Improving Health Outcomes for Indigenous Communities
The buzz around the ten-time Oscar-nominated movie, Killers of the Flower Moon, based on a book by the same name, is well warranted. Lily Gladstone, who portrays the film’s protagonist Native Osage Tribal member Mollie Burkhardt, became the first Indigenous American woman to be nominated for an Oscar. The film, based on true events, tells the story of white settlers’ nefarious plot in early twentieth century Oklahoma to cheat, murder, and rob the people of the Osage nation in an effort to seize natural resource rich land. Unfortunately, this story is one of many in a long anthology of colonization and exploitation of Indigenous people at the hands of European imperialism, the effects of which are still very much felt today, especially when it comes to healthcare.
As of 2021, the average life expectancy for American Indians and Alaskan Natives is 65.2 years. This stands in stark comparison to White and Hispanic populations, which boast life expectancies of 76.4. and 77.7, respectively. On reservations, Native persons are most likely to die from unintentional injury, homicide, chronic liver disease, and diabetes at rates significantly higher – between two and five-fold times higher – than those of their White and Hispanic counterparts.
Partnerships between Indigenous communities and medical schools have been mutually beneficial for both parties. An example is a partnership between the Rosebud Sioux Tribe in South Dakota and where I work at Massachusetts General Hospital, in Boston. Through the partnership, the Rosebud Sioux Tribe has brought in new resources for its health system, and physicians like me have had the opportunity to spend time engaging with community members both through educational sessions in Boston and in direct community outreach in South Dakota.
The Lakota Nation, living primarily on reservation lands across North and South Dakota, has had challenges to ensuring consistent access to quality healthcare. Reliable access to quality healthcare is known to be a direct influence on life expectancy in the U.S. Rosebud Hospital, the only hospital on the Reservation where the Rosebud Sioux are located, was closed for seven months due to concerns about healthcare quality, overwhelming other area hospitals and emergency medical services. On top of this, the Lakota struggle with a particularly high suicide rate – partially a product of decades of forced cultural assimilation in boarding schools and other forms of repression. In Todd County, South Dakota, where the Rosebud Sioux Tribe calls home, the suicide rate is nearly four times as high as the U.S. as a whole, and over twice as high as the state of South Dakota in aggregate. Delivery of constructive and compassionate medical care is paramount to enable the community to gain the upper hand in the fight against these lifestyle diseases and increased suicide risk. Therein lies the issue today.
The Indian Health Service (IHS) is the federal entity designed by the U.S. government in 1955 in an effort to improve more than a prior century’s worth of ineffective and culturally incompetent healthcare. Unfortunately, this model as it currently functions has left much to be desired. In 2010, a U.S. Senate report highlighted the need for reform of the Service after an investigation found multiple shortcomings to delivering quality care including substantial diversion of health care services, mismanagement of contract health service funding, and significant risk for facility accreditation and certification revocation, just to name a few. And, it remains not only chronically underfunded — federal funds address less than half the medical and health needs for the Native American and Native Alaskan populations — but also understaffed. IHS health provider vacancies average around 25% at any given time.
Despite these considerable obstacles, the Rosebud Sioux have had victories in advancing the autonomy of their community. Within the past few years, there have been successful efforts at reintroduction of bison, the animal whose relationship with Native communities is linked closely with cultural values as well as economic revitalization and resilience. The Rosebud community is actively working towards building their own resilience. As an example of leaders in this effort, Nora Antoine, PhD, a Native to Rosebud, now works as an educator and leadership consultant to encourage members of her Tribe to become leaders in their own right. Today, she works with Rosebud community members to advance policy and advocacy by preparing individuals for elected leadership positions, coaching them in the method of community organizing, and working closely with them and educational institutions to ensure equitable education for young Tribal members. A lifetime resident of Rosebud and member of the Oglala Sioux Tribe, Butch Artichoker, provided insight into the ongoing debate that exists within Rosebud on whether to run their own hospital with federal funds rather than be subjected to federal oversight through the IHS. However, this comes with its own challenges that the community recognizes. Infrastructure and human capital alike would need to be considerably increased from what is currently available in the community in order for the Rosebud Hospital to be fully self-sufficient.
The difficulties faced by the Lakota are not unique to them — they are endemic — or rather a pandemic of common threads such as these running through many communities around the world that have experienced the social and health effects of colonization at some point in their history. So, this spring, as the Hollywood community recognizes the efforts of the actors, directors, and producers of the many films showcased in 2023, let us make more concerted efforts to recognize Indigenous communities across our country and around our world, allying with them for better autonomy and health outcomes, to ensure a better future for them — and by extension —all of us.
