Over 70% of Indigenous people in the United States live in urban areas. But urban Indian health makes up less than 2% of the Indian Health Service’s annual budget.

While enrolled members of federally recognized tribes can access the Indian Health Service or tribally run health care on their reservations, Indigenous people who live in cities can find themselves without access to the care they're entitled to.

“Even though we're living in urban areas now, that doesn't mean that our benefits should leave us,” said Esther Lucero, president and CEO of the Seattle Indian Health Board.

The Seattle Indian Health Board is one of many urban clinics across the United States that opened to address the discrimination and lack of services Indigenous people face in cities. These clinics work to meet the cultural and ceremonial needs of the populations they serve.

“We are much more than a community health center or place that provides direct service. We are a home away from home,” Lucero said.

Episode 12 explores the barriers Indigenous people face to accessing quality health care in cities and the efforts of urban Indian clinics to meet the needs of this population.

Click here for a transcript of the episode.

Voices from the Episode:

• Esther Lucero, president and CEO of the Seattle Indian Health Board
• Dr. Patrick Rock, CEO of the Indian Health Board of Minneapolis
• Douglas Miller, an associate professor of Native American History at Oklahoma State University
• Richard Wright, a spiritual health adviser with the Indian Health Board of Minneapolis

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Lanor Curole is a member of the United Houma Nation. She grew up in Golden Meadow, a small bayou town in Southern Louisiana. The impacts of repetitive flooding in the area forced her to move farther north.

Louisiana’s coastal wetlands lose about 16 square miles of land each year. This land loss, pollution from the 2010 BP oil spill, and lingering devastation from Hurricanes Katrina and Ida are pushing many Houma people out of their homes.

Since 1985, the United Houma Nation has been seeking federal tribal recognition status. Without this status, the tribe has fewer resources to respond to the climate crisis.

“Our people are on that front line, but we don't have a seat at that table,” Curole said.

Gaining federal recognition would grant the Houma access to the Indian Health Service and would allow the tribe to work directly with federal agencies like the Federal Emergency Management Agency when storms strike.

“It's not like Willy Wonka’s ‘golden ticket’ … but I think it does open some additional doors that are definitely closed to us right now,” Curole said.

Episode 11 explores the Houma people’s efforts to preserve culture in the face of the climate crisis.

Click here for a transcript of the episode.

Voices from the episode:

• Lanor Curole, Houma tribal administrator
• Thomas Dardar Jr., former chief of the United Houma Nation
• Shanondora Billiot, assistant professor of social work at Arizona State University
• Daniel Lewerenz, assistant professor at the University of North Dakota School of Law

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

Mending broken trust may be a first step for investigators who want to increase the participation of Native people in medical research.

“There's such a history of extractive research in Indigenous communities, such that ‘research’ and ‘science’ are sometimes dirty words,” said Navajo geneticist and bioethicist Krystal Tsosie.

Poor communication and a lack of transparency are among the missteps that have eroded the trust Indigenous communities have in medical research. And that mistrust has contributed to the underrepresentation of Native people in clinical trials.

In 2018, Tsosie co-founded the Native BioData Consortium, a research institute led by Indigenous scientists. The consortium is working to improve health equity by actively engaging community members in the research process. When the group collects biological samples from Native tribes, they are stored on sovereign Native American land and made accessible only to researchers who are prioritizing Indigenous health needs.

“The benefits are directly rolled back into the people and their communities without a profit to outside entities,” Tsosie said.

Episode 10 explores the history of exploitation of Indigenous communities by outside researchers and some of the health consequences of being left out of medical trials.

Click here for a transcript of the episode.

Voices from the Episode:

• Dr. Dakotah Lane – Executive medical director of the Lummi Tribal Health Clinic
• Krystal Tsosie — Twitter – Co-founder and ethics and policy director for the Native BioData Consortium

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Correction: This episode was updated on July 27, 2022, to accurately characterize Dr. Charles Eastman’s academic milestone.

In 1890, Dr. Charles Eastman became one of the first Native people to graduate from medical school in the United States. Today, one of his descendants, Victor Lopez-Carmen, is a third-year student at Harvard Medical School. He described feeling isolated there.

“I did feel alone. There wasn't any Native person around me I could turn to,” said Lopez-Carmen.

Less than 1% of medical students in the United States identify as American Indian or Alaska Native. That’s according to a 2018 report from the Association of American Medical Colleges and the Association of American Indian Physicians.

Lopez-Carmen is working to change that. In 2021, he co-founded the Ohiyesa Premedical Program, which provides mentorship and support to Native American students as they navigate the medical school application process.

While Lopez-Carmen is mentoring future medical students in Boston, in Oklahoma, Ashton Glover Gatewood has found community at the first medical school in the United States affiliated with a Native tribe. Gatewood attends Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation.

“I told my husband about it, and he said, ‘That sounds like they're building you a medical school. You have to go,’" Gatewood said.

She’s noticed a “momentum” in medical training that she said could one day lessen the health care disparities Indigenous people experience.

Episode 9 explores the barriers Indigenous people face to becoming physicians and includes the stories of two medical students working to join the ranks of Indigenous health care workers in the U.S.

Click here for a transcript of the episode.

Voices from the Episode:

• Victor Lopez-Carmen — Twitter — Student at Harvard Medical School
• Mary Owen – Director, Center of American Indian and Minority Health at the University of Minnesota; President, Association of American Indian Physicians
• Ashton Glover Gatewood — Twitter, Instagram — Student at Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

Abby Abinanti is chief judge of the Yurok Tribal Court and a member of the tribe.

While previously working in the California court system, she was discouraged and angered by the number of cases in which Indigenous families were separated or tribal members were removed from their communities because of nontribal foster care placements or incarceration. The Prison Policy Initiative, a research and advocacy organization, found that Native people are overrepresented in jails in the United States.

Abinanti said the Yurok Tribal Court is helping to address these disparities. The court is one of roughly 400 operated by federally recognized tribes in the United States. These courts reflect the values of their communities, and Abinanti said for the Yurok that means prioritizing restoration over punishment.

“I don't think any human being is disposable,” she said. “Our system is designed to help you return to the community and be an asset in the community.”

Episode 8 explores the intergenerational impact of historical traumas on the Yurok people and a local tribal court’s work to meet community needs.

Click here for a transcript of the episode.

Voices from the Episode:

• Abby Abinanti –Chief judge, Yurok Tribal Court
• Ursula Running Bear – Assistant professor of public health at the University of North Dakota
• Blythe George – Assistant professor of sociology at University of California-Merced

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

Rachael Lorenzo works to address reproductive health disparities in Native communities. In 2018, they founded Indigenous Women Rising, a fund that provides financial help for Native people seeking an abortion.

Historically, the federal government has restricted Native people’s reproductive autonomy. Between 1973 and 1976, more than 3,500 Native people were sterilized without their consent.

Today, the chronic underfunding of the Indian Health Service (IHS) and remote location of many reservations create barriers for Native people to access testing for sexually transmitted infections, prenatal care, and contraception.

Lorenzo is determined to fight for their community.

“My people deserve accessible health care, and I will make it happen no matter what, because this is our land,” they said.

Episode 7 explores efforts to protect and expand access to comprehensive reproductive and sexual health care in the face of historical and contemporary efforts of the government to control Native people’s fertility.

Click here for a transcript of the episode.

Voices from the Episode:

• Rachael Lorenzo — Twitter – Co- Founder, Indigenous Women Rising (Twitter, Instagram)
• Sarah Deer — Twitter – Distinguished Professor at the University of Kansas
• Sunny Clifford, Reproductive Rights Advocate
• Elizabeth Rink, Professor of Community Health at Montana State University

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

In 2020, during the first wave of the coronavirus pandemic, Zoel Zohnnie was feeling restless. Growing up on the Navajo Nation, he said, the importance of caring for family and community was instilled at an early age. So Zohnnie wanted to find a way to help members of his tribe. One need in particular stood out: water.

American Indian and Alaska Native households are 3.7 times more likely to lack complete plumbing compared with households whose members do not identify as Indigenous or Black, according to a 2019 mapping report on plumbing poverty in the United States.

“Climate change and excessive water use is exacerbating these struggles,” explained George McGraw, CEO of DigDeep. “Much of the western United States has been in severe drought for years. Many rivers and wells on or near the Navajo land have dried up. As groundwater recedes, people are forced to seek water from unsafe sources.”

To answer that need, Zohnnie began hauling water to people who were without, and he founded Water Warriors United. In this episode, listeners come along for the ride as he ― and his truck ― make one herculean trek across snow-covered roads in New Mexico.

Episode 6 is an exploration of the root causes behind the Navajo Nation’s water accessibility challenges and a story about the water rights that some communities have effectively lost.

Click here for a transcript of the episode.

Voices from the Episode:

• Dr. Ernestine Chaco, emergency medicine physician and lawyer — Twitter
• Brianna Johnson, community health representative with the Naschitti Chapter, Navajo Nation
• George McGraw, CEO of DigDeep — LinkedIn, Instagram, Twitter
• Jeanette Wolfley, assistant professor of law at the University of New Mexico — LinkedIn
• Zoel Zohnnie, founder of Collective Medicine and actor — TikTok

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

Editor’s Note: This episode includes descriptions of violence that some might find disturbing. Intimate partner violence, also known as domestic violence, can take the form of physical, sexual, or psychological abuse. If you or someone you know is experiencing intimate partner violence, help is available.

StrongHearts Native Helpline provides culturally appropriate support and advocacy for Indigenous women. Call 1-844-7-NATIVE or text the corresponding number: 1-844-762-8483.

National Domestic Violence Hotline: 1-800-799-7233.

—

Mary Kathryn Nagle is a citizen of the Cherokee Nation, an attorney, a playwright ― and an advocate working to increase protections for Native women in the U.S. justice system.

Not long after the Violence Against Women Act, or VAWA, was reauthorized in 2013, she sat with fellow activist Lisa Brunner to talk about a new play Nagle was working on in response to the ruling.

Brunner said she told the playwright that VAWA is just a “sliver of a full moon” of the protection Native women need.

The metaphor resonated with Nagle, and “Sliver of a Full Moon” would become the title of her play. It shares the stories of Native survivors of domestic abuse, and exposes the gaps in the justice system that often let non-Native perpetrators commit crime without consequence. Critics say that over decades those gaps became an opportunity for abusers to flourish on Native land.

“Just imagine your own community,” said attorney Alfred Urbina, “where certain people weren't prosecuted or arrested for crimes. If you lived in an area where certain people didn't have to abide by the law, what does that do to a community?”

Urbina is the attorney general for the Pascua Yaqui Tribe in southwestern Arizona, one of the first tribes to begin prosecuting non-Native offenders under the VAWA 2013 rules.

Among Native survivors of violence, more than 90% reported they had experienced violence from a perpetrator who was non-Native, according to a survey funded by the U.S. Department of Justice.

The Violence Against Women Act was reauthorized on March 10, 2022, reaffirming tribes’ authority to prosecute non-Native perpetrators of sexual violence and certain other crimes. It expands prosecution power for tribal nations in Maine and Alaska and offers funding to support law enforcement implementation of VAWA.

“It's not the totality of everything that we need. Right?” said Brunner. “But, you know, the full moon is bright. And we're just starting with the moon. I'm after the universe.”

Click here for a transcript of the episode.

Voices from the episode:

• Lisa Brunner, founding member of the Violence Against Women Task Force, adjunct professor at the White Earth Tribal & Community College — LinkedIn
• Mary Kathryn Nagle, playwright, partner at Pipestem Law, specializing in tribal sovereignty of Native nations and peoples, executive director of the Yale Indigenous Performing Arts Program — Twitter, Instagram
• Alfred Urbina, attorney general for the Pascua Yaqui Tribe, Arizona — Twitter

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.