Learning with Indigenous Communities to Advance Health Equity

Oct 7, 2021, 11:00 AM, Posted by Karabi Acharya

Tribal Nations, resilient stewards of the natural resources that give us life, can lead the way to a more sustainable and healthy future. Indigenous Peoples' Day marks the urgent need to embrace the expertise they’ve held since time immemorial.  

A woman speaks into a microphone at a dance show. A Tlingit Native welcomes an audience to a community house. The traditions and leadership of the Tlingit, the people indigenous to Sitka, are infused throughout the community, including through educational and environmental programs.

For generations, Indigenous Peoples have known that our health is intertwined with the health of our earth. Their worldview recognizes that being healthy means ensuring the natural resources that give us life are well cared for.

In contrast, Western mindsets tend to view the natural world as an inventory of useful commodities—separate from, and existing only in service to, humanity. Overusing, polluting, and extracting without considering the long-term impacts has created conditions that fuel health inequities in our country: contaminated drinking water, food scarcity, air pollution, and extreme heat are contributing to poor health and driving up disease, particularly in low-income neighborhoods and communities of color.

Transforming our relationship with nature is key to building a sustainable, equitable, and healthy future for all. Through the forcible removal, violence, oppression, and other injustices Indigenous Peoples have experienced, they have remained powerful stewards for many of our natural resources. Their values, practices, and policies can show us the way to heal and reclaim the health of our earth and humanity.

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How a Native American Tribe Found Healing Through Horses

Oct 6, 2021, 10:00 AM

Bring horses and Native youth together, and connections are built that can change lives. 

Editor’s note: Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

Deep ties to the land and close connections with animals have long helped to define Native American culture and make their way of life possible. In Fort Peck, Montana, Charlie Four Bear reclaimed that legacy by helping young people develop enduring relationships with horses. Four Bear (Dakota and Lakota) was an elder on the Fort Peck Indian reservation and a former police officer.

 “First they took away our land,” he said, describing the destruction that occurred as White settlers pushed West. “And then they took away our buffalo. And then they took our horses away.” The theft of so much Native culture, and the inequitable distribution of resources and opportunity that continues to this day, have damaged lives and undermined communities. The scars are apparent in the substance use and loss of hope revealed in one horrifying statistic: in a single year, 28 of 223 students at the local high school attempted suicide.  

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A Historic Day for SNAP

Sep 30, 2021, 1:00 PM, Posted by Jennie Day-Burget

October 1 ushered in the largest permanent benefits increase in the nearly 60-year history of what is known today as the Supplemental Nutrition Assistance Program (SNAP). 

SNAP benefits for health care.

A recent report from the U.S. Department of Agriculture (USDA) finds that approximately 10.5% of families experienced food insecurity in 2020—the same percentage as 2019.

That finding may not seem groundbreaking. But it is truly stunning.

How is it possible that rates of food insecurity did not increase during the worst pandemic in a century? After all, the economic upheaval caused by COVID-19 was swift and severe, with a perfect storm of factors—including massive job loss, significant wage reductions, widespread school closures, and marked increases in food prices—that one would naturally assume a sizable increase in rates of food insecurity across the board would occur.

It didn’t happen.

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Healing Our Rivers and Ourselves: Learning with Indigenous Peoples of New Zealand

Sep 22, 2021, 10:00 AM, Posted by Aleena M. Kawe

Our health is inextricably connected to the health of land, water, and all living things. The ways in which Indigenous peoples live that connection offer lessons that could benefit all of humanity. 

A woman stands on a walking trail bridge over a river.

Our nation’s health is intertwined with the health of our rivers. And our rivers are unwell.

Drinking water, food, sanitation, clothing, transportation: almost everything we do involves an interaction with water. Yet many people in America take water for granted, not realizing that pollution, overuse, and climate change are putting a chokehold on the country’s natural water reserves—posing a direct threat to health, equity, and our way of life.

While many may think that new technology and innovation can resolve our water crisis, I believe that the solution lies with Indigenous practices that have fostered a holistic approach to living in relationship with the natural environment for millennia. Let me explain.

Our Relationship with Nature

Indigenous peoples share a common worldview of our relationship with the natural world. One that is guided by Indigenous values and principles of respect, cooperation and responsibility. These principles govern our individual and collective beliefs, behaviors and relationships—as given to us from our ancestors. While our customs may differ, our lived connection with our environment is universal. In sharp contrast, Western mindsets tend to view nature as a commodity, maintaining a relationship that is centered on resource-taking.

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Why Building Black Wealth is Key to Health Equity

Sep 9, 2021, 11:00 AM, Posted by Najaf Ahmad

To dismantle structural racism, says a renowned economist, our nation needs a new narrative—and systems and policies that advance racial and economic justice.

Illustration for racial wealth gap. Illustrator: Cat Willett

Darrick Hamilton, the Henry Cohen Professor of Economics and Urban Policy at The New School, has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people.

Hamilton’s early experiences provided an ethical orientation toward justice that shaped his career as an economist. Growing up in Bedford-Stuyvesant while attending the Quaker-run Brooklyn Friends School exposed him to two worlds in which fundamentally similar people experienced markedly different life trajectories—primarily due to one group benefitting from greater resources than the other.

In this Q&A, he shares powerful insights on the impact of the racial wealth gap, strategies to address it, and reflections on how events of the past year are shifting narratives and providing hope for change.

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Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative

Sep 7, 2021, 11:00 AM, Posted by Avenel Joseph

Closing the Medicaid coverage gap would save lives, reduce costs, and help eliminate the racial and ethnic health disparities that have persisted for generations.   

Illustration of the U.S. highlighting states without Medicaid expansion.

“I am grateful for Medicaid because I can live on my own,” said Theresa, who has Spastic Quadriplegia Cerebral Palsy. Medicaid covers the costs associated with Theresa’s physical and occupational therapy, a wheelchair, and personal care attendants.

“I wouldn’t be alive if it wasn’t for Medicaid,” said Laticia, who received Medicaid coverage while growing up in the foster system that allowed her to receive care for both physical and mental health conditions.

“Medicaid has been a blessing,” said Regina, who relies on Medicaid to cover her daughter’s routine medical and preventive care that would otherwise be unaffordable.

There are approximately 75 million people in the United States enrolled in Medicaid, making it the largest health care provider in the country. And while each participant’s story is unique, Theresa, Laticia, and Regina have at least one thing in common: each lives in a state—Montana, Missouri, and Iowa, respectively—that has expanded Medicaid under the Affordable Care Act (ACA) to provide quality and affordable health care coverage to more of its residents. In fact, 38 states have done so since that landmark law was enacted.

But 12 states have refused to expand their Medicaid programs under the ACA, denying health care coverage to more than two million people—disproportionately people of color—who would qualify for the program if expansion was implemented in those states. These holdout states have refused to budge even as the federal government would cover the vast majority of expansion costs; even as Medicaid expansion states reap a variety of health and economic benefits; and even as the United States remains in the throes of a deadly pandemic.

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The Case for Having Health Equity Guide Community Preparedness

Aug 24, 2021, 1:00 PM, Posted by Anita Chandra, Carolyn Miller

The coronavirus pandemic has exacerbated long-standing inequities in communities across the United States. To prepare for the next crisis, communities must build health equity infrastructure now.

Health equity and community preparedness illustration.

We can’t prevent disasters, but proactively developing strategies to address health equity can ease some of their most harmful effects on people and communities. 

In our research, we’ve found communities that developed these strategies before and throughout the pandemic were better positioned to target resources to address health disparities that were highlighted and exacerbated by COVID-19.

Take Harris County, Texas, for example. In 2014, Harris County Public Health (HCPH) developed a health equity framework that was tested by an outbreak of the Zika virus in the county two years later. This experience informed HCPH’s management of the COVID-19 vaccine rollout and decision to collect vaccination data by race. While the state of Texas’ vaccination strategy emphasized mass vaccination sites, mobile vaccine clinics administered the one-shot Johnson & Johnson vaccine in parts of Harris County that were hit hardest by the pandemic.

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How Taking a Simple Quiz Reaffirmed My Love For Global Learning

Aug 12, 2021, 1:00 PM, Posted by Shuma Panse

Can the bold ideas needed to advance health equity be found beyond our borders? A global learner reflects on the value of looking abroad for solutions and the 12-question quiz that can help us all get started.

The Blue Marble

One out of four people living in the United States today are either immigrants or children of immigrants. That’s approximately 85 million people, all of whom have connections to other countries and cultures. I’m one of those people. While I was born in Michigan and call New Jersey home today, I’ve spent considerable time visiting, living and working in Mumbai—the city my parents migrated from and where my public health career kicked off.

My connection to my country of origin—through ties to family and friends, time spent living and visiting there, language and culture—has profoundly shaped me and made me the person I am today. Perhaps most importantly, though, it has fostered a deep appreciation for the many different ways people experience, live day-to-day and move through the world—and the great possibilities for learning this brings. Years ago, as a new mother in the United States, I benefited enormously from Indian postpartum food traditions, lovingly prepared for me by my mother and mother-in-law. Now, with school-age children, I wonder which Indian teaching methods could be helpful, trading notes with my cousins and their kids.

These types of exchanges have enriched my life, and I often hear the same sentiment from friends and colleagues with immigrant backgrounds from various other countries. Moreover, they remind us that the way things are done in the U.S. isn’t the only way to do things. Countries around the globe, from Brazil to Malawi, are finding creative ways to overcome similar health challenges to the ones we’re facing in the U.S. By looking beyond our borders, we can uncover new inspiration for advancing health and health equity across our communities.

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Database Tracks Health Equity Implications of State COVID-19 Policies

Jul 28, 2021, 2:00 PM, Posted by Julia Raifman

A publically available database is helping researchers, policymakers, journalists, and others understand how over 200 state policies implemented during the pandemic are impacting health equity.

COVID-19 U.S. State Policies image.

Rapid response is synonymous with moments of crisis. From first responders to communication experts, responding quickly to a crisis is critical for community health and well-being. But what about rapid response research? 

COVID-19 has epitomized a complex crisis of infectious disease, food and housing insecurity, and mental distress. People who are Black, Latinx, Native American, and living in low-income households are the most vulnerable to these conditions. It is clear that health and social policies enacted during the pandemic will affect communities for decades to come. 

To inform rapid response research and policymaking, my team at Boston University and I developed the COVID-19 U.S. State Policy database—also known as CUSP—in 2020. This resource aims to inform health and social policy decisions that promote health equity and focuses on policies that affect vulnerable and historically excluded populations. Now over a year after its inception, we are assessing what we have learned and where we have yet to go.

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Nurse Leader Shares Five Lessons on Breaking Down Barriers to Vaccination

Jul 19, 2021, 10:00 AM, Posted by Maria S. Gomez

A nurse leader who has been vaccinating a diverse community offers a candid assessment of false starts, wisdom gained, and the best way forward.

Vaccine barriers illustration.

Maria S. Gomez is a public health nurse who received a Presidential Citizens Medal in 2012 from President Barack Obama. She along with other colleagues founded Mary’s Center in 1988 an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. Today, it serves over 60,000 people each year. Here, Gomez shares lessons learned through Mary’s Center vaccination program.

Lesson One: No Wrong Door

Mary’s Center’s vaccination program didn’t have an easy start. Like the community we serve, our team was fearful and struggling in the pandemic. Suddenly, there was a vaccine that offered promise to keep us safe, but people were confused and anxious about it. It fell to us to provide information—but first we had to educate ourselves. There was no shortcut and no chance of success unless we did. So we put in the time, even holding Town Hall Meetings with our team of nearly 800, to learn and become effective messengers.

We learned that for some in the Mary’s Center community, a lack of trust stemmed from our country’s history of medical abuse—and not just horrors like the Tuskegee syphilis study but also more recent atrocities including involuntary sterilizations of Puerto Rican women and of women detained at the U.S. border. Many in our community have experienced those abuses well.

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