Health Equity

Prioritizing Equity video series: Advocating for Change in Native Health Policy

. 37 MIN READ

In this Feb. 6, 2023 edition of the Prioritizing Equity series, medical student organizers and policy advocates discuss increasing access to care in Native communities and improving care within the Indian Health Services through health policy.

  • Tamee Livermont, MPH—citizen of Oglala Lakota Nation, medical student at the University of Minnesota Medical School, secretary of the AMA Medical Student Section Committee on American Indian Affairs, 2022 Udall Native American Health Policy Fellow
  • Alec Calac, MD/PhD Candidate—medical student at UC San Diego, national president of the Association of Native American Medical Students, chair of the AMA Medical Student Section Committee for American Indian Affairs
  • Ashton Glover Gatewood, MPH, OMS-3—medical student at the Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation
  • Aletha Maybank, MD, MPH—chief health equity officer, senior vice president, Center for Health Equity, American Medical Association

Dr. Maybank: Hello, everyone, and welcome to Prioritizing Equity. I am Dr. Aletha Maybank. I am senior vice president and the chief health equity officer at the American Medical Association, and thank you for joining us for a brand new episode in the Prioritizing Equity Series.

In today's panel, we have three wonderful med student organizers and policy advocates who will discuss their work to increase access to health care in Native American communities through health policy change and to improve care through the Indian Health Services.

Health inequities in Native American communities are a result of hundreds of years of disinvestment, racism, cultural genocide. In addition, the Indian Health Services has been inadequately funded, further contributes to the health outcomes of Native individuals and communities. And at the latest AMA Interim Meeting, the American Medical Association, we were joined by an impressive group of nearly two dozen Native American medical students from the Medical Student Section Committee. And this group of students successfully advocated for seven policies focused on increasing investment and capacity for Native American health through policies focused on areas such as EMR, traditional health services and graduate medical education for the Indian Health Services.

And I have to say, the Medical Student Section, and folks have heard me say this before, is a really strong part, from my perspective of my vitality, really at the American Medical Association. They have created so many doors for the work that we have been able to pull together as a Center for Health Equity and really lead in this country. And just, I really thank kind of the optimism, the courageousness, the directness, and really the great intention of the Med Student Section. So I just wanted to acknowledge and honor you all for that because I'm really grateful for you all.

So let's give a warm welcome to everyone. You all can just kind of raise your hand very quickly. Alec Calac, who has been a strong advocate, partner with us at the Center for Health Equity, a wonderful student leader. He's an MD/PhD candidate at UC San Diego and national president of the Association of Native American Medical Students and chair of the AMA Medical Student Section Committee for American Indian Affairs. Thanks for being here.

Next we have Tamee Livermont, who's a MPH, love my MPHs, and she's a citizen of Oglala Lakota Nation and a current medical student at the University of Minnesota Medical School. She is currently secretary of the AMA Medical Student Section Committee on American Indian Affairs, and is a 2022 Udall Native American Health Policy Fellow. Welcome.

And then next, we have Ashton Glover Gatewood, also an MPH, OMS-3, is a medical student at the Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, and as a member of the inaugural class of the first tribally affiliated med school in the United States. Completely awesome. And she is a proud member of the Choctaw Nation and a descendant of the Chickasaw and Cherokee Nations.

I'm really honored to be here and having this conversation with you all. So before we get deep into the questions, but I think this is a really important part of the questions and how we show up as human beings in order to relate to one another is, how are you all coming into the conversation today? How are you? And how are you feeling at this point in time? And I will start with, Tamee, you were to my left and so I'm going to start with you.

Livermont: I'm glad to. I'm really excited to be part of this conversation, and also at the same time, exhausted. I think being in med school and constantly advocating for communities can be exhausting, but opportunities to speak with many individuals that will interact with this panel and with my beloved colleagues that I just so enjoy being in the presence of. I'm just really excited to be here. Thank you.

Dr. Maybank: Awesome. Alec?

Calac: I think, for me, it's recognizing that I've been in my MD/PhD training for almost half a decade now. And after watching my medical school classmates leave residency, and now in the midst of studying my dissertation work, it can definitely be daunting. But this is the kind of energy that renews me and affirms why I do the work that I do. So really, trying to come into this conversation in a good way, new year, same priorities, and really trying to, again, advance health equity, while also at this level of our education.

Dr. Maybank: Awesome. Thank you. And, Ashton?

Gatewood: Well, since I'm a third year, I'm doing my clinical rotations. And so I am currently on internal medicine, and I am a member of the inaugural Tribal Medicine Track at my school. So that means, I just came home from my away rotations at a lot of our major Tribal health systems. And so that was just very reaffirming and energizing for me to get to see some of our Tribes that have built these entire health systems to care for our people. So I just came off of getting to go out to those sites and work with Native physicians at Native hospitals, and I think that's just been something really unique and inspiring that I've been fortunate to do this year. So that's kind of the place that I'm at right now.

Dr. Maybank: Oh, fantastic. It sounds affirming and inspiring, just listening to it. The ability to be able to connect with people in the work that we do, culturally, is very grounding, I think, and honestly, and as Alex said, kind of refocusing, kind of recenters why we're doing this work in the first place. So I think that that's just an amazing opportunity and a need and an important way of going in medicine for all of us, being connected culturally to what we know and understand and can lean in.

All right. So, Alec, so we're going to go back to you. You mentioned being an MD/PhD student, and your educational experiences have really been focused at the intersection of medicine and health policy, and what are some of the high priority health equity issues right now facing Native communities, and what are the priorities in key policies at Tribes, and what they're experiencing really to address the issues. And I think, what's really important for me about this conversation, also about the leadership that you have had and what you've offered, myself and the Center, is just really pushing to make sure these opportunities and the realities and experiences of Native communities does not remain invisible or is invisibleized. It's not really invisible. People are experiencing it, people see it, it's their day-to-day.

But making sure that those who are in these policy spaces and health care spaces are also talking about it and that doesn't get pushed to the side. And so, I'd love for you to talk just more about what is on the forefront of what is being faced and addressed right now.

Calac: Sure. I think bringing our lived experiences, our professional experiences, into the AMA Medical Student Section, a key kind of philosophy or kind of charge to the Committee on American Indian Affairs was that, we were going to, not just work on our own interests, but really bridge the priorities of the Medical Student Section, the AMA, with the priorities with Tribal Nations and our nonprofit organizations that do the work in Congress and also with policymakers each and every day.

So these issues range from medical education to workforce development to payment reform. And there's really no shortage of issues to address, so we've really taken an approach of taking existing priorities and issue areas that much smaller organizations have worked on, and really embedded that into the work that the AMA is doing, so that we broaden the kind of reach and scope of our advocacy work. Because when you have all organizations, you can have pretty sizable impact, but when you really work together and think about how influential the AMA can be, I think, again, bringing that Indigenous perspective to the Center really opens the opportunity for meaningful reform.

Dr. Maybank: Absolutely. And what would you say, for this year or this past year, maybe for this coming year, what are you really focusing on in terms of advocacy this year? What do you think is a really critical opportunity that we can't let up on?

Calac: Certainly. So it was truly historic at the close of the last Congress, where we saw legislators choose to advance appropriations for the Indian Health Service, meaning that, instead of just providing funds for Fiscal Year 2023, we also saw funds given for Fiscal Year 2024 to give funding certainty, not just the federal health programs operated by the government, but also health programs that are operated by Tribes and urban Indian health programs. So that certainty allowed for long-term planning to strengthen the workforce.

But in addition to that, we saw a rather flat increase in the budget for the Indian Health Service. So only a $294 million increase, while similar federal health programs like the VA receive billions of dollars in increased funds. So we're always trying to make sure that from federal program to federal program, we really lift up funding equity and have that as a priority, but also think about the charge of the Medical Student Section, which is medical education. Virtually, every medical student, resident, fellow trained in the U.S. today will have experiences with the VA, but almost none of them will work with the IHS. So we want to make sure that people get that exposure because when you're exposed to something, you're more likely to practice there, the rather simple kind of relationship.

Dr. Maybank: Absolutely, and I would love to come back to that. Because I don't want to make the assumption that everyone who's listening in understands the Indian Health Service, when it came and why, and kind of the opportunity, but also the challenges, because that kind of gets, to your point, because the education is not out there, the exposure's not out there. There's so many assumptions, and I think that contributes to the lack of advocacy, in part, clearly, it's not fully, to it. So we'll come back to that, because, Tamee, I want to ask you a few questions. It can be more of a conversation, but I just want to ask you a few questions as well.

As somebody who plans to utilize your policy and your clinical degree to defend treaty obligations for the provision of health care and increasing services to improve health outcomes, can you speak to your work around, not only self-determination for health care. I believe our context is more around collective determination. We can't do it ourselves, I'm very picky on words, but I understand the context of a community having self, but it's also a collective. And so I would just love to hear you kind of speak to that. What does it look like? And what are the examples in policy that you think really make a difference in achieving that and access to health care?

Livermont: Sure. So you touched on it. What does self-determination mean? And I think it's important to explain that, because as people that are citizens of tribal nations, I think the understanding of what self-determination means is kind of taught to us since we were children. That was something that we grew up understanding and being taught was what's self-determination, what is sovereignty. But for people listening in that aren't familiar with that, they might be wondering, what is self-determination of health care? And I think Ashton shared some perfect examples, but what that really means is, Tribal Nations being able to take control of providing health services, public health infrastructure, whatever it is to their communities, in the way that their communities need it, in a way that's informed by their community.

And this was really mobilized initially in the 1970s. So before the 1970s, we saw a lot of federal policy related to providing services in Tribal communities, which is kind of where the IHS came from. But they were paternalistic, they were geared towards the federal government kind of coming in and providing services. And in 1975, the Indian Self-Determination and Education Assistance Act was passed. And this was really a huge win for tribes, because it was one of the first times that federal policy related to treaty obligations give tribes the authority to provide these services to their communities. And this is really what self-determination or how self-determination is even possible today is through that single policy and then other policies that have been built up off of it.

But for me, personally, a lot of my work related to self-determination is thinking about, how do we transform the provision of health services or the provision of services that are seen as health oriented to our communities, from a tribal lens and not from a federal standpoint? So often, or at least in the area that I'm from, many of our health services or many of our IHSs are ran by the federal government. And that has just really never worked for our communities. Those services and the provision of them weren't informed by our communities.

And we see, like Ashton talked about, the Cherokee Nation. I remember the first time I visited there and they had this immaculate hospital that had, their language was splattered across every wall, and you could tell that that space was really informed by the community that was receiving services there. And I had never known this before because the community that I came from, we were a little bit further behind when it comes to determining our own health services. But it's going to look different across communities. But at the core, what self-determination of health services means is allowing tribes the authority and flexibility to provide services based on the priorities of their own communities, and that reflect the values of their people and the people that their system is serving.

Dr. Maybank: I appreciate that, and I would love to hear more how that connects to policy as well and how that shows up in policy. And a lot of the frames, not a lot, but some of the frames that are emerging that I know you all are familiar with, are around kind of decolonizing health. And I think that's a core part of decolonizing health and health care is that we're focusing on and centering the people, the ideas, the lived experiences. And it's not only just about a center, because that almost feels like somebody's doing that for you, is to your point of self-determination saying that, oh no, folks have the power to do that for themselves and with themselves, in order to lead and create a system and a way of being that work. So I just want to really acknowledge and start to recognize, the movement was there, but I think it's even more so now starting to build with other folks coming in. So thank you for that.

So, Ashton, as a med student at Oklahoma State College of Osteopathic Medicine in a Cherokee Nation, the first only medical school in the United States affiliated with a Native tribe, can you speak to your experience? And I guess you don't have anything to compare it to, because I don't think you went to med school before. So it's really just speaking to your experience and what you understand, maybe some of your other colleagues and what they're experiencing at med school. But how are they structuring it? What's the culture like in the med school?

Gatewood: Well, I actually did go to medical school before.

Dr. Maybank: Oh, you did? Okay.

Gatewood: So that's maybe part of my story that's a little bit different.

Dr. Maybank: Okay!

Gatewood: But I did go to an allopathic medical school for almost two full years of curriculum. I went out of state and was kind of separated from my family and my culture at that time, and I ended up withdrawing and came back home. When I came back home, I transferred my IHS scholarship to a nursing program, and I started working at the Oklahoma City Indian Clinic during nursing school as a pharmacy tech. And then, after I got my nursing degree, I got my MPH. And when OSU Cherokee Nation announced that they were starting this medical school program, I just felt a calling that this was the perfect opportunity for me to go back and finish my medical degree in a setting that was culturally significant for me and supportive and that I could be successful in.

It's been very personal and very meaningful to me to get to be at a tribally affiliated medical school, because I think my story is very specific, I guess, to the proof that it does make a difference. And I think the tribe has been so welcoming. The community has been so welcoming, just being at the headquarters of the Cherokee Nation because all of our signage is in English and Cherokee, all of the art, and even just our gift shop has Native things in it. Our walls have Native art on them. There's never a moment when you don't know where you're at at my school.

And we've actually been working on a project, looking at perspectives of Native students attending this school. And we're starting to see that sense of belonging is actually really conducive to academic success and keeping these students enrolled and helping them to finish out their education in the communities that they come from, instead of pulling them out of their culture and out of their community. And the data all shows that, you're more likely to practice where you go to residency. So the tribe has actually taken it even a step farther. And they currently have a family medicine, internal medicine, and pediatrics residency programs in Tahlequah. So the plan long-term would be to continue that and to be able to keep our Native students able to attend higher education, medical school and residency, all within the tribal counties or reservation area.

And OSU has done a lot of work over decades with the tribe to set the foundation for this. I think it's been about 10 years in the making before they even opened. And a lot of that's been done through our Native Explorers Program, which starts in middle school and high school students, or Operation Orange, which works with the undergrad students. Our NAPA workshop, which was a student-led initiative that I got to help launch to get our undergrad students to our medical school. And now we're seeing the results of that. In my class, at my site, 25% of my class is Native tribally enrolled member, and we have a total of 30 students on average between the two campuses in all three years since we started our tribal site.

So to put that in perspective, many medical schools maybe have one or two students who identify as Native per class. For my school to have 30 students per class, to have one fourth of our class identify as Native, is incredible. And it's a big deal to even have another Native student in your class with you. But for me, I have other Native students from my tribe, which is awesome, because when our tribe has community events or stomp dances or powwows or even scholarship opportunities, we're able to talk with the other students and share, "Oh, did you hear we can apply for funding to support our board exam fees?" Or communicate about cultural things that are going on, "Hey, are you going to Choctaw Nation powwow this weekend?"

So just having that cultural support has really made a huge impact on student success and happiness during school. And we're already hearing from the community just their excitement to see us. And from everything, from just pulling into the parking lot and seeing all the tribal tags, that's something that gives me joy. I always know when I'm getting close to an Indian clinic or hospital or my med school, when I start to see all the tribal tags on the cars, to seeing the faculty and staff walking around with their beaded badge reels. You never wonder, "Is it okay that I'm here?" You never feel that imposter syndrome of, is this where I belong? You never question that because all around you is your community.

Dr. Maybank: I mean, you don't even question your own...there's imposter syndrome in terms of just in the context of everybody else, but your own existence, right? It's validating for you and your community, and as just a human being that I'm okay to just even be alive, and that it's okay to be alive and to be focusing on our health, that, that is okay. There's nothing wrong with that. So many message that we tend to get in white dominant spaces, that we're not enough, that we don't deserve to even be here. So just thank you for sharing all of that.

And I would like to talk about, so in terms of...I think about then the investments and what needs to happen to create an opportunity, Ashton, for others in other places from an investment perspective, and then from the policy perspective, which are very much tied and related to one another. So, Tamee and Alec, can you speak to, more specifically, some more policies? One, I think, Tamee, I think you started to talk about, some that really demonstrate what self-determination looks like and how that shows up in policy and advocacy. And, Alec, I would love to hear you chime in on that as well.

Livermont: I think the best example, and Alec might contribute to this, is the Special Diabetes Program for Indians. It's been a very successful policy that we constantly are having to fight for more funding towards. But the Special Diabetes Program for Indians is a federal program or a federal grant, but tribes are able to apply for it and then it's really open. So they are given the funding with hopes to decrease diabetes rates in their communities. But they really use that funding in whichever way works best for their own community. And we've seen diabetes rates decline drastically through this policy. And I can't think of another policy off of the top of my head that is so specific to a health outcome that is so successful.

And I think SDPI really illustrates the power of self-determination and programs being community informed.The problem with SDPI is, we have the data that shows that this type of policy works for our communities having self-determination of these programs, and we still are constantly fighting for it to be refunded. So we have all of the data to prove that it works and we're still fighting.

Then I think more specific to tribes determining their health systems, you can either contract or compact, and this is getting in the weeds of the ISDEAA policy, which is what I mentioned earlier, but it's really, tribes are given the bucket or a pot of funding that would typically run a federally-run IHS program in their communities. And then they get to do with it whatever their community needs. So an example that I'm currently working on is, at home, one of the first self-determination contracts in the Great Plains area is with the Great Plains Tribal Leaders Health Board, and they took over a federal hospital in Rapid City, South Dakota. And so with that funding that they get through their contract, the community responded to a community survey that said they want traditional healing services.

So last fall, I went home for a couple of weekends, drove 24 hours round trip to be in the community, but we met with elders from the community who have a lot of that knowledge around traditional healing, and sat there for hours with them, asking them, "What does this look like? What would these services look like? Do you want traditional medicines? Do you also want language classes? What are the opportunities? How can we dream up what this looks like?" And Sioux San, which is the health system that Great Plains took over, had existed for 30, 40 years and had never done that type of thing. But then the tribes take it over and they're able to listen to the community and implement policies, procedures, programming that really meets the needs of the communities. And that's going to look different across every community. But based on my personal work, those are a couple of examples that I have.

Dr. Maybank: That's great to hear. And, Alec, I want you to chime in, but also, I want to ask just something to that. In the sense that you're saying people want to change the policy, they want to take the policy away, or they want to make it less or the funding less, what do you think is needed to not do that, outside of clearly the will of people to just not do it? But what else is needed to help support, I think, the advocacy around, I think, a lot of the policies and opportunities that you all are looking to promote and have go through? What do you need in terms of the support?

Livermont: I think visibility, really being able to put a face for a community to what a community looks like to these issues. I think you talked about it a little bit in the beginning, but our communities have been invisible, not because we're not experiencing it, but in the larger scheme of society and policy spaces, our stories haven't been welcomed at those tables. Our faces haven't been welcomed in those spaces. So I think really, this panel is a great opportunity to amplify voices from our communities and bringing it to people's attention and awareness. We know we can't do this work alone. We are three very passionate individuals, and we have many mentors that came before us and tribal leaders that have come before us and been doing this work for many years, and are very passionate about it, but we need others to also advocate for these issues. And I think visibility is a large piece of that, and just being able to put a face to an issue.

Dr. Maybank: Thank you. 

Calac: I share and affirm really everything that Tamee and Ashton have said. I'm trying to determine if it's my stage light or just my emotional reaction to everything that's being said as to why I'm seemingly on the verge of tears, because this is why we do the work that we do. I have the honor, the pleasure of working with friends, working with colleagues, and as of just a few months ago, working with 21 other students with the same passions and interests and motivations. But they don't just have the knowledge that they've learned in school or in their studies, but they bring their lived experience into their advocacy where we seemingly walk into these spaces like the MSS and the greater AMA. And there is that period of educating others or bringing everyone up to speed about what the IHS is, what treaties are, what this legal obligation is, and all this new terminology that seems strange and unfamiliar, but it's our reality every day.

And once you bring everyone up to speed, people understand why you're always at the microphone, or why you're always trying to bring attention to something or that something's always wrong, because things have been wrong for centuries. And only now are we starting to see more native medical students, more Native physicians in these spaces where, what Ashton said, you're seeing Native artwork and Native languages in education and clinical spaces, Native physicians working with Native medical students, serving Native patients.

It's not just about things like racial concordance between patient and provider, patient-physician. It's having someone who understands who you are, and understands your values and how you approach help from an Indigenous perspective. And realizing that we have just a few tribes represented on this panel, there are hundreds in North America, and thousands upon thousands across the world. And when you think about our issues, all we're trying to do in these spaces are address our issues and make life just a little bit better for the next generation so that they can work the generation after them.

And that's why we do what we do. When we surveyed the Association of Native American Medical students about a year and a half ago, the two factors that students cited as barriers to their training were distance from family, separation from their culture. I mean, I don't think Native students, and really any student from a cultural background, should have to leave who they are at the door or minimize who they are. They should be able to bring their full selves into the picture.

And in the course of just this webinar, we've talked about more things, about Native health and policy, than virtually all medical students receive in their entire medical school training. And that's the kind of attention and, at least, knowledge that we want others to have. Because why learn about the overwhelming burden of obesity and diabetes and shorter life expectancy and all these negatives, when we can actually learn how communities are responding when they're at the forefront of addressing these problems themselves, rather than having others say, "You can wait. You're not a priority." Well, we are a priority. We're here. We're still here. And that's, again, what keeps us going is that fight for a better future.

Dr. Maybank: Thank you for that, Alec.

We all evolve as we lead in this work and in life in general. And as I think, advocates and organizers, you evolve in what you're advocating for, how you are advocating, what you realize is more important potentially. And I think the context of what you just said in terms of, don't focus on what we don't have, those stats. We need to know the data, now I'm not saying we don't need that, we don't need better data to understand certain things because that's important to get other things and funding. But understand that the root of us is not about our deficits or what we don't have or those things that are negative. It's all about the assets, how we have, like you said, been able to build, create, not only just the context of surviving, but thriving, I think, culturally especially, in ways that it's actually quite remarkable in how that happens with all the kind of generations and centuries of oppression.

And so I think that that is really important, from my perspective, in a space of health and pursuing health equity. And that's how change has always been made by focusing on, what are our strengths? We're using our strengths and our power as people to advocate and aligning with other values. And I think explicitly saying that, I feel can be, one, again, validating, I think relieving for some folks, truthfully, but also clearer that it's not about poor me and poor you or poor them. It's about, this is what we need to do and we need to get it done and we need to do it together. So I really want to acknowledge what you just said because I think, at this point in time, we need to claim that and say that more and more in many of the spaces that we are. So thank you.

Ashton, in light of all of that, one, I want to give you space if you wanted to add anything to all that has been said by Tamee and Alec over the last couple of things. And then, you're out of school, and what do you think is needed and available to let more people know about your experience out there and how can we support that as well?

Gatewood: Sure. I think the biggest thing is to get involved, get engaged, educate yourself as much as you can, because I think there's often kind of a burden put on Native students to educate everyone around them about our culture and about our historical trauma and policies and where we're at. So I really encourage people to try to find ways to inform themselves, do some of the work and the research to get involved. If there are IHS clinics or hospitals that have volunteer options, I think it's great to come in for a volunteer day or a shadow opportunity. If medical students have a tribal track or a rural track at their school, or even an opportunity for an elective to do an elective at a tribal site, an IHS site, or even an urban Indian health care organization, I think getting that exposure, like Alec talked about earlier, and getting to see, connect people and faces with those statistics really gets you invested in trying to consider this community and how you can give back and be involved in the positive change.

So I think exploring opportunities to learn yourself and to gain exposure to the communities, I think is really going to be something valuable to, not just learning more about tribal health and Native communities, but in underserved and underrepresented groups. And learning how to work with people from these communities and understanding the bio-psychosocial and just the political environment that we're trying to work in and live in, I think is really important, because it's one thing to see the statistics or to hear one lecture in your entire training, but it's another to go out and actually be at the hospital, work with the physicians, see the patients, hear their stories.

I think getting to work with a Choctaw female surgeon at Choctaw Nation in Talihina was incredible experience for me. I mean, getting to work with a Chickasaw pediatrician down at Chickasaw Nation in Ada at the Chickasaw Nation Capital. I mean, I think once you're in the communities and you see the gratitude and excitement of the people, that...not just Native people, but just interest in the greater medical community and coming out and helping and serving and trying to give medical care and services. The people are so welcoming and so kind. And I just really encourage anyone to try to get opportunities to come out and experience these training sites if that's available at your school and your program, because it'll give you a new perspective that you can't get from statistics or a lecture.

And as physicians, there's always the opportunity to get involved with AAIP, and the Association of American Indian Physicians has a lot of education and conferences and ways to get involved as a American Indian physician or even just someone who wants to be an ally to our causes and support us. So those are kind of my biggest takeaways of how to get involved. There is no scarcity of opportunities. There is more work than we have hands to do. So I always tell people, please, if you want to get involved, we will have a job for you. So that's my biggest takeaway is, at least come out, experience it, so you can learn.

Dr. Maybank: Great. As we start to conclude, time always goes by really quickly, Tamee, what is it that want a resource that you can point people to that you would want them to learn more about and get the education that's needed, but also the connection that's needed? Can you share that and anything else, your final statements of what do you want people to know and understand?

Livermont: I feel like there are a lot of places you can go, but Alec and I have shared this space a lot, and I will always advocate for people to visit the National Indian Health Board's website. You can educate yourself on many of the priorities. And those priorities are all being informed by tribal leaders across the nation. The NIHB is really that organization that is in Washington DC, advocating for issues around native health care. And they have many conferences every year. Some of my favorite conferences. One, you will find the best native vendors probably other than some of the large powwows. But also, there are a lot of people, a lot of Native people and non-Native people, who are very passionate about and really on the front lines of trying to transform health, health care delivery and improve health outcomes across tribal communities.

And I just really appreciate the NIHB because it's so tribally informed and informed by our tribal leaders, and really doesn't just focus on how we improve the provision of Western medicine as a lot of people think we're talking about when we talk about health care delivery, but really covers the gamut of what health care delivery means to tribal people. So whether it's traditional healing services or public health infrastructure, all of those things are covered and talked about. And there are just so many opportunities to network and get to know people who are so passionate about this work and are really doing it. So it's a great space to be in, and I would love to see other people at those conferences and learning.

Dr. Maybank: Great. Thank you. Alec, closing us out here.

NCUIH Urban Indian Health Education

Supporting culturally competent health care for urban American Indians and Alaska Natives.  

Calac: Certainly. I think, whenever we close out a conversation, it can always be difficult because we try and kind of cover all these different topics in a limited amount of time. You hit play, you hit pause, you rewind, you disseminate. But I think I'd really challenge just that everyone go that extra step and take something that you heard here and learn more about it. I always kind of push past concepts like cultural competency and proficiency, but really think about cultural humility and acknowledging that people likely don't know a lot about Indigenous health care, Indigenous peoples, Indigenous values, because that was the goal of this country, is this invisibility, this marginalization. So in order to advance health equity and really push towards things like racial justice and really lifting up all groups, there's a lot you have to unlearn before you can start to learn about what Indigenous cultures are like, because we have a perspective that has always been present, but never really valued and acknowledged.

So I'm, again, just so happy to be joined by everyone here and have these conversations, because I typically kind of have these talks in November, Native American Heritage Month, and you talk from the beginning of November to the end of November, and then you have to wait a whole year. But with this conversation, our committee, this commitment to advancing these priorities is year round. And I'm really excited to see where we go, because the MSS, when we got the approval for our Committee on American Indian Affairs, I had no idea how successful it would be. I thought it was going to be this small group of five people, and then seemingly was 21, and now it's 24. And virtually, the entire committee is a member of the Association of Native American Medical Students. And it was like, okay, this is happening. And we have mentors and we have resources, nd it's just really special. If this is what happens just while we're in medical school, I'm really excited to see what happens when we're practicing physicians.

Dr. Maybank: Beautiful. Well, thank you all to our wonderful panelists and students and leaders and advocates and organizers and everything else. We're everything. And just thank you for all that you are. And I don't mean that in a sense of burden. I mean that in the sense that we mean so many things to different people, and who we are and the lives that we have around us that make us who we are. And it's all very important and all very relevant to how we lead in the advocacy that we do on a day-to-day basis for our families and for ourselves and our friends. So I acknowledge the kind of totality of how we have to hold the space oftentimes. So I thank you all again for your leadership.

And I encourage, one of the other spaces I'm getting to is, so we have kind of our political advocacy strategy, but how do we build in a cultural strategy in the sense of how do we promote. So how do we partner more with cultural strategists in the sense, I'm using kind of jargony language, but other people who are in film or media or communications to get our stories out in more consistent ways and have those relationships, and understand that that's an important part of the strategy too. So I look forward to kind of building, creating all of that with you all as the years go on.

So thanks again to our panelists, for everyone listening in. I just want to highlight real quickly, we recently did a soft launch on a coalition called Rise to Health, which is a national coalition for equity and health care and health overall. We encourage people to visit the website, risetohealthequity.org. Lots of voices have informed this opportunity across the country, a lot of voices and hearts and minds and all of it. So we have our first, also, National Equity Grand Rounds, which will be on February 7. And we can either put links or you can also go to the AMA website and the AMA Educational Hub to find out more information, but to talk about the history of racism in health care. And so we hope that you all can join. And really thank you again, and see you all the next time.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

Table of Contents

  1. Panel
  2. Moderator
  3. Transcript

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