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Shoalwater Bay Indian Tribe’s past guides its present. The result: better health.

This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

Through tall cedar and fir trees on Eagle Hill, Charlene Nelson can spot the distant homes of the Shoalwater Bay Indian Reservation. If all goes as planned, those dwellings will someday move to this higher ground. Tribe members have voted to relocate their community to protect their families from tsunami hazards. "The health and safety of our tribal members are my primary goals," explains Nelson, the tribal chair.

The will to survive and thrive propels the Shoalwater Bay Indian Tribe. The federally recognized tribe has 373 members, of whom 84 live on the remote reservation in Pacific County, WA, 150 miles southwest of Seattle. Although small in size, the tribe has big goals to improve and maintain the physical, social, emotional, and spiritual health of its people. The community promotes healthy behavior and active living, invests in the lives and well-being of its youth, and tends all residents' medical, dental, and mental health needs with its wellness center.

Earl Davis (left) teaches tribal youth, including Aiden Davis (right), the traditional Salish style of woodcarving.

[How a spike in infant mortality shed light on glaring health needs]

The tribe's approach to life, fed by its rich and deep history, reflects the core values of the RWJF Culture of Health Prize. "Our elders and our ancestors taught us that health is a holistic thing," explains Earl Davis, a former Marine and a master woodcarver. "It's not just whether you get up and exercise and eat right. It's taking care of your mind, taking care of your body, taking care of your spirit, and taking care of everything around you."

Formed 150 years ago, the one-square-mile reservation is located in a crook of coastline where tribes from the Pacific Northwest used to gather to trade. Much of the area is wetland or tidal plains with little room for the tribe to grow. Flooding and extreme erosion are constant threats. A neighborhood just north of the reservation on Highway 105 has seen houses and beachfront swallowed by the sea. In 2013, the US Army Corps of Engineers rebuilt a mile-long dune barrier to protect the reservation. But everyone knows that even that would be insufficient to withstand "The Big One" — an anticipated offshore earthquake that could trigger a catastrophic wave within minutes. Up and down the coast of Washington, other communities have taken steps to relocate to higher ground in response to stepped-up tsunami planning in the Pacific Northwest. The Shoalwater tribe has purchased land on Eagle Hill, using funds from tribal businesses, including a small casino, a restaurant, a motel, a gas station, and a convenience store. It also has constructed a multi-purpose building, 55 feet above sea level, that doubles as an evacuation center in case of a tsunami, earthquake, or flood.

From left to right, Alyssa Auvinen, Mechele Johnson, Jamie Judkins, Jan Ulmstead, James Kissee, and Charlene Nelson are members of the tribe’s Pulling Together for Wellness group.

[In the Pacific Northwest's tsunami hazard zone, emergency preparedness is a way of life]

All the members of the tribe take emergency preparedness very seriously. On a recent summer morning, hundreds of neighbors took part in a "tsunami and health walk," which started at the reservation's gym next to marshes and wound its way along a path to Eagle Hill Road and the new evacuation center. Along the way, participants, from toddlers to seniors, learned what to do and where to go in the event of an earthquake-triggered wave as high as 50 feet.

The tribe's sharpened focus on community health began in the early 1990s after tribal women experienced a perplexing increase in the frequency of miscarriages and infant deaths. Epidemiologists from state and federal agencies conducted investigations but came up with nothing conclusive.

[Teens lead the way on a path to wellness]

With the very future of the tribe in jeopardy, the experience proved to be a turning point. At the time, the closest tribal clinic was 70 miles away at another reservation. Motivated to improve the health of its community, the tribe started a small clinic in four rooms at the tribal center. The clinic's success led to the opening, in 2005, of the larger, stand-alone Shoalwater Bay Wellness Center, which provides medical, dental, behavioral health, and substance abuse services not only for tribe members, but for all neighbors. "It's a great step forward," Nelson says.

Evidence of the tribe's improving well-being is measured in the number of young people: 40 percent of residents on the reservation are under 18. Nelson recalls being "thrilled" with the first few births. "It was wonderful," she says, "because we hadn't had babies and suddenly we had babies. Lots of them."

The Shoalwater tribe sees life within the frame of seven generations: The current generation, they say, is shaped by the experience of people three generations before and tasked with setting the course for three generations to come.

[Tribe members reclaim 10,000 years of history and culture to restore health]

This view is why Earl Davis teaches children the traditional Salish style of woodcarving, so they can pass it on to their own children. And it is why he leads Shoalwater tribe members on an annual seafaring canoe journey that connects them not only with their own culture, but with the customs and traditions of tribal neighbors from the Pacific Northwest, Canada, and Alaska. This year, thousands of paddlers from all over the region converged at the Nisqually Reservation near Olympia, WA. Men, women, teens, and children from the Shoalwater tribe were invited to join their neighbors from the Chinook Indian Nation to paddle together in a dugout canoe for eight days and 200 miles.

The seven-generation view of life is also why the Shoalwater tribe looks towards Eagle Hill and a new chapter for the tribe among the pines.

[Putting out the welcome mat for neighbors]

"The main reason why we want to move up the hill is because we don't want our kids to have to go through the worry and stress that we're going through now," says Joel Blake, a fifth-generation tribe member who has two children, ages five and three. "We have to offer them a place that's safe."

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This feature was produced by Robert Wood Johnson Foundation, and does not reflect the opinions or point of view of Vox Media or Vox Creative. Vox Media editorial staff was not involved in the creation or production of this content.

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