American Indian and Alaskan Native Health Inequities

I was born in Oklahoma City and raised in Texas, Wyoming and Idaho. I am of Caucasian and American Indian decent. Professionally, I am the Chief of Psychology at Massachusetts General Hospital, and I am the Faculty Chair for the Harvard University Native American Program. I am also an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School, and teach courses at the Harvard Kennedy School and the Harvard Graduate School of Education that involve community projects with Native American nations and organizations. My professional identity is as a health care provider, cross-cultural psychologist and educator.

In a nutshell, I work on increasing resources that address American Indian and Alaskan Native health inequities and projects that foster Nation Building. I focus on promoting community driven wellness programs, increasing the pipeline of young natives prepared for advanced educational opportunities and leadership, and increasing the awareness of universities to engage in bi-directional learning with Native communities.

Needless to say it wasn’t a direct path. I didn’t know what I wanted to do in high school or college, except that I knew that I was generally very interested in health. When I went to college in the late 60’s, there were a lot of distractions. I became a conscientious objector to the Vietnam War and did two years of alternative service, during which I worked in a community hospital.

Over these two years, I became certified as an x-ray technician in a radiology department. As one of the few x-ray technicians with a bachelor’s degree, I ultimately was recruited to get a master’s degree in teaching radiological sciences at the University of Houston and Baylor College of Medicine in Houston. I really hated it. It just wasn’t humanistic enough for my interests (laughs).

While I was down there, I met my wife, who was a child development specialist for Harris Country Child Welfare. I thought what she was doing was a lot more fun than what I was doing, so we both decided to go back to school, which brought us up to Boston. I first did a master’s degree at Tufts in child development, and then I came over to Harvard to do the Human Development: Cross-Cultural Program. Harvard started a clinical program, Counseling and Consulting Psychology, while I was there, so I did both of those programs.

I completed both my internship and post-doc at Massachusetts General Hospital. One of my unrealized goals was to go work for Indian Health Service after completing my training, but my wife didn’t finish school when I did, so I needed to take a job while she finished her dissertation. I stayed at MGH, was offered absolutely incredible opportunities, and I’ve had a hard time getting out of here (laughs). I’m still here 30 some years later.

More recently, I got involved with the Harvard University Native American Program. A while back, HUNAP was going through real identity and financial difficulties, and Steve Hyman, a psychiatrist I’d known at MGH, who was then the provost at Harvard, asked me to get involved. I talked with Steve about goals for HUNAP and then started the Native Health Initiative. I also volunteered to work with students at HUNAP, and about a year and a half later, the previous faculty chair, Joe Kalt, asked me to take over his position. Since 2005, I’ve split my time 50% between MGH and 50% between HUNAP and my health projects.

Well I must say I wouldn’t wish what I do day-to-day upon anybody. I will go from a meeting at one place, to a meeting with students over at HUNAP, to a committee meeting back at MGH. I work a bit at Harvard Medical School, and I still do some clinical work with patients, too. So I’m in motion constantly (laughs). It’s a challenge to be at all the different places with shifting meetings and schedules. Two half time jobs are a lot more than one full time job. I also do a fair amount of travel for either recruitment purposes or for the community and joint health projects that we’ve got going. A significant portion of my time involves program planning, both at MGH and HUNAP.

I teach a graduate course called Native Americans in the 21st century: Nation Building II, which is offered at HKS and HGSE and accepts students from all professional and graduate schools at Harvard. I solicit social, governmental, education and cultural projects from native communities, leaders, and organizations. The students then work with these clients over the course of the semester to develop resources and conduct basic research. The projects cover a wide variety of topics, such as constitutional reform, economic development, natural resources, cultural and heritage museums, language, and mental health. As an example, one of our students developed an iPhone application for a tribe to teach it’s own language to itself. The native communities that I work with are all over the U.S. and Canada, but specifically the health projects that I work on tend to be based in the Great Plains (Montana, North Dakota, South Dakota), and the Southwest (New Mexico, and Arizona), where the disparities are the highest.

I also collaborate closely with the Indian Health Service, which by treaty is responsible for providing health care to all federally recognized tribes. We recently did a pilot a project to create a rotation at Pine Ridge for a primary care resident. We are now working on a case study on Indian health for all primary care residents to increase the awareness of the opportunities and challenges of health care in native communities. I really love working with the national leadership of the Indian Health Service, and I’ve been very impressed with a lot of the dedication, despite how underfunded they are.

So on a day-to-day basis I think I wear too many different hats, but I love it. I get to meet so many talented students both at the medical school, the teaching hospitals, and throughout the University. I also get to interact with all 200 of the native students at Harvard, split about 50-50 between the College and the graduate programs.

Living here was a very difficult adjustment for me in terms of the crowdedness and the environment. I’ve always loved my colleagues, and the students, but I really did not enjoy living in the Northeast. All of my family is out West, and I always wanted to go back there. The distance and the combination of environmental and social assault were challenging.

That distance also kept me from connecting with things that I wanted to learn. I was not raised in a native community, but I’ve always lived in Indian country. There was so much I wanted to learn, and staying at Harvard delayed my learning curve a lot on that. Luckily, I’ve been able to return, to learn a lot about communities, and to make some contributions, too. But it was really hard living here: the weather, the sky, the crowded environment, everything. It’s still difficult.

My wife and I love going to culturally diverse places, especially not going anywhere that tourists go (laughs). Just as an example, we spent a month in Myanmar. Despite the repressive regime in place, we had a friend who had gone to school with Aung San Suu Kyi, so we were able to go and visit places that had been off limits for decades. We spent a month visiting disparate parts of the country and I really enjoyed it. I love those kinds of experiences where you get to know people, you live like they live, you eat the food that they do. That’s my favorite thing to do in the world: go to new places and immerse myself in the culture and food of people.

– 1491, Charles Mann
– Mountains Beyond Mountains, Tracy Kidder
– Lies My Teacher Told Me: Everything Your American History Textbook Got Wrong, James Loewen

My number one advice is to stay curious your whole life, follow your passions, and never be afraid to change your interests. I feel so lucky to have been able to change career focus and interests as they emerged. In fact, my wife can tell when I’m moving in a new direction. She can tell that something is brewing because I start getting moody. Then, after I become focused, a new interest comes up, I delve into that, and I’m fine for another 5 years (laughs).

I think the ability to rejuvenate your interests and to follow your curiosity should never go away. I’m not young anymore, but I still feel totally young that way. I’m excited every day to get up and work, because it isn’t work to me. It’s following my curiosity and my passions about what I do. I just love it.

My vision is to be able to provide an opportunity for anybody at the University who wants to work with native communities on any kind of a project. I like the two-way learning: Harvard learns about these communities, and the communities can get something from our students and faculty. People often forget that the global world also includes parts of the United States that might not be so well known and deserve attention. I think there exists a very rich cultural, educational service environment in Native communities that are excellent sites for learning. The faculty that I’ve got involved and the students love it, and I would like to make that more accessible to the student body.

In terms of my vision for my health projects, I am most interested in community health right now. I have learned, even though I was trained as a psychologist to focus on individuals, that community health fosters individual mental health, individual physical health, and creates common resources that protect against causes of illness. I’m interested in helping communities on their own terms and strengthening the social networks that protect people in those communities.