Interview with Dr. Valarie Blue Bird Jernigan: Native Communities Working to Improve Their Health
diaTribe recently spoke with Dr. Valarie Blue Bird Jernigan about how tribal communities are being affected by both COVID-19 and diabetes, the structural inequities these communities face, and what they are doing to live healthier lives
By Tom Cirillo and Divya Gopisetty
Indigenous people in the United States are three times more likely to be diagnosed with diabetes than their non-Hispanic white counterparts. To learn more about how diabetes affects Native communities and what these communities are doing to improve their health, diaTribe interviewed Dr. Valarie Blue Bird Jernigan. Dr. Jernigan is the Director of the Center for Indigenous Health Research and Policy at Oklahoma State University, a Professor of Rural Health, and a citizen of the Choctaw Nation of Oklahoma.
Through her powerful work, Dr. Jernigan identifies ways tribal communities can improve the quality and quantity of healthy food available to their citizens. Dr. Jernigan had a special feature in the new PBS documentary, Blood Sugar Rising.
Here are some highlights from our conversation:
Divya: COVID-19 is having a disproportionate impact on Native Americans, putting a spotlight on the structural inequities we’ve known existed for a long time. Can you tell us what is happening in the tribal communities you work with?
Dr. Jernigan: COVID-19 came out of nowhere and has now publicly exposed some long-neglected cracks in the system. We’ve known the system is fragmented, broken, and unequal. In our communities, COVID-19 is exacerbated by poverty, multi-generational households, household crowding, availability of healthcare professionals and facilities, and even the availability of running water.
The Indian Health Service (IHS) is not adequately funded or distributed. We have tribal health systems that get some funding from IHS, but most tribes don’t actually have those health systems in place. Furthermore, 70% of Native Americans now live in urban settings, and they receive almost no benefit from IHS funding. Urban clinics, which are federally qualified health care centers, may receive some IHS funding, but very little.
From a researcher perspective, what worries me with COVID-19 is the lack of surveillance and epidemiological oversight. Tribal health centers rarely have epidemiologists (doctors who study the patterns and causes of health conditions and disease). When cases started hitting, no one knew where they were coming from. Were there clusters? And where? In addition, tribal health centers and states don’t regularly communicate health data, creating larger issues with tracking the course of the pandemic and receiving support. Data drives allocation of resources.
Divya: How does diabetes affect Native communities?
Dr. Jernigan: Diabetes has long been known to be a problem and disparity in our community, and thus it has been a significant focus. We were one of the earliest population groups subject to NIH studies – specifically the large diabetes study of the Pima Indians, which is what the NIH called that study (though the term Pima is not their preferred tribal name).
While diabetes care has long been a tremendous concern of tribal health systems, until very recently the focus has been primarily on treating people with diabetes, and not on diabetes prevention. For example, there has been a huge investment in dialysis centers to treat kidney failure, a common complication of diabetes. Unfortunately, the tendency to focus on treatment over prevention in communities may have perpetuated the idea that diabetes is inevitable. Success in both treating and preventing diabetes is further hindered by the fact that few tribal health systems have their own specialty services for diabetes. Those services have to be contracted out.
Just one snippet of the on-the-ground reality - we have an urban clinic just up the street, Tulsa Indian Health Care Resource Center. The patient population can be as high as 20,000. But like most urban Indian clinics, when we run out of funding at that clinic, you can only see a dentist if you live with diabetes or are pregnant.
Divya: I was reading yesterday that there are 13 grocery stores across 27,000 square miles in Navajo Nation. What does this mean for diabetes among the population and what can be done?
Dr. Jernigan: My dissertation work was on diabetes self-management within Native communities, but now, for ten years, I’ve been working on the food system and the way it impacts health – looking largely at food availability and preferences. As part of that work, we conducted the THRIVE Study on food insecurity and chronic diseases among American Indians in rural Oklahoma to better understand the problem. A top-level conclusion is that we need healthier food in stores. We then implemented “healthy makeovers” in eight tribal convenience stores in the Choctaw and Chickasaw Nations, where most people shopped for food. It was extremely difficult to get healthy produce to rural stores, but we did, and the stores saw an increase in healthy food purchases and sales.
Based on this work, we are now implementing the FRESH study with Osage Nation, intervening at a food production level, with a farm to school intervention, which has shown success in increasing fruit and vegetable intake and reducing food insecurity. We are expanding to include a community supported agriculture program driven by an indigenous food sovereignty model – intervening through an indigenous lens – which is really exciting work. We’re following this up with assessments of the impact on hypertension (high blood pressure), body mass index (BMI), and A1C. All of our studies are funded by the NIH, are tribally driven, and use science with action for social change.
To further this work, in 2019 we launched the Center for Indigenous Health Research and Policy at Oklahoma State University, supported by funding to improve minority health and health disparities. That funding helped us do the farm-to-school program, in partnership with Osage nation and Osage’s Bird Creek Farm. These kinds of studies show that you can do rigorous scientific research that is community-oriented.
Tom: How do you think the narrative around diabetes among Native Americans could be changed to promote positive change?
Dr. Jernigan: In the last 12 years, with the IHS implementing the Diabetes Prevention Program (DPP), we’ve seen the narrative of prevention come into focus. Diabetes is not inevitable, and there are approaches that speak more effectively to people. A key part of this is moving the discussion beyond statistics and placing it in the greater context of the realities we are currently facing; the contexts of poverty and the systemic long-term effects of being marginalized.
We need to raise awareness about these connections, but in ways that are action oriented. The current story of diabetes doesn’t paint an accurate picture of us as human beings. Yes, we have serious health challenges, but we are resilient and thriving nevertheless. We can and must transcend trauma by taking care of ourselves and each other. This narrative engages members of our community on a level that is more in line with their values than a Western narrative that we should “make healthy choices to lose weight.”
We need to look to the younger members of our community who are focused on decolonization and strengthening Indigeneity. Alongside that group, we have the “boarding school generation” – a whole group of our elders removed from their homes and made to feel ashamed of being Native in many cases. Our elders have lived through a transition during which they could be abused for knowing their language and cultures and are now questioned as to why they do not. All these experiences have value and power. They all can be held and respected.
There is also much to learn from our partner communities, and we need and want to welcome them as allies. If we waited for Native people alone to do this work in public health or medicine, it could not be done. There are simply not enough of us. The lessons of Indigenous food systems and seventh generation thinking have great value for humanity. There is value in sharing these lessons with those who genuinely want to learn.
This is the fourth in a series of pieces by diaTribe on Blood Sugar Rising: