The Impact of Cove 19 on the Indian Health Service

CPSolvers: Anti-Racism in Medicine Series

Episode 12: Our Land is Our Health: Addressing Anti-Indigenous Racism in Medicine

Show Notes by LaShyra Nolen

November 23rd, 2021

Summary: This episode is about the ways we can combat anti-Indigenous sentiments and actions in our efforts to promote anti-racism in medicine and public health. This discussion is hosted by our new team members Alec Calac and Victor Lopez-Carmen, as they interview Dr. Tom Sequist, member of the Taos Pueblo Tribe and Chief Patient Experience and Equity Officer at Mass General Brigham, and Dr. Sophie Neuner, proud member of the Karuk Tribe, and a Research Associate at the Johns Hopkins Center for American Indian Health. Together, these two phenomenal guests help us understand the structural and individual challenges of Indigenous peoples in academic medicine, public health, and beyond.

Episode Learning Objectives:

After listening to this episode learners will be able to…

1. Understand the historical and present-day role of settler colonialism behind health disparities in Indigenous populations.
2. Learn ways to address the lack of representation of Indigenous peoples in academia and how to create safe learning environments for Indigenous peoples in these academic spaces.
3. Understand the importance of disaggregated health data and how the burden of proof for “blood quantum” requirements can be detrimental to Indigenous peoples.
4. Learn the ways COVID-19 and climate change have exacerbated health inequities within Indigenous populations.
5. Learn tangible ways to center the Indigenous communities in advocacy efforts at the interpersonal and institutional level.

Credits

• Written and produced by: Rohan Khazanchi, MPH, Michelle Ogunwole, MD, Alec Calac, Victor Lopez Carmen, MPH, Utibe R. Essien, MD, MPH, Jennifer Tsai MD, MEd, Sudarshan Krishnamurthy, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Dereck Paul, MD, MS, Ayana Watkins, Jazzmin Williams
• Hosts: Alec Calac and Victor Lopez Carmen, MPH
• Infographic: Creative Edge Design
• Audio edits: David Hu
• Show notes: LaShyra Nolen
• Guests: Dr. Tom Sequist, MD, MPH and Dr. Sophie Neuner, MD, MPH

Time Stamps

00:00           Introduction

05:25           What do I call you?

10:37           “Blood quantum” and the burden of proof

18:05           Challenges of Indigenous Peoples in medical spaces

24:50           COVID-19 and climate change’s impact on Indigenous Peoples

30:27           Racism in academia and creating safe spaces

41:22           “Data genocide”  

50:11           What can listeners do going forward?

62:10           Key takeaways

Episode Takeaways:

1. Take the time to learn about how Indigenous Peoples influence the world around you.

From the street names of the cities in which we live to the nature that surrounds us, Dr. Sequist reminds us of the importance of taking the time to learn about how Indigenous Peoples have influenced and continue to influence every aspect of our lives. He encourages us to learn about the original inhabitants of lands on which we reside and to do the work to learn about the ongoing contributions from tribes around us. This is especially important when we consider the lasting role colonialism, genocide, and racism has played in attempted erasure of these communities and their culture.

2. Learn about the good and the ugly when it comes to the history of Indigenous Peoples.

Victor reminds us that we can hold two truths at the same time. Dr. Sequist also encourages us to, in addition to learning about the rich cultural traditions and invaluable contributions of Indigenous Peoples, to also acknowledge the historical and ongoing oppression these communities face. Indigenous Peoples continue to suffer disproportionately from health inequities, mental illness, poverty, climate change and police brutality, all of which have been exacerbated by the COVID-19 pandemic. We must recognize these struggles were born out of settler colonialism and learn this history while actively working to undo present harms.

3. Do not exclude Indigenous peoples in your research narratives. If you’re going to, acknowledge your limitations. 

Dr. Neuner reminds us of the importance of centering Indigenous Peoples in our research and data because this information helps drive policy and health initiatives that can address barriers to health in the community.

Pearls

 Common Terms Used to Refer to Indigenous Peoples

• Our guests and hosts remind us of the importance of not making assumptions about someone’s identity. It is often preferable to use tribal affiliation when referring to Indigenous Peoples rather than terms like Indigenous or Native American. By not doing so, we obscure critical knowledge about relationality, Indigenous clans, and communal origins.
• The term “American Indian or Alaska Native” is a legal racial and ethnic identifier which is why we might see it used in legal documents and research manuscripts. Many manuscripts have moved towards using Black, Indigenous, People of Color (BIPOC), but this term may be doing more harm than good for Indigenous Peoples. Read III.A.I-2 of Why BIPOC Fails (Deo, M., 2021) to understand why.
• The term “Native American” is frequently used but does not cover Indigenous Peoples from across the world

The Burden of Proof

• Dr. Sequist discusses “blood quantum”, which is an attempt by the federal government to reduce one’s identity as an Indigenous person to a percentage of blood affiliated with specific Tribes in the US. This flawed measure can be harmful for many reasons. It notably creates a burden of proof for Indigenous trainees to prove their identity, which can provide additional stress during application and interview cycles.

COVID-19 and Indigenous Peoples

• Alec reminds us that Indigenous Peoples represent 6% of the global population across more than 70 countries, but around 15% of the global population experiencing poverty.
• Many of the health inequities we have seen for Indian Country during COVID-19 are directly linked to settler colonialism. This is further exacerbated by poverty, lack of cell phone coverage, food insecurity, broadband internet, and a shortage of trusted messengers with appropriate training in Tribal communities.
• Dr. Neuner reminds us that many Native communities live in multigenerational housing (over 65% of communities have elders living with them) which made it challenging to socially distance during the pandemic.

Data Genocide

Dr. Neuner reminds us about the importance of data for advocacy for Indigenous communities, especially during COVID-19. More background here from the Urban Indian Health Institute.

“Without data you can’t change anything.” 

Some of the challenges with data collection discussed were:

• Limited availability disaggregated data and how being listed as “other” on surveys leads to compounded distrust in medical systems  
• Limited accessibility to that data for Tribal communities being surveyed
• Logistical challenges of collecting necessary data, including the training and funding of community members

Ways to Help Uplift Indigenous Peoples in Academia  

Our guests share some ways we can help support and uplift Indigenous peoples:

• Community-based participatory research that benefits Tribal communities in meaningful ways
• Working towards making education free for Native students
• Promoting Tribal sovereignty 
• Advocating for climate justice
• Aligning institutional missions to support Indigenous peoples locally, nationally, and globally  

Creating Supportive Spaces

Our guests remind us of the importance of thinking beyond addressing the “pipeline” to increase representation of Indigenous Peoples in medicine, but also emphasize the importance of creating safe spaces for these students to thrive.

• This includes being mindful of language and the etiology of the words we use in academic and medical spaces (e.g., “low on the totem pole”, “let’s have a powwow”)
• This also includes understanding the unique challenges Indigenous students face when away from their communities in predominantly white institutions, which can often affect their mental health and wellbeing.  

References

1. Dr. Neuner’s podcast, Indiginae: https://caih.jhu.edu/programs/indigenae-podcast
2. United Nations Declaration on the Rights of Indigenous Peoples https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.html
3. Native Land is an app to help map Indigenous territories, treaties, and languages. https://native-land.ca/
4. NPR Code Switch Podcast Episode: “So What ‘Exactly’ is Blood Quantum?” https://www.npr.org/sections/codeswitch/2018/02/09/583987261/so-what-exactly-is-blood-quantum
5. Indigenous Peoples and global poverty rates https://www.worldbank.org/en/topic/indigenouspeoples#1
6. Teem Vogue: “Native Communities Face Higher Risks During Coronavirus Pandemic Thanks to Legacy of Colonization” https://www.teenvogue.com/story/coronavirus-native-reservations
7. Perspective by Dr. Tom Sequist “Paving the Way — Providing Opportunities for Native American Students” N Engl J Med 2005; 353:1884-1886. doi:10.1056/NEJMp058218
8. The Impact of Internet Access in Indigenous Communities in Canada and the United States: An Overview of Findings and Guidelines for Research https://www.internetsociety.org/wp-content/uploads/2020/07/Impact-Indigenous_Communities-EN.pdf
9. Boston Globe article: “Where are all the Native American medical students?” by Victor Lopez-Carmen https://www.bostonglobe.com/2021/01/24/opinion/where-are-all-native-american-medical-students/

Disclosures 

The hosts and guests report no relevant financial disclosures.

Citation

Sequist T, Neuner S, Calac A, Lopez-Carmen V, Tsai J, Krishnamurthy S, Ogunwole M, Fields NF, Nolen L, Onuoha C, Watkins A, Williams J, Paul D, Essien UR, Khazanchi R. “Episode 12: Our Land is Our Health: Addressing Anti-Indigenous Racism in Medicine.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. November 23, 2021.

TRANSCRIPT