Confronting 'dispiriting' disparities
Two UND faculty publish world’s first book on health disparities in Indigenous populations.
“The COVID pandemic is a microcosm of the health disparities affecting American Indian/Alaskan Native peoples. SARS-CoV-2 has hit poor, underserved, and vulnerable populations especially hard throughout the U.S., and persons of color are disproportionately affected.”
So begin editors Donald Warne, M.D., M.P.H., and Cornelius “Mac” Dyke, M.D., in the first chapter of their new anthology American Indian Health Disparities in the 21st Century. Published by Cambridge Scholars on Indigenous People’s Day 2021, the first-of-its-kind book describes in often painful detail the disparities in both incidence and outcomes between the American Indian/Alaska Native (AI/AN) community and the rest of the population living in the United States—for the same conditions.
The book was almost ready for release when COVID emerged last year to both delay publication and put a capstone on the physicians’ argument that for reasons historical, structural, and socioeconomic, AI/AN communities suffer poor health at much greater rates than non-Indigenous populations—and have been doing so for centuries. COVID, which has “struck AI/AN communities particularly hard,” was only the latest example.
“It is vitally important to identify and quantify health disparities in the American Indian population so we can prioritize interventions and determine the best path forward to improve health outcomes,” said Warne, director of the UND School of Medicine & Health Sciences Indians Into Medicine (INMED) and public health programs. “I appreciate all of the co-authors for their efforts in developing this important resource.”
Part of the project’s genesis, added Dyke, chair of the School’s Department of Surgery, was the database he’d built of such disparities in cardiac patients years ago.
“When I came [to North Dakota] I noticed that we were taking care of a lot of American Indian patients,” said Dyke, who reached out to Warne—who was then at NDSU in Fargo—for help. “It seemed to me that [Indigenous] patients were sicker and had more comorbidities by the time they got to me in the hospital for cardiac surgical problems. But I wanted to prove that, so I started a database where we looked at 1,200-plus
patients who underwent cardiac bypass surgery and went to see what the population was of American Indians versus non and how they presented and how they did after surgery.”
As Dyke explained, analysis of the data was both encouraging and troubling: while the difference in outcomes between Indigenous and non-Indigenous patients was not statistically significant, AI/AN patients tended to be “older, sicker and presented later,” suggesting poorer general health and much less access to not only healthcare but things healthy food and exercise or wellness programs.
Exploring these disparities is a host of mostly North Dakota-based authors, including some current UND School of Medicine & Health Sciences residents and medical students, like second-year student Kole Hermanson.
“This book looks at disparities through the lens of many different specialties in medicine, and importantly examines the primary literature to explain these inequalities,” noted Hermanson, who contributed to the book’s chapter on cardiovascular health. “Cardiovascular disease is now a leading cause of death among AI/AN communities and is a contributing factor for a significant reduction in life expectancy. The most fascinating aspect of this fact is that 60 years ago American Indians were perceived to be ‘immune’ to cardiovascular disease. It was not until the Strong Heart study [which began in 1989] that the disparities in cardiovascular disease were better understood.”
Such historical misperceptions, and the misdiagnoses they produced, have contributed to the disparities the book explores and hopes to reduce, said Hermanson.
“I was very excited to be invited to be a part of the project,” added Lynn Mad Plume, diversity & equity coordinator for INMED whose own chapter, “Violence and Injury in American Indians,” examined injury and violence outcomes in AI/AN populations. “Not only was it one of my very first publications in the Indigenous Health space, but it was also an opportunity to give back. All the book’s profits will go toward our INMED programming, ensuring we continue to create opportunities that improve the lives of Indigenous peoples. Although the book highlights negative outcomes, the final chapter stresses the importance of utilizing strengths-based approaches for Indigenous Health.”
Additional chapters in the book address disparities of infectious diseases in American Indian populations, plus AI-AN disparities in cancer, behavioral health, traumatic injury, and women’s health.
“With mostly local authors and people at different hospitals in the state, and some of our INMED students,” concluded Dyke, “we were able to put together a nice book. It’s short, but it’s a place where people can go as a first step if they want to learn more about all of this.”
And chances are, there are many physicians, researchers, and students who will soon be doing just that.
Readers interested in the book can find it at Cambridge Scholars online at: cambridgescholars.com/ product/978-1-5275-7358-1.