Program seeks to improve health among Eastern Band of Cherokee Indians

A new partnership brings Western North Carolina one step closer to achieving a goal of bringing more Indigenous people into health care fields.

The Center for Native Health, a nonprofit focused on culturally competent health care among the Eastern Band of Cherokee Indians, and the UNC Asheville-UNC Gillings Masters of Public Health Program announced the partnership April 21.

Along with Mountain Area Health Education Center, UNC Asheville and UNC Gillings School of Global Public Health teamed up to launch the Masters of Public Health Program in November. (Previously UNC Gillings had permitted students in the Asheville area to pursue the degree through distance learning.) The program is unique in that it focuses on “place-based health” — in this case, on rural communities.

Trey Adcock, Ph.D., executive director of the Center for Native Health and director of American Indian and Indigenous Studies at UNCA, says the new partnership is ideal for MPH students who want to focus on eliminating health disparities in marginalized communities.

Filling the pipeline

Registered nurse Mary Newman, a candidate for a master’s degree in the UNC Asheville-UNC Gillings’ MPH program, will be the first student to pursue an internship at the center. “I’m really honored and privileged and grateful to work with the EBCI,” she says.

Newman will gather data about students’ experiences within the Medical Careers and Technology, or MedCaT, Pipeline program, which exposes Indigenous and Appalachian high school students to health care and biomedical science careers. It’s a partnership between EBCI, MAHEC, the Center for Native Health and the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine.

According to Cherokee One Feather, an EBCI news source, the MedCaT Pipeline program has operated since 2010. It began as a summer intensive program on the Wake Forest campus and expanded to year-round in 2015.

Newman will hold  listening sessions with MedCaT alumni and collect data to “understand the impact of that program as students go into higher education and, we hope, medical professions,” Adcock says. The research hopes to discover if participation in the program moves the needle on encouraging more Indigenous youth to pursue health care careers.

The ultimate goal is to “encourage people to go into these fields where they’re much needed,” Newman says. She anticipates wrapping up her research by July 2023.

EBCI health concerns

Indigenous people face particular challenges within the health care system. According to Reshaping the Journey, a 2018 report by the Association of American Medical Colleges, 19% of American Indians and Alaska Natives (the term for this population used by the report) state that they do not have  health insurance. The report called “AI-AN health status among the worst in the nation,” noting that 25% of the AI-AN population dies before age 45.

“The poor health of AI-AN people can be attributed to the social determinants that negatively affect health: poverty, low education, joblessness, lack of medical insurance, inadequate housing, poor sanitation and lack of safe drinking water,” according to the report.

Members of the EBCI formed the Center for Native Health in 2008 with funding from the Cherokee Preservation Foundation. The center seeks to bring a more nuanced focus on health in the Indigenous community, particularly regarding chronic disease and diabetes. As part of its work, the center partners with organizations like Cherokee Choices, a diabetes prevention program for the EBCI under the tribe’s Public Health and Human Services Division.

Addressing Indigenous people’s health concerns should include an understanding of their history. “There’s a whole host of [issues] that afflict Native communities — suicide prevention, mental health, Type 2 diabetes,” explains Adcock, who is an enrolled member of Cherokee Nation in Oklahoma. “[There are] all sorts of issues that are triggered by historical trauma.”

A crucial component of the Center for Native Health is support, training and mentoring  young people with cultural competence in Indigeneous communities, Adcock says. Various cultures can have significantly different understandings of birth, death and sickness, as well as diagnosis and treatment, he explains.

“If you want to treat patients to the best of your ability, you’ve got to understand where they come from and the history, values and culture of where they come from,” he says.

Underrepresented

The Center for Native Health’s partnerships are part of a larger cultural conversation regarding representation in health care.

“People who are members of all of the BIPOC [Black, Indigenous and people of color] community are really underrepresented in professions of power in the health care setting, like pharmacists, nurse practitioners, doctors, surgeons and physicians,” says Newman. “But the tribal members are extremely underrepresented.”

According to the Reshaping the Journey report, only about a half percent  of practicing physicians nationwide (4,099 of 727,300) in 2016 identified as American Indians or Alaska Natives.

There are roughly 13,000 enrolled EBCI members, according to the Cherokee Preservation Foundation. In 2000, 12% of American Indians earned a bachelor’s degree or higher, according to the Center for Native Health. Among those students who were enrolled members of the EBCI, 2% worked in health care fields.

“One of the ways you disrupt health disparities is you have people who are fluent in the communities in which they serve,” explains Adcock. “Hopefully, that’s Native people serving Native communities. … We need more Native EMTs and nurses and doctors and surgeons.”

Newman hopes her work can be used to make the health care professions even more hospitable for Indigenous young people. “Organizations and people in positions of power need to look at why certain groups are underrepresented in medical schools, because the pipelines are currently in place,” she says.

Newman adds, “An important part of creating resilience and building our nation’s health care is the representation of all cultures that make our country the melting pot that it is.”

Collaborative nature

Newman moved to WNC in 2020 to be closer to the mountains, as she enjoys camping and hiking. Prior to that, she worked as a hospice nurse at Community Hospice & Palliative Care, a nonprofit hospice, in St. Augustine, Fla.

Upon moving here, Newman learned about the MPH program at the UNCA-UNC Gillings through her next-door neighbor, Tammy Cody, a social worker at MAHEC. Intrigued by the program, she applied.

She knew little about Indigenous communities before moving to WNC, Newman says. Her first real exposure to Indigenous health topics came in fall 2021, when Casey Cooper, CEO of Cherokee Indian Hospital Authority, spoke to professor Sarah Thach’s class “Place-Based Theory in Public Health.”

Newman says she was inspired by Cooper’s holistic view of health care among the EBCI, which reminded her of the collaborative nature of hospice care. “It’s more of a community-based, circular program where all members of the team that are caring for a patient in the hospital work together,” she explains. “That’s not something that currently goes on in our health care system.”

She elaborated, “Working as a nurse for so long [I’ve seen how] so many parts of our health care system in the United States — nonprofit and profit — are run tangentially with many different moving parts of the puzzle that don’t always work well together.”

Newman connected with Adcock, who told her about the MedCaT Pipeline program, she says. Her work at the Center for Native Health begins in October.

Adcock anticipates one or two MPH students will work at the center per year, and their focus will depend on the center’s current programs. Food sovereignty and language revitalization are potential areas of programmatic focus, he says.