Native Americans have the highest mortality rates of any racial group in the country — and the lowest life expectancy. That’s according to the Centers for Disease Control and Prevention. And now, new research shows nearly half of American Indians on Medicare suffer from a serious heart problem.
Lauren Eberly, a cardiologist with the IHS at Gallup Indian Medical Center and a health equity researcher, conducted that research on the Navajo Nation.
But she also found some surprisingly simple ways to improve health outcomes for her patients. She wrote about it recently in an opinion piece in the Los Angeles Times and spoke to The Show about it.
Full conversation
LAUREN EBERLY: The topic of settler colonialism and its impacts on Indigenous health are often absent from the mainstream academic discourse, and particularly within cardiology. And so our group felt like it was really time to highlight the inequities in this population and really prioritize their cardiovascular health. So to kind of lay the landscape, we first performed a large study which was actually one of the largest epidemiologic evaluations of the American Indian Alaskan native population nationally, which was just to really say you know, what is their cardiovascular health status now.
What we found is, is, unfortunately, but not unsurprisingly that cardiovascular health indices among this population are, are really worse than any other racial and ethnic group in the U.S. And what we found is over 50% of elder American Indian Alaskan Native patients nationally. So over 65 about 50% have a serious cardiovascular condition, which is really remarkable and worth noting.
LAUREN GILGER: Wow. And, and that compares to the rest of the country, it's worse, obviously, but how much?
EBERLY: It's significantly worse. And with that, we also recently have some updated data from the CDC that shows that American Indians have the highest mortality and the lowest life expectancy of any other racial group. And so it's really an urgent issue that really deserves, you know, more attention and more discussion.
GILGER: Right. Talk a little bit more about, you know, what you attribute this to like you're, you're making big connections from health disparities in something like, you know, how often somebody's going to get a heart attack or, you know, you're looking at life expectancy rates here equivalent to 1944 like and you're connecting them to these really big and systemic problems in the country.
EBERLY: Absolutely. I think so often we as a country and especially in the health care field are really uncomfortable naming those underlying causes of health inequities. So whether it's naming racism in this case, naming settler colonialism as a direct cause of health inequities in this population. And often because of that, I think the discourse has really been around behavioral factors or, you know, personal choices on behalf of the patient. And we really need to be historical in our context.
When we think about this disproportionate burden of disease and what we really want to call attention to is that when we are seeing this disproportionate burden of cardiovascular disease and poor outcomes, that it's really the direct results of the impacts of settler colonialism, which is not only this history of land theft, you know, exclusionary government policies, broken treaties, forced displacement, genocide, structural violence, all of those things actually are not just of the past but have enduring and lasting and contemporary impacts. They've really concentrated poverty, and they've really fueled the worst health inequities in the United States.
GILGER: Tell us a little bit about your work here. You, you've worked with the IHS for some time. You're from New Mexico. Is that right?
EBERLY: I am. Yes, I grew up in New Mexico. I went to medical school at UNM School of Medicine. Go Lobos! And I think growing up where I grew up, it was, it was really apparent the impact of poverty on health. And so I always had the dream of returning back to my home state to really try to use medicine and health equity research to rectify injustices, particularly, the focus on racial justice?
GILGER: Yeah. Yeah. So working with the IHS like that is an example of a program, you know, that was created basically in exchange for some of the land from many of these tribes, right? Like we would give health care to these communities in exchange. It's underfunded. Are there any improvements on that front? Like, what does it look like? What are the frustrations?
EBERLY: Yes. It's chronically underfunded and understaffed and when you look at the annual health care expenditures or what the U.S. government kind of allots in terms of their budget for the Indian Health Service, it's much less per patient than what's allotted for Medicaid, Medicare and the VA. And so we know that based on the budget, the government is really sending this message that is really problematic, which is that the health of our indigenous patients is not prioritized. And so yes, it has improved in recent years, but you know, challenges certainly still remain.
And I think it's really important to continue to call attention to the issue and really demand increased funding and priority to improve health and health care access for this population.
GILGER: So talk about that on a micro level, right? Like in your own work with your own patients, how have you approached improvements? Like there are interesting approaches that you took, I think.
EBERLY: I'm a cardiologist. So a lot of my work centers around cardiovascular care delivery, but for our patients that we take care of in our catchment area out in eastern Navajo Nation, we're covering about a catchment area, 50 to 60 mile radius. So a very large area and specialty care is often two to three hours away by road, which can be inaccessible especially during winter months.
And that cost can be really prohibitive for patients to get, you know, all the way to the big city and back the gas costs, you know, taking a day off work. And so we really felt like we had to rethink how “can we improve access to care in our setting?” What does care look like if we actually could kind of design it from the beginning. And so for heart failure, we decided to design a telehealth phone based optimization model to reach our patients.
And so it was actually quite simple, you know, our patients said, you know, sometimes it's just too hard to get to the doctor and we have very limited broadband capabilities. And so a lot of patients said, “can you just call me over the phone?”
And so the other thing, you know, we did is we said, we often wait for patients to come find us and often they can, they don't make it to us. And so we found all those patients that, you know, had this diagnosis that weren't getting the medicines that we know save lives. And then we gave everyone a blood pressure cuff to have at home, we taught them on its use.
And then, you know, just through our telehealth team, we just called patients that weren't optimized. And we took the time to talk to them about the medicines and why, you know, we recommend a certain medicine.
And what was so cool is we have a Navajo speaking nurse who would call the patients and provide, you know, ongoing education, which aligned with the Navajo wellness model to again, really center Indigenous frameworks of health. And so yeah, it was really simple, but I think it just shows you that when you listen to patients and you listen to community members, we can really start to kind of redesign health care to meet their needs.
And so we found it was tremendously successful. And so we're excited to expand this model to other IHS sites and to other disease states and really continue to let the community and patients, you know, teach us and guide us along the way.
