, because it would mean the State of Berlin overstepping its jurisdiction under Germany’s constitution. Federal legislators make Germany’s real estate laws on a national level, and a decision confined to only the State of Berlin could risk distorting that national legislation.

The rent freeze, Seehofer’s October 31 email says, would unfairly ban landlords from factoring rising maintenance costs into the rates they charge tenants. What’s more, while rents for new contracts have been galloping higher in the city, not every Berlin landlord has raised their rents to the maximum level. This group would now be prevented from raising rents even though their tenants are now paying substantially below-market rates.

These objections are a problem for the State of Berlin. They aren’t necessarily a nail in the law’s coffin, however, because the national government doesn’t itself decide the law’s legality—and as a body dominated by the right-wing CDU, it tends by default to look askance at policies forged by Berlin’s ruling center-left coalition. Furthermore, as CityLab previously reported, these issues were not entirely unforeseen. Any ruling would be up to the courts if (or, more likely, when) landlords legally challenge the law.

Seehofer’s emails are, nonetheless, a warning sign that courts might rule in landlords’ favor, and will certainly heat up a debate over the law, against which the backlash is particularly fierce. This month, a developer withdrew from a project to build 900 new apartments on the edge of the city, citing the rent freeze. These apartments would not have been subject to the freeze, but the developer claims that rent freezes at its other properties would reduce the amount of cash it had for further investments, and thus make the development unviable. Sections of the media have also gone on the attack. A representative of the center-right party FDP, writing in the business publication Handelsblatt, recently damned the law as an example of “German envy culture,” motivated more by a vindictive attitude toward wealth than a desire to improve market conditions. Others have accused the city of trying to “rebuild the wall.”

That view is not going unchallenged. As an article in left-leaning newspaper Tageszeitung points out, the abuses the law seeks to remedy are real enough. It cites as an example the Swedish landlord company Akelius, which has relied on the legal loophole of  “modernization” as a justification for hiking rents on its 14,000 Berlin apartments. These rent increases can happen even if the actual quality of the supposed modernizations is poor and does nothing to improve living conditions. Meanwhile, other sections of the business media are asking if, rather than being an example of Berlin radicalism, the city’s new laws might become a template for action across Germany.

The debate isn’t over, and it may just be heating up. For now, Berliners are left in a curious position. They can’t be certain that the rent freeze will genuinely make the city more livable. They also can’t be certain, at this point, that it will come into force at all.

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It’s a Funhouse for Selfies. Is It Really a Museum?

When the Museum of Illusions opened in Greenwich Village last fall, it drew lines down the block to get in. Visitors flocked to photogenic exhibits that make it look like you have lost your head or can walk on walls. Following in the footsteps of other viral-experience purveyors like the Museum of Ice Cream, Museum of Pizza, and Color Factory, the Museum of Illusions’ takeover of a prominent corner building seemed to assert that the age of the pop museum—or “museum”—is only beginning.

The Museum of Illusions’ New York outpost was the second location to open in a burgeoning international franchise. MOI lists 18 current locations around the globe, with another 14 in the works, including in Chicago, Miami, and Washington, D.C. Unlike many of its predecessors in the world of Instagram-bait exhibitions, the Museum of Illusions isn’t a temporary pop-up—its locations are intended as long-term fixtures. The stately downtown NYC location, a landmarked neo-classical former bank, underlines that ambition.

These immersive experiences are branded as exhibits, but that might be where the link to traditional museums ends. The companies are, after all, for-profit businesses that sell experiences that have been expressly created for social media postability. That’s quite a contrast from the conventional idea of a museum as an educational institution that’s driven by the public good. Traditionally speaking, museums have mission statements, standards, accountability, and other responsibilities (including generating enough income to survive).

Their viral brethren are here to sell a good time for a profit, though providing education can be a welcome side benefit. Renne Gjoni, the CEO of MOI’s New York City outpost, says he is gratified that educators value the exhibits so much that they keep bringing school groups back.

A visitor poses for a picture in the “Rotated Room” of a Museum of Illusions franchise in Pristina, Kosovo. (Armend Nimani/AFP/Getty)

Why, then, has it become trendy to make a funhouse for grownups and brand it with the M-word? For one thing, pastimes among the well-off have evolved and converged. For example, the “experiential retail and entertainment” complex Area 15, set to open in Las Vegas next year, advertises, “It’s retail, it’s entertainment, it’s art—redefined.” (See also the popular immersive experiences by Meow Wolf and TeamLab.) Then there’s the global popularity of museums as travel destinations, and their primacy in online searches. And there’s also the possibility that businesspeople aren’t too cautious with the word museum, as Museum of Ice Cream founder Maryellis Bunn told The Atlantic last year: “It’s not so damn serious. I like ice cream, so do you, that’s enough,” Bunn said.

As the Museum of Ice Cream’s business grows beyond pop-up installations, though, the company’s founders have signaled a shift in thinking about its use of museum. Speaking to Forbes in August about the company’s future—including opening permanent locations in New York and San Francisco this year—Bunn unveiled a new word: experium, a combination of experience and museum. She told Forbes:

For the last three years, we’ve been having conversations about what we create. Museum is not the right word and experience is not the right word, because an experience can be having a cup of tea, writing a letter or walking outside. So we need to properly define this word for ourselves and for the world.

There certainly has been some value in adopting the museum as a brand. Research shows that museums generally are among the most trusted institutions in America, earning higher marks among the public than local news, government agencies, and academic researchers, according to the American Alliance of Museums.

“The fact that many successful immersive experiences are identifying themselves as museums demonstrates they feel there is economic value in museums and in associating their work with more traditional organizations,” says Elizabeth Merritt, founding director of AAM’s Center for the Future of Museums. “Traditional museums, in turn, can watch how these for-profit experiments operate and create new revenue sources.”

The looming question, then, is if appropriating the word museum threatens to diminish that hard-earned trust.

That’s the crux of the matter for Peter Kim, executive director of the nonprofit MOFAD, the Museum of Food and Drink. “I have no quarrel with the approach and goals of a place like the Museum of Ice Cream, or the Museum of Pizza, or the Museum of Illusions to create a space for fun, and a space for play,” Kim tells CityLab. “My only issue arises, and it’s a very serious one, when they use the word museum to describe what they’re doing. That’s where the entire problem lies.”

Kim has been working since 2011 toward the eventual establishment of a permanent museum with the professional level of quality and practice to eventually be accredited by AAM. Presently, the temporary “MOFAD Lab” is open in Brooklyn and exhibiting “Chow: Making the Chinese-American Restaurant,” whose webpage cites 10 scholars and experts who advised the exhibition.

The word museum invokes expectations, and if those are not met, “then you warp and change the meaning of the word,” Kim says. “It means education, it means community building, it means service, it means mission. And these places are pretty much devoid of that.”

“Space for fun is a laudable effort in many ways,” Kim says. “But the real hard stuff comes when you want to connect people in new ways, or teach new things.” In the moments when a museum isn’t all sparkles and photo ops, he says: “I worry that there will be a sense of disappointment from people who are no longer used to experiencing things in this way.”

Of course, it’s an eternal challenge to know what to expect of the public, or how much credit to give. You want to believe that people understand the University of the Streets does not grant MBAs, the Brandy Library is not about lending, and you can’t reach the Fountain Pen Hospital by calling 911.

Laura Lott, president and CEO of AAM, says she trusts that people can understand the difference between different types of places that call themselves museums. “Generally the public can distinguish what kind of experience they plan to have,” Lott told CityLab. “I don’t worry about people confusing the Met and the ice cream museum.”

Still, there’s something refreshing about the straightforward billing of the Selfie Fantasy in Ocean City, Maryland: “Ocean City’s first immersive selfie inspired Instagram worthy experience. Enjoy many different atmospheres—all while snapping awesome selfies.” There is also the House of Selfies in Las Vegas, and even the meta Museum of Selfies in Los Angeles, which have photo settings reminiscent of the food- and illusion-based places, and make it clear what the real subject of the experience is. It’s not ice cream or illusions or bright colors—it’s you, the visitor.

That concept might also offer up the strongest connection between the selfie factories and the M-word. Museum comes from a Greek term meaning “shrine to the muses.” The lofty institutions that use the term today are the spiritual descendants of 16th-century “cabinets of curiosities” and “wonder rooms,” in which private collectors gathered the objects that captured their attention. Maybe it’s not so big of a reach, then, to suggest that people might enter the cabinet of curiosities themselves, and find the muse right there in their camera lenses.

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