WARM SPRINGS – Retirees flock to live out their golden years in Bend, but about 60 miles north on the Warm Springs Reservation many residents aren’t even making it to their 50th birthday.

According to a mortality study by a Warm Springs Health and Wellness Center doctor presented to the tribal council and obtained by The Bulletin, the average age of death between 1991 and 2000 was almost 47. The study was not made public at the time.

In contrast, the average age of death in Oregon in 2001 was 74, according to state statistics.

Dying younger is far from being a Warm Springs problem. Indians nationwide are struggling to live as long as the average American.

”Life expectancy for American Indians is shorter,” said Doni Wilder, the director of the Portland area Indian Health Service. ”Historically it’s always been the case. We’ve made great strides in improving it.”

Health officials nationwide have struggled to discover why Indians have a life span that is shorter than most Americans.

Scientists have studied if there are genetic components that make Indians more susceptible to problems like diabetes. Hearings in Congress have pointed out the need to teach Indian youngsters that a good diet, physical activity and lifestyle choices can prevent the fate that meets far too many of their elders.

Dr. Miles Rudd’s mortality study was of about 5,000 people, who are or were patients at the Warm Springs Health and Wellness Center.

The patients in the study include some people who do not live on the reservation, for instance other Indians who live somewhere else. However, most of the patients are reservation residents.

Rudd found:

-The No. 1 cause of death was accidents, primarily car wrecks. Alcohol was a factor in 72 percent of those car accidents.

-No. 2 was diabetes and complications related to the disease.

-No. 3 was heart disease.

-No. 4 was suicide.

-No. 5 was chronic liver disease and cirrhosis.

-Tied for the No. 5 cause was cancer.

Heart disease is the No. 1 cause of death in the U.S. according to the Centers for Disease Control and Prevention’s statistics from 1999, but No. 3 for patients at Warm Springs, according to Rudd’s study.

Cancer is the second leading cause of death in the U.S., according to the CDC, but No. 5 in causes of death among Warm Springs patients in Rudd’s study.

The doctor’s study does include some good news. The average age of death went up by about 11 years from 1991 to 2000. Infant mortality rates have also declined since the late 1980s. There were eight infant deaths between 1991-2000, four of which were due to what is called sudden infant death syndrome (SIDS).

Between 1987 and 1988, there were four infant deaths due to SIDS in that two-year period alone, according to Rudd’s study. The doctor credits the health center’s encouragement of the use of baby boards as contributing to the decline. Babies are swaddled in on their backs on traditional baby boards.

One tribal leader points to the growth rate of the tribe as a positive sign for Warm Springs’ future.

”I don’t want to sound callous,” said William Fuentes, the tribes’ chief operating officer, explaining that death is a tragedy for the entire community.

”The growth rate is such the tribal membership will continue to grow. When someone does die at a young age it just seems like there are other people being born to replace that loss.”

The number of tribal members has grown from 1,062 to 4,222 from 1950 to 2003, according to the tribes’ vital statistic department.

Fuentes said that some teenage deaths ”skewed” the average death rate for the tribe.

Because young deaths can bring down averages, Oregon doesn’t publish the average age of death, said David Hopkins, a research analyst for the Center for Health Statistics, which is part of the state Department of Human Services. The median – the number in the middle of all the ages of death – is used instead.

However, the average and the median ages of death in Oregon were only a few years apart in 2001. The average was 74 versus 78, the median.

Better health care on the reservation can’t save everybody, said Russ Alger, the chief executive officer of the Warm Springs Health and Wellness Center. ”A lot of health care is personal choice. People have to make a decision early on in life they’re going to live a healthy lifestyle,” he said.

”If we have people dying young in car accidents, they don’t have the choice.”

But better understanding of what leads to patients’ deaths can guide the Warm Springs health clinic’s prevention efforts, said Dr. Rudd, who is a senior staff physician at the clinic.

”I hadn’t realized the degree of difference of what we were seeing at Warm Springs versus what we were seeing in the U.S. as a whole,” he said.

Armed with mortality statistics, Rudd and other administrators encouraged the tribal council to pass a reservation seatbelt law, which went into effect in 2000. Police Chief Don Courtney supported it.

”I’ve been here 14, 15 years and again if I were to put a percentage on it in all the (vehicle) fatalities probably 95 to 98 percent were as a result of not wearing a seatbelt or were a contributing factor to death,” Courtney said.

The health clinic itself has already acted on Rudd’s research, running safety prevention months in response to the high accident rate. Those months included public service announcements on the radio and a campaign in the elementary school about seat belt use.

The report has helped increase awareness among health staff about causes of mortality and it will be one part of the tribe’s future strategic health plan, said Russ Alger, the chief executive officer of the Warm Springs Health and Wellness Center.

That plan is expected to identify causes of mortality, health priorities and medical needs of the community.

The diabetes program at Warm Springs continues to put an emphasis on early detection by trying to identify residents with a higher risk of diabetes before they even get the disease. Once patients are diagnosed with diabetes, the staff works with them to prevent the disease from getting worse.

Even if the tribe is growing, residents agree that death causes the reservation to lose leaders and resources. Losing elders means losing culture, said Carolyn Wewa, a tribal council member and a community health education specialist.

”We may lose some stories or knowledge because they may have been the last one who knew where to gather a sacred medicine but they never shared where to get it,” she said.

Health awareness is increasing, she said, but some people still struggle to think beyond tomorrow.

”I still feel like there’s this portion of our people who are just surviving – trying to make ends meet, pay bills, keep their lights on and that takes over their life.”

Wilbur Johnson, 65, said he grew up in the traditional way on the reservation fishing for salmon, digging for roots and hunting animals during different seasons.

”Everything we got, God created it. God planted it,” he said. ”The only thing we had to do was hustle for it.”

He believes people are living shorter lives these days on the reservation and the world is out of balance.

Of course some tribal members do go on to live long, successful lives.

After finishing the lunch meal at the Warm Springs senior center earlier this week, Faye Waheneka, 72, talked with pride about the accomplishments of her family. Waheneka has more than 20 grandchildren. Her mother is 94.

Despite her diabetes, Waheneka believes her attitude toward life helps her live longer. She was also raised eating traditional foods and doing outdoor physical activity.

The Warm Springs lifestyle has dramatically changed in the last century, explained Jennie Smith, coordinator of the Warm Springs diabetes education program.

”One hundred years ago, people were out and had to work hard for what they got,” she said.

Without cars, without fast food, Smith believes the number of diabetes cases would be dramatically lower.

The diabetes treatment program has had some success. Though the number of people diagnosed with Type 2 diabetes, which is either when the body does not produce enough insulin or the cells ignore it, has gone up in the last decade, there are fewer people needing kidney dialysis treatment, Smith said. .

But longer lifespans bring different health risks.

As Indians do live longer, Rudd believes some diseases could become more prevalent. For example, the number of deaths due to heart disease increased in the late 1990s.

”This would be expected due to the increase in average age of death during the same time period,” the report states. ”As people live past their young adulthood, they run greater risk of heart disease.”

In the last decade, more people are taking advantage of health care at Warm Springs. There were about 34,400 clinic visits in 1994 and about 57,700 in 2001. The tribes are helping pay for a $1.5 million expansion of the health center to begin this summer that will increase the number of exam rooms, among other changes.

Not everyone believes these statistics are an accurate representation of reservation life. Margaret Buckland, 74, said she believes more people live longer than people say. ”I guess it’s one of my biases,” she said.

Rudd, the doctor who wrote the report, said he hoped people would accept that it’s true.

”To make changes, I really think it takes a community effort,” he said.

Julia Lyon can be reached at 541-504-2336 or at jlyon@bendbulletin.com.