Ashton Glover-Gatewood, RN, MPH, CPH, OMS-II, and Natasha N. Bray, DO, MSEd, FACP, FACOI, discuss the barriers to care in the American Indian/Alaska Native community—and how one college of osteopathic medicine is trying to drive change to address this issue.
By Ashton Glover-Gatewood, RN, MPH, CPH, OMS-II, and Natasha N. Bray, DO, MSEd, FACP, FACOI
American Indians and Alaska Natives (AI/ANs) domesticated many edible plants and animals used in the modern Western diet—including corn, potatoes and chocolate, along with turkeys and honeybees. The League of the Iroquois developed the structure of governance that served as a model for modern federated representative democracy. The Quechua discovered the medicinal use for quinine and Mayans were the first to use the zero in mathematics.
With a rich history of agricultural, governance and medicinal contributions to the modern way of life, it is a stark contrast to view the current data for the descendants of these proud people.
Today, AI/ANs have higher poverty, suicide and homicide rates, and deaths from preventable illness combined with lower rates of health insurance and the lowest level of educational attainment compared to other racial or ethnic groups. However, to address such glaring health disparities, there are gaps in services and resources. According to the Indian Health Services, the annual Congressional appropriations only meet about 50% of the healthcare need.
While to many these may seem like abstract statistics, these data reflect the more intimate details we see in our community. Fragmented healthcare systems, gaps in social services programs and generational trauma all contribute to the burdens carried by the AI/AN community. The weight manifests as uncontrolled diabetes mellitus, substance use disorders, and depression and suicide. Physicians from within the AI/AN community are desperately needed to provide culturally relevant care. However, AI/ANs are currently largely underrepresented in medicine. The U.S. Census Bureau estimates that less than 0.2% of physicians are AI/AN to serve the more than 1.7% of the population that self-identifies as AI/AN.
Members of medically underserved communities are not less deserving of basic human rights, such as health care; rather, they are made vulnerable by their circumstances and are underserved by the sociopolitical environment. For health care to effectively evoke long-term, meaningful improvements in health outcomes, it must be patient-driven and physician-led.
The patient-physician relationship is truly the heart of health care. It is upon that foundation of trust and respect that continuity of care can develop to combat the current chronic disease crises. Therefore, it is not surprising that the Cherokee Nation of Oklahoma has invested more than $40 million in a medical school partnership with Oklahoma State University to train future osteopathic physicians. And many other tribes are doing likewise with hospital expansions, satellite clinics and workforce development programs; they are breaking ground in rural American Indian Country to make whole their people.
Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation (OSUCOM-CN) is positioned to help address the dramatic under-representation of AI/AN physicians in the workforce. Through partnership with tribes across Oklahoma, pathway programs such as Operation Orange and Native Stars begin working with K–12 students to inspire them to pursue careers in medicine or other STEM fields. These early pathway programs support the purposeful recruitment efforts that target students from tribal and rural communities.
The classes of 2024 and 2025 at OSUCOM-CN have matriculated with student populations of 22% and 25% AI/AN, respectively. While pursuing the medical school curriculum, students can complete all their clinical rotations in a tribal healthcare track or a rural healthcare track. Students can learn not only important medical knowledge but also develop and understand the sociopolitical environment affecting communities. Knowing the importance of graduate medical education in ultimate practice specialty and location, OSU continues to work with tribal partners in Oklahoma to support primary care residency training.
The future doctor of osteopathic medicine who graduates from OSUCOM-CN will be perfectly positioned to be primary care physicians in essential areas, such as family medicine. There is hope that these AI/AN medical students will utilize their educational background, diverse skill sets and compassionate approach to vulnerable populations to improve health outcomes from the very heart of the system—in the very heart of Native America.