Our next presenter is Dr. Ursula Bauer.

She is the director of CDC's National Center

for Chronic Disease Prevention and Health Promotion,

a position that she has held since 2010.

Her topic today is culture is prevention, overcoming trauma

and nurturing resilience through identity and connection

to culture, Dr. Bauer.

>> Good morning.

I've had the privilege during my time at CDC to spend time

with American Indians and Alaska Natives on their land,

in their homes, with their government and in dialogue.

As impressed as I've been with the challenges they face,

I've been more impressed with the drive

to thrive on their own terms.

As overwhelming as the challenges may seem

in Indian Country, the solutions are there too,

growing from within.

I'm going to talk about trauma

and resilience among American Indians and Alaska Natives

in the context of names.

Names say a lot about who we are, both positive and negative.

When Michelle Obama welcomed a group of American Indian

and Alaska Native youth to the White House this summer,

she talked about all the beautiful places in our country

and how our language, English,

lacked the words to describe these.

So we use the indigenous names, Alaska, Connecticut,

Mississippi, Missouri, Nebraska.

That's a positive aspect of names.

But there's a negative aspect as well, and I'm not even going

to mention the R word.

We have a saying that we learned in our culture

when we're very young.

And by we, I mean, white Americans of European ancestry.

If I give you the first line,

I'm sure you can give me the second line.

Sticks and stones will break my bones --

>> But names will never hurt me.

>> But names will never hurt me.

That's the way I learned the saying.

Names say a lot about who we are

and names have characterized the adversarial relationship

that we've had with American Indians and Alaska Natives

over our entire history.

Navajo, for example, is a Spanish adaptation

of a Zuni Pueblo phrase, Apache de Navajo

where Apache means enemy

and Navajo means farms in the valley.

To the Zuni Pueblo and thus to the Spanish and then to us,

the Navajo were the enemy who farmed in the valley

and the people we came to call Apache were the other enemy

who lived to the north.

The Navajo and the Apache each have a word for themselves

and that word means people.

Pequot is derived from a Narragansett word

meaning invader or destroyer.

Comanche is derived from an Ute phrase meaning the

ones who hate everyone.

Sioux is a French corruption

of an Ojibwe word meaning "snake" referring to their enemy

and Iroquois is a French corruption of an

Algonquian word meaning "snake" referring to their enemy.

The Pequot, Comanche and Iroquois have a name

for themselves in their own languages it means people.

And the Sioux have a word for themselves.

It means allies or friends.

I could go on but you get the picture.

Throughout the 21st century, we Americans are still referring

to our fellow citizens by names they never called themselves.

These names are on our treaties.

They're in our government documents.

They're in our official correspondence.

They're on our CDC cooperative agreements.

They're in our everyday speech.

So even with something as basic as a name, we're still defining

who people are and it's not the way

the people define themselves.

If you think that these names and languages

that few people understand don't convey their original meaning,

consider the study

of kindergarten students in Minneapolis.

Over three-quarters of them have negative views of Indians

and of those, 25% use these terms to describe Indians,

enemy, killer, mean, I don't like them.

Here's another aspect of names.

My colleague, Chris Percy says,

"If you ask a Navajo grandmother how to prevent heart disease,

she'll tell you it begins with the naming."

Now does she mean it begins in infancy

which is something I understand and something

around which I can build a logic model that begins at birth

and ends with a lower risk of heart disease?

Or does she mean it begins with culture, with the communal act

of welcoming a new person into the world and among the people

which is something I understand less or not at all and around

which it's almost impossible to build a medical model

of discrete cause and effect all driving toward a lower risk

of heart disease?

That failure of understanding marks the entire history

of our relationship with the people,

with American Indians and Alaska Natives.

And that failure, our failure manifests itself today

in a tremendous amount of trauma that reflects as poor health

and social outcomes for example.

But as brutal as that failure has been,

it has not extinguished an extraordinary resilience

which I'll talk about in a minute.

The willful lack

of understanding is particularly pernicious

because when we don't understand, we prohibit.

So we prohibited the sacred rituals and ceremonies

the religious practices, language,

the right to educate your children,

to practice your own medicine, to wear your own clothes,

to sing your own songs, to choose your own hairstyle,

we took that all away or tried to, just like we took the land.

And that's the crux of the trauma.

We killed people and we took land

which was traumatic but familiar.

That had been going on the world over

and long before Europeans ever arrived on these shores,

the people versus the enemy, stealing each other's children,

enslaving each other's captives, killing each other's warriors,

pushing each other off the land.

That's the history of human beings on this earth.

We just took it to a new level.

And we did something different.

We did something more.

In addition to killing people and taking land, we took culture

and identity and that was unfamiliar.

And we didn't take it like the land to make it our own.

We took it like murder, to destroy it.

That's the trauma and that's what's still going on today.

We haven't succeeded though.

And that's the resilience.

The people are continuing to preserve their culture,

to rebuild their populations, to nurture their traditions,

to rediscover their food, practice their healing,

and they're gaining political strength.

There's an emerging movement in Indian Country

that culture is prevention.

That naming ceremonies actually do prevent heart disease.

That traditions and community do support and sustain health

and healthful behaviors.

That connecting people to culture and heritage save lives

by building esteem, by grounding values,

by creating belonging, and purpose, and pride.

The movement is building against all the failed policies

of the past two centuries, allotment, assimilation,

relocation, boarding schools, termination,

all our best practices, all done our way, all failures.

We've gotten it so wrong for so long, one failure after another,

creating quite a bit of misery along the way and

yet we continue to think that we know what's best.

And we keep imposing our terms.

Religion is done this way.

This is food.

Education happens this way.

This is the way governance works.

This is what a constitution looks like.

This is the way you'll do it, our way.

This is another aspect of names.

Commodity canned beef.

I was visiting friends

on the Pine Ridge Indian Reservation this summer

and I had breakfast at Kathy High Hawk's home.

This is Kathy.

Her T-shirt depicts some Lakota ledger art of a buffalo hunt.

You can't see it but the title is Fast Food [laughter].

So Kathy always has a big crowd at her house for meals.

People sit around the table.

They stand around the room.

They take her food and go outside.

I was sitting at the table and the plate of fried eggs came

around and I took some.

The plate of saltine crackers came around and I took some.

And then a bowl of something I didn't recognize came around.

It didn't look good.

It didn't smell good.

I didn't take any.

I just passed it on.

Well, the bowl made its way to the head of the table

where Kathy's cousin Bryan picked it up

and brought it right back around to me.

He put a spoonful of this stuff on my plate and he said,

"This is the meat your government gives us.

You can't pass on this.

You have to eat it."

So I ate it.

It tasted like rancid fish.

And I thought, this is what my government says food is.

My government removed access to buffalo, for example,

and replaced it with this.

Separating people from their land

and their culture means separating people

from their food.

And for 150 years, this or worse is what we've provided instead.

It's gotten a lot better recently

but this has been the state of the art for a long time.

Separating people from their food is particularly harmful.

It harms the spirit as well as health.

It's demoralizing on a massive scale.

One tenet of culture is prevention is returning the

locus of control so that the people decide what food is.

The failure of understanding might persist

but it matters less if we are not dictating the terms.

We get out of the way and the people decide what food is,

how religion works, how government works,

how education is delivered, how healthcare is delivered.

The people take the traditions and the innovations that work

for them, just as they always have adapting, innovating,

incorporating the new even

as they are reclaiming their identities,

strengthening their culture and defining themselves

and their practices on their own terms.

I'm guessing that you're all with me, that you all think

that buffalo is better than commodity canned beef.

And you probably think if the people want

to have a naming ceremony, no reason for our government

to have an opinion about it, much less pass a law against it.

But I'm guessing I'm going to lose you when I extend

that self-determination to our work,

to CDC grants, for example.

We're CDC after all and we're really smart.

But is it really our call for people

in cultures we don't understand

to decide what the evidence based practices are,

to set the goals, to monitor the progress?

Why wouldn't we say, "We don't really understand what works.

You give it a go.

You do what you know works.

We'll provide the resources.

We'll provide any assistance you ask for.

But you decide what you're going to do.

And if you fail, no worries.

We have centuries of experience with failure.

Just keep trying.

In the 1950s, the people numbered fewer than 400,000.

Today, there are more than four million American Indians

and Alaska Natives in this country.

That's resilience.

In the 1950s, the people were prohibited

from speaking their languages.

Today, many Native children attend language immersion

programs in their tribally-run schools.

That's resurgence.

The past 20 years has seen an explosion of hunting, fishing