'Native Lives Matter'
Third-year med student Marcos Moreno talks health disparities, a book chapter, and activism among American Indian youth.
The statistics can be overwhelming: on the Pine Ridge Reservation in South Dakota, life expectancy is lower than anywhere in the western hemisphere, with the exception only of Haiti.
Likewise, the incidence of substance abuse, diabetes, cancer, and suicide are all higher among American Indians and Alaska Natives than non-indigenous people—and in some cases are increasing.
Born on the Pascua Yaqui Reservation in Arizona, Marcos Moreno couldn’t help but be struck by the similar figures on his reservation.
“Many of the tribes [in Arizona] also have some bleak statistics of their own at the national level,” said the third-year medical student, who is in the middle of clinical rotations in Fargo for the UND School of Medicine & Health Sciences. “Between my reservation and the Tohono O’Odham reservation near Tuscon—that’s maybe 12,000 people—there were more suicide attempts than in all of southern Arizona combined one year.”
Neuroscience as Public Health
It’s these facts that set Moreno on the path not only of studying medicine long ago, but conducting public health research with his tribe more recently.
Although Moreno started writing about disparities in public health outcomes at Cornell University when he was an undergraduate, most of his research focused on the neurological bases of addiction, specifically opioid, alcohol, and amphetamine use.
But medicine proper quickly followed as Moreno found himself talking public health with both Dr. Carlos Gonzales, the director of the INMED program at the University of Arizona, and, eventually, Dr. Donald Warne, director of the INMED program at the UND School of Medicine & Health Sciences.
So he applied to UND and was accepted.
“I remember on my interview for UND, one of the professors was grilling me on the neuro research I’d done as an undergrad—making sure I knew what I was talking about,” laughed Moreno, who has in interest in practicing medicine for his tribe in the future. “At first I thought ‘Oh man, this guy doesn’t like me.’ But as the interview went along he warmed up to me and we talked about the East Coast, where he was from, and where I had been living. We talked about what adjusting to life in the Midwest was like, and some of the special things that he felt UND had to offer that other places didn’t. It ended up being a really good experience.”
Describing his interest in specializing in either neurology or psychiatry, Moreno noted that while studying public health is important for any physician—“There’s a whole host of social factors that overlap with medicine, so you can’t avoid [public health],” he quipped—this fact is especially true for doctors looking at working with tribal populations.
Just as important is reporting your work to a variety of audiences, especially those outside medicine.
To that end, Moreno recently contributed a chapter—“America’s Forgotten Minority: Indigenous youth perspectives on the challenges related to healthcare access, widespread poverty and public misinformation regarding Native Americans”—to the book Global Indigenous Youth: Through Their Eyes, which describes the health disparities facing American Indians in the United States especially.
Featuring essays by indigenous youth from all seven United Nations-designated indigenous regions, the book, co-published by Columbia University and the United Nations in 2019, documents the challenges, hopes, and prospects of indigenous youth from around the world.
Moreno’s chapter is the only one in the nearly 300-page book that deals with indigenous health in a formal way.
“The big issue with native health care in the U.S. is that while some tribes have designed their system such that the disparity isn’t that drastic, there are others where these trends have persisted for a very long time, for whatever reason,” Moreno explained, adding that on a per capita basis the federal government spends more on the health of federal inmates than persons using the Indian Health Service for medical care. “There’s a lot of variation from tribe to tribe, but that’s what I wanted to capture [in the essay]—the spectrum of outcomes.”
Far from laying blame, though, Moreno notes that the IHS, which has seen a series of budget cuts for decades, understandably struggles to face such devastating issues alone.
“When the IHS was established, I don’t think [the federal government] realized how long these problems would be around or how big they would get,” he said. “The problems have definitely outgrown what IHS can provide on its own in most cases. But as tribes take more control of their own systems and have more autonomy, their outcomes tend to improve. When they can decide where resources go and handle problems as they arise, it does benefit them.”
Adverse Childhood Experiences
Relying on Dr. Warne, among other voices, in his chapter, Moreno notes that recent scholarship suggests a connection between unresolved trauma, adverse childhood experiences, and poor health outcomes—not only in Indian Country but everywhere.
Furthermore, such health outcomes cannot be divorced from the realities of a racism that has persisted into the 21st century.
So have native youth began speaking up and out with greater frequency on the impact social and political issues have on their tribes’ physical and emotional wellbeing.
Calling Native peoples’ resilience their greatest asset, Moreno wrote in the essay that the recent “strong and invigorating series of movements led by [indigenous] youth, including the national protests of the Dakota Access Pipeline and the beginning of the Native Lives Matter Movement” intersects with population health.
“Especially for tribes who’ve lost most of their land, you can see how exaggerated the disparities are for things like mental health, addiction, and suicide,” he said.
Such health activism coincides too, said Moreno, with more college attendance by American Indians and Alaska Natives in the 21st century.
“Because my generation is one of the first to attend school in much larger numbers than in past times, we’ve had the opportunity to reclaim and learn a lot about our own tribes’ history and traditions on our own, and have tried to give those back to our parents a bit,” he added. “When I talk to my dad about this, he says he’s learning things about his tribe from me at times— and I feel like that says a lot because my dad’s not that old. It just shows you how much things are changing.”
This is why rather than feeling merely discouraged at the statistics cited above, Moreno is optimistic for his tribes’—and Indian America’s—future.
“In my lifetime I’ve seen quite a bit of change in the sense that [suicide and other health disparities] are being recognized as issues by not only Native peoples, but others observing the statistics coming out of Indian country,” he concluded. “UND does things that pay recognition to tribes’ struggles with health care like including lectures on it within the medical curriculum. Cornell had a whole minor that could be focused on Native health care. These are all positive things, and steps in the right direction no doubt.”