Section One: Footnotes
1"Alaska Health Facts." Section of Epidemiology, Alaska Department of Health and Social Services, 1992.
2Source: U.S. Census.
3Alaska Area Profile: 1992. Alaska Area Native Health Service, Anchorage, Alaska, 1993.
4Fortuine, Robert, Chills and Fever: Health and Disease in the early History of Alaska (Fairbanks: University of Alaska Press, 1989) pp. 9, 14, 16, 20, 24.
5Fortuine, 19S9, p. 116, p. 199ff.
6Fortuine, 1989, p. 229, p. 236.
7Antonson, Joan M., and William S. Hanable, Alaska's Heritage, 2nd ed. (Anchorage: The Alaska Historical Society, 1992), p. 537.
8Antonson and Hanable, 1992, p. 539.
9Antonson and Hanable, 1992, p. 540.
10Antonson and Hanable, 1992, p. 540.
11Antonson and Hanable, 1992, p. 540.
12Antonson and Hanable,, 1992, p. 545.
13Singyke, Robert, past Director, Alaska Area, Indian Health Service, interview, September 21, 1993.
14Singyke, September 21, 1993.
15See, for examples: Osgood, C. The Ethnography of the Tanaina . New Haven: Yale University Press, 1937; Hippler, A.E. The Athabascans of Interior Alaska: A cultural and personality perspective. American Anthropologist, 1973, 75, 1529-1541; Briggs, J.L., Never in Anger. Cambridge: Harvard University Press, 1970; Briggs, J.L. Playwork as a tool in the socialization of an Inuit child. Arctic Medical Research, 1990, 49, 34-38; Sprott, J.E. One person’s "spoiling" is another's freedom to become: Overcoming ethnocentric views about parental control. Social Science and Medicine, in press.
16See, for examples: Brower, W.C. Ethnic identity and revitalization: psychocultural adaptation among the Eskimo of North Alaska. Ph.D. dissertation: University of Colorado at Boulder, 1980; Koenig, D.M. Cognitive styles of Indian, Metis, Inuit, and non-Natives of Northern Canada and Alaska and implications for education. Dissertation Abstracts International, 1981, 42 2013A.
17There was, of course, Russian influence in Aleut and Alutiiq villages from the mid-1700's,but that marks the exception rather than the rule. Although there were great numbers of individuals affected at the time by the Russian invasion, so many of them died as a result of that invasion that the number of their descendants is small, compared to other Native groups in Alaska.
18Act of September 30, 1976, 90 Stat 1400, 25 USCA -1601 et seq.
19Healthy People. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1979: p. vii.
20Indian Self-Determination and Education Assistance Act, 25 USC 450.
21Ibid, 25 USCA 1602.
22White vs. Califano 437 F. Supp 543 (D.C. S.D. 1977) aff'd. sub nom White vs. Matthews, 420 F. Supp. 882 (D.C. S.D. 1976) aff'd., per curiam 581 F. 2d 697 (8th Cir. 1978), as quoted in Case, D.S. Alaska Natives and American Laws. Fairbanks, Alaska: University of Alaska Press, 1984: pp. 259-260.
23Legend: Watering Point — single community source of water available; residents haul water to homes. Washeteria — community served by washeteria as watering point. Individual Wells — homes served by individual wells with piped water. Circ. Pipe — circulating piped water system with heat add features. Conv. Pipe —conventional piped water distribution system.
24Legend: Honey Bucket — hauled by individuals to disposal site; Honey Bucket Haul — taken to container then hauled to disposal site; Privy — individual privy in homes; Vacuum Truck Haul — flush toilets with outside storage tanks, hauled by truck; Septic Individual — flush toilets with individual septic tanks and drainfields; Septic System — community septic and drainfield; Piped Gray — flush toilets drain to a community collection and treatment system; Piped Vacuum — special flush toilets discharge to vacuum sewer system.
25In a State of Disrepair. Anchorage Daily News, September 23, 1992.
26Lcffcl, I.P. Methods of used-oil disposal from diesel powered electric generators in rural Alaska Native communities: A descriptive study. U.S. Public Health Service, Indian Health Service, Anchorage, Alaska, 1992; Journal of Environmental Health, in press.
27Testimony of Eileen Norbert, speaking on behalf of Matthew Iya, Director of Kawerak's Department of Natural Resources, appearing before the Commission at hearings held in Nome on September, 21, 1992.
28See, for example, Housing the Alaska Native, published by the Alaska State Housing Authority (ASHA), 1967, and Native Housing in Alaska, also published by ASHA, 1968.
291988 Alaska Rural Housing Needs Assessment Study, Final Report. Prepared for the Alaska Department of Community and Regional Affairs by the Rural Alaska Community Action Program, ASK Marketing Information Search, and Alaska Public Interest Research Group, 1988: pp.3-5.
30Testimony before the Commission, Barrow, February 24, 1993.
31Villagers knock HUD housing: Critics say many bush homes show construction defects." Anchorage Daily News, February 9, 1994.
32Native services face ax." Anchorage Daily News, March 1994.
33Regional Differences in Indian Health. Washington, D.C.: U.S. Government Printing Office, 1992.
34Ibid.
35Middaugh, J.P.; Miller, J.; Dunaway, C.E.; Jenkerson, S.A.; Kelly, T.; Ingle, D.; Perham, K.; Fridley, D.; Hlady, W.G.; and Hendrickson, V. Causes of Death in Alaska, 1950, 1980-1989. Juneau: Alaska Department of Health and Social Services, 1991.
36See, for example: Forbes, N., and Van Der Hyde, V. Suicide in Alaska 1978-1984: Updated data from State files. Juneau: Alaska Department of Health and Social Services, 1986; and Marshall, D.L., and Soule, S. Accidental deaths and suicides in Southwest Alaska: Actual vs. official numbers. Alaska Medicine, 1988, 30, 45-52.
37See, for example: Thorslund, J. Suicide among Inuit youth in Greenland 1977-86. In Postl, B.D.; Gilbert, P.; Goodwill, J.; Moffatt, M.E.K.; O'Neil, J.D.; Sarsfield, P.A.; and Young, T.K. Circumpolar Health 90: Proceedings of the 8th International Congress on Circumpolar Health. Winnepeg: University of Manitoba Press, 1991.
38Alaska Area Program Information Summary, Division of Planning, Evaluation, and Health Statistics, Alaska Area Native Health Service, 1991.
39Henshaw, S.K.; Kenney, A.M.; Somberg, D.; and Van Tort, J. Teenage Pregnancy in the United States. The Alan Guttmacher Institute, 1989, Healthy Children 2000. U.S. Public Health Service, 1991.
40Weeks, M. Memorandum to Senator Drue Pearce: Adolescent Pregnancy in Alaska: 1989 and 1990. Legislative Research Agency, Research Request 92.065, February 11, 1992.
41The State of Adolescent Health in Alaska. Minneapolis, Minnesota: University of Minnesota, Division of General Pediatrics and Adolescent Health, May 1990. Native-specific data are reported in a separate, untitled document produced by the National Adolescent Health Resource Center, Minneapolis, Minnesota.
42Davidson, M., Schnitzer, P.; Bulkow, L.; Parkinson, A.; Schloss, M.; Fitzgerald, M.A.; Knight, J.; Murphy, C.; Kiviat, N.; Toomey, K.; Reeves, W.; Schmid, S.; and Stamm, W. The prevalence of cervical infection with human papillomaviruses and cervical dysplasia in Alaska Native women. In press, 1993.
43Alaska Area Program Information Summary. Division of Planning, Evaluation, and Health Statistics, Alaska Area Native Health Service, 1991: p. 20.
44In 1993, the Centers for Disease Control and Prevention broadened the cast definition of AIDS. Although the data from the State of Alaska Section of Epidemiology are reported as diagnosed in the year the person first met the revised case definition, there may still be some artifactual enhancement of the count for the first half of 1993.
45Section of Epidemiology, Alaska Department of Hea1th and Social Services Bulletin No. 26, July 26, 1993.
46Section of Epidemiology, Alaska Department of Health and Social Sciences Bulletin No. 28, August 5, 1993.
47Dividson, M.; Builkow, L.R.; Lanier, A.L;. Sebbelov, A.; Hawkins, I.; and Jensen, H. Invasive cervical cancer preceded by negative screening and its relationship to human papillomaviruses. Paper presented at the 12th International Papillomavirus Conference, September, 1993.
48Arctic Investigations Program: Program Planning and Review FY 92. U.S. Department of Health and Human Services, Centers for Disease Control, 1992: p.20.
49Lanier, A.P. Epidemiology of Cancer in Alaska Natives. Paper presented at the "Cancer in Indian Country" conference, Rapid City, South Dakota, September, 1992.
50Lanier, A.P., and Mostow, E.N. Screening for cancer in remotely populated regions — lessons from mammography and breast cancer. In Postl, B.D., et al., (Eds.) Circumpolar Health 90, op cit., pp. 464-465.
51Young, T.K.; Schraer, C.D.; Shubnikoff, E.V.; Szathmary, E.J.; and Nikitin, Y.P. Prevalence of diagnosed
diabetes in circumpolar indigenous populations. International Journal of Epidemiology, 1992, 21, 730-735.
52Alaska Area Report of Indian Health Service Objectives: FY 1992. Anchorage: Alaska Area Native Health Service.
53Beller, M., and Middaugh, J.P. "Surveillance for Tuberculosis in Alaska, 1986." Alaska Medicine, 1989, 3l, 4-8.
54Regional Differences in Indian Health, 1992, op cit.
55Alaska Native Population 1993. Division of Planning, Evaluation, and Health Statistics, Alaska Area Native Health Service, March 1993.
56A Map for the Future: Alaska's Family Health P1an, 1990-1995. Juneau: Section of Maternal, Child, and Public Health; Department of Health and Social Services, March 1990.
57Morbidity and Mortality Weekly Review, 1993, 42, No. 16.
58Morbidity and Mortality Weekly Review, 1993, 42, No. 12.
59Lanier, A. Tobacco use and its consequences in a northern population. Arctic Medical Research 1990, 49, 42-48.
60See Kruse, J.A., and Aegerter, E. The Health of Alaskans: An Assessment of the Prevalence of Behaviors Posing Health Risks. Anchorage: Institute of Social and Economic Research, University of Alaska, 1993; Segal, B. Patterns of Drug Use: A Community Survey. Anchorage: Center for Alcohol and Addiction Studies, University of Alaska, 1983; Segal, B. Drug-taking Behavior Among Alaskan Youth, 1988: A Follow-up Study. Anchorage: Center for Alcohol and Addiction Studies, University of Alaska, 1988.
61Investigative Report: Ombudsman Complaint F89-0072. State of Alaska Office of the Ombudsman, Juneau; February 4, 1993.
62Ibid, p. 25.
63Source for Figures 2 and 3: Bureau of Vital Statistics, Alaska Department of Health and Social Services.
64A Map for the Future: Alaska's Family Health Plan, 1990-1995. op cit., p. 94.
65Ibid, p. 36.
66Alaska Ross Mothers Survey. Conducted by Ross Laboratories in coordination with the Alaska Department of Health and Social Services and the Alaska Area Native Health Service, 1990. (Report available from the Department of Health and Social Services.)
67Nobmann, E.D. Dietary intakes of Alaska Native adults 1987-1988. In Postl, et al. Circumpolar Health 90, op cit., p. 738.
68Ibid, p. 735.
69Report produced by the National Adolescent Health Resource Center, Minneapolis, Minnesota, p. 13; see endnote 27, supra.
70Arctic Investigations Program: Program Planning and Review, February 1993,. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 1993: p. 18.
71Jones, D.B.; Schlife, C.M.; and Phipps, K.R. An oral health survey of Head Start children in Alaska: Oral health status, treatmcnt needs, and cost of treatment. Journal of Public Health Dentistry, 1992, 86-93; Jones, D.B. "Oral health status of Native Americans: Selected findings from a survey of dental patients conducted in 1991." Paper presented at the Annual Alaska Area Chiefs and Prevention Coordinators Meetings, November 2, 1992.
72Schlife, C.M., and Jones, D.B. The oral health status of the Inuit people of the North Slope of Alaska. In Postl, B.D., et al., (Eds.) Circumpolar Health 90, op cit., pp. 664-665.
73Data provided by Rosalyn Singleton, M.D., Area Immunization Coordinator, Alaska Area Native Health Service. Memorandum to Mr. G.H. Ivey, Area Director, July 23, 1993.
74The data contained in this section were reported in the Annual Report for the Division of Family and Youth Services, Alaska Department of Health and Social Services, March 1993.
75Report of the National Adolescent Health Research Center.
46Source: Bureau of Vital Statistics, Alaska Department of Health and Social Services.
77Ibid.
78See Kelso, D.; Hobfoll, S.F.; and Peterson, W.J. A Descriptive Analysis of the Downtown Anchorage Skid Row Population. Anchorage: Center for Alcohol and Addictions Studies, University of Alaska, 1978; and Segal, B. Homelessness and Drinking: A Study of a Street Population. New York: Haworth Press, 1991.
79Access to Care: Crisis for Alaska Natives. Anchorage: Alaska Native Health Board, 1991, p. 17.
80Position papers: National Tribal/IHS Consultation Conference, Sacramento, California, May 12-15, 1992. Anchorage: Alaska Native Health Board, p.19.
81Resolutions and Position Papers: National Tribal/HIS Consultation Conference, St. Paul, Minnesota, August 7-10, 1990. Anchorage: Alaska Native Health Board.
82Berger, T. Key Note Address. Circumpolar Health 90; op cit., p.3.
83Ibid, p. 4.
84Ibid, p. 5.
85Ibid, p. 6.
86In Alaska, there is evidence that one cannot eliminate food as a cause of deteriorating health, as Dr. Evans suggests. A factor that has been acknowledged to be of major influence in the deteriorating heath of Alaska Natives is the radical change in diet that has occurred over the last few decades. The research findings that were presented in the last section show the negative impacts that a reduction in subsistence foods has caused. Not only have healthy protein sources been replaced by less healthy sources, but the introduction of artificial, high-sugar substances has compounded the problems. It has been estimated that in Barrow, the average consumption of soda pop is seven cans per day for every man, woman, and child. The resulting acceleration of dental disease, tooth decay, and gum disease has been accompanied by high rates of childhood sickness in general and middle ear disease in particular.
87Berger, T. Key Note Address. Circumpolar Health 90, op cit.; pp. 4-5.
88Phares, E.J. Locus of Control in Personality. Morristown, New Jersey: General Learning Press, 1976; Deaux, E.B. Health causes and effects: Differences in perceptions of health outcomes among the youth of Kodiak Island villages. Paper presented to the Alaska Anthropological Association Annual Meeting, Anchorage, Alaska, 1987; Deaux, E.B. Health locus of control in Chukotka children. Alaska Medicine. 1992, 34, 135-139.
89A Commitment to Alaskans, Executive Summary: Recommendation of the Alaska Sanitation Task Force, October 1992.
90The Kakawis Program: History and Current Description. Published by the Kakawis Development Centre, Tofino, British Columbia.
91The Commission is aware of the fact that existing confidentiality laws and regulations present an obstacle to the integration of these different data bases. However, the Task Force strongly recommends that, except in the rare instance that the welfare of a patient would be put in jeopardy, the laws must be changed to permit sharing of information that will ultimately lead to the improvement of the health of Alaska Natives.
92Murphy, S.; Orkow, B.; and Nicola, R.M. Prenatal prediction of child abuse neglect: A prospective study, Child Abuse and Neglect, 1985, 9, 225-235; Breakey, G., and Pratt, B. Healthy growth for Hawaii’s Healthy Start: Toward a systematic statewide approach to the prevention of child abuse and neglect. Zero to Three, April 1991.
93Caldera, D. Alaska Community Health Aide Program in Crisis, Alaska Native Health Board, March 28, 1988; p. 7.
94Alaska Statistical Summary of Workload. Division of Planning, Evaluation, and Health Statistics, Alaska Area Native Health Service, February 16, 1993.