American Indian/Alaska Native (AI/AN) communities experience a disproportionate burden of disease and die at higher rates than every other racial/ethnic group in the United States. In fact, the 2022 CDC report on provisional life expectancy estimates conveyed that “the life expectancy for an AI/AN person born in 2021 is 65.2 years, 11.2 years less than an NHW [non-hispanic white] person’s life expectancy born in the same year (76.4 years)” (Arias et al 2022). They also experience a disproportionate burden of disease overall including diabetes, at a ratio of 3:1 as compared to all other racial groups in the U.S.; alcoholism, at a 6:1 ratio; and intentional self-harm/suicide, at a 1.7:1 ratio (Indian Health Services Report 2019). Data show that AI/AN disease burden can largely be attributed to multiple health inequities, including structural barriers to healthcare access across Indian Country, and unremitting trauma as an outcome of settler colonialism and forced assimilative practices.
My master’s capstone project will address these inequities through a discussion of existing literature and a series of ‘prose portrait’ essays in which I will portray the Cherokee Nation’s efforts to combat their disproportionate disease burden via interview-based essays on three physicians in the Cherokee Nation Health Services. I will also shed light on innovative strategies used by OSU-COM (Oklahoma State University-College of Osteopathic Medicine) as a progressive beacon of medical education infrastructure. With stories collected via interview, I will weave the words of healthcare providers who operate at 3 stages in the system (Dean/Founder of the medical school, Chief Medical Officer of the Nation and Student/Retained Resident) into creative nonfiction, shedding light on the work they are doing. A hopeful outcome of my project is that other tribes may use the Cherokee Nation’s efforts as a model for their own approach to structural sovereignty and physician staffing.
The project will root present-day tribal health disparities in the centuries of sustained genocide, forced assimilation and imposed imperial order that are integral to understanding the issue as a structural one. My work is deeply rooted in previous scholarship emphasizing the settler colonial critique in public health improvement efforts, using the theoretical frameworks and arguments put forth by Patrick Wolfe, Mahmood Mamdani, Lana Ray, Bram Wispelwey and Daniel Health Justice, among many others.
My intent is also to bring the experiences to an audience outside of the tribal Nation: to the Harvard community, and perhaps even further as I hope to pitch these essays for publication. Unfortunately, large swaths of the US population are unfamiliar with the struggles that face AI/AN communities; I hope to inform more people (policymakers, medical providers, artist-storytellers, general public). Ultimately, my series of portraits seeks to move toward decolonization in demonstrating how a tribal community is taking structural action to work against the settler colonial state in the sphere of public health. The essays and photographs from my time spent at the Cherokee Nation demonstrate the innovative healthcare infrastructure designed and sustained by tribal stakeholders, underpinned by the values of indigenous community and sovereignty.