Health Innovation: Transcending 638
Donald Warne, MD, MPHOglala Lakota
Associate Dean, Diversity, Equity & Inclusion Director, INMED & Public Health Programs
Land Acknowledgement
Today, the University of North Dakota rests on the ancestral lands of the Pembina and Red Lake Bands of Ojibwe and the Dakota Oyate - presently existing as composite parts of the Red Lake, Turtle Mountain, White Earth Bands, and the Dakota Tribes of Minnesota and North Dakota. We acknowledge the people who resided here for generations and recognize that the spirit of the Ojibwe and Oyate people permeates this land. As a university community, we will continue to build upon our relations with the First Nations of the State of North Dakota - the Mandan, Hidatsa, and Arikara Nation, Sisseton-Wahpeton Oyate Nation, Spirit Lake Nation, Standing Rock Sioux Tribe, and Turtle Mountain Band of Chippewa Indians.
Overview• Transcending 638 • Linking Innovation and Economic Development
• Public Health • Medicine• Research• Policy
• UND Initiatives (Mayo collaborations) • INMED Programming & Workforce Development • Indigenous Health MPH and PhD (AI Faculty Development)• Indigenous Trauma & Resilience Research Center • Clinical Trials Network Great Plains AI Initiative • Practice-Based Research Network / AICoRN • Department of Indigenous Health
• Dr. David Gipp Endowed Scholarship
US Health System
Health Innovation & Transcending 638 • I/T/U System • Population Served: (as of January 2020):
• Members of 574 federally recognized Tribes in 37 states• 2.56 million American Indians and Alaska Natives
• IHS Budget Appropriation:• FY 2016: $4.8 billion• FY 2017: $5.0 billion• FY 2018: $5.5 billion• FY 2019: $5.8 billion• FY 2020: $6.0 billion
• >60% of the IHS appropriation is administered by tribes, primarily through self-determination contracts or self-governance compacts
Traditional View of Public Health
Roles for Public Health InnovationCultural Frameworks for: • Community Health Workers • Health Promotion/Disease Prevention—Holistic Wellness • Food Sovereignty
• Local control, traditional foods, whole foods
• ACE prevention • Traditional Parenting and Family Structures• Home Visiting Programs/CHWs
• Economic Development through a PH lens
Roles for Health Policy Innovation• Cultural Frameworks for Policy Development—traditional values • Self-Governance • “638” other HHS programming • AI/AN Medicaid Program (51st State) • Sustainable CHW Programs • Education Policy
• Indigenous STEM curricula • Need TCU Medical Schools
• Research Policy • Owning the Agenda • Intellectual Property
Indians Into Medicine (INMED)
IHS Workforce Shortages by Area
IHS Workforce Shortages by Area
Indian Health Service Vacancy Rates as of November 2018
AreaVacancy
Rate Overall
Medical Officers Vacancy
Rate
Nurse Vacancy Rate
Nurse Practitioner
Vacancy Rate
Vacancy Rate for Certified Registered Nurse Anesthetists
(CRNAs)
Vacancy Rate for Nurse Midwives
Dentist Vacancy
Rate
Pharmacist Vacancy Rate
Physician Assistant
Vacancy Rate
Alaska 7% 0% 0% 0% 0% 0% 0% 0% 0%
Albuquerque 27% 28% 42% 47% 0% 0% 18% 20% 57%
Bemidji 32% 52% 33% 26% 0% 0% 47% 6% 0%
Billings 23% 33% 31% 33% 33% 33% 24% 11% 31%
California 13% 50% 29% 0% 0% 0% 0% 0% 0%
Great Plains 21% 39% 26% 37% 25% 10% 31% 15% 36%Headquarters 12% 20% 13% 0% 0% 0% 0% 0% 0%
Nashville 30% 30% 35% 0% 0% 0% 25% 0% 0%
Navajo 25% 24% 41% 36% 22% 37% 41% 22% 26%
Oklahoma City 18% 20% 12% 9% 0% 0% 29% 17% 43%
Phoenix 20% 20% 18% 32% 0% 22% 20% 7% 32%
Tucson 0% 0% 0% 0% 0% 0% 0% 0% 0%
Portland 23% 18% 26% 20% 0% 0% 11% 10% 14%
Total 22% 27% 30% 31% 11% 26% 29% 15% 31%
INMED Programming
Bachelor’s Medical Leadership
Summer InstituteNEURO
INMEDCLIMB
Indigenous Health MPH & PhD
Med Prep
High School
Middle School
Graduate School
Dual Degrees-MD/MPH-MD/PhD-JD/MPH
INMED Programming
Bachelor’s Medical Leadership
Summer InstituteNEURO
INMEDCLIMB
Indigenous Health MPH & PhD
Med Prep
High School
Middle School
Graduate School
Pre-K/ Elementary
Residency/Fellowship
INMED Pre-Med -PH Education BS-Biomedical Sciences-AIS Major/Minor
Dual Degrees-MD/MPH-MD/PhD-JD/MPH
Family Medicine Residency
Rural/Tribal Preventive Medicine
Residency
Indigenous STEM -INBRE-SEPA -ND IEA
Fellowship-MPH-Certificate
Indigenous Health Post-Doc-NIH T32/G-RISE
MEDICINE WHEELStudent Support
SPIRITUAL
MENTAL
PHYSICAL
EMOTIONAL
MEDICINE WHEELStudent Support
CULTURAL
ACADEMIC
FINANCIAL
SOCIAL
INMED Programming• Summer Institute • Med Prep • INMED MD Cohort – CLIMB • Indigenous Health MPH • Indigenous Health PhD
Indigenous Health MPHUnderstand determinants and solutions to health disparities
Advocate for solutions to health disparities
UND's specialization is the only 100% online Indigenous Health program in the U.S.
Coursework in: qPrinciples of Indigenous Health
qSocial & Ecological Determinants of Indigenous Health
qAmerican Indian Health PolicyqPublic Health Programming in Indigenous Populations
Indigenous Health PhD
The doctoral degree in Indigenous Health is the first of its kind – Students will:• Develop skillsets and competencies in research and evaluation methods, policy, and leadership
• Gain a deeper understanding of the unique health issues facing Indigenous populations
• Join the elite group of culturally aware experts who are setting new standards in the fight against Indigenous health disparities worldwide
• Principles of Indigenous Health 1 • Principles of Indigenous Health 2 • Applied Biostatistics • Applied Epidemiology • Quantitative Methods • Qualitative Methods • Mixed Methods
• CBPR & Tribally-Driven Research Frameworks
• Indigenous Research Methods • American Indian Health Policy • Indigenous Health Policy • Public Health Program Evaluation • Indigenous Evaluation Frameworks • Indigenous Leadership & Ethics
Coursework
Purpose & Goals of PhD
• Promote culturally relevant research • Cohorts of well-trained academics,
researchers, tribal health leaders • Decolonize & Indigenize
• Research, Evaluation, Programming • Decrease Disparities vs Promote Equity• Faculty Development
• MD/PhD
UND Indigenous Health Scholars
Donald Warne, MD, MPH (Oglala Lakota) Allison Kelliher, MD (Athabascan) Melanie Nadeau, PhD, MPH (Ojibwe) Nicole Redvers, ND, MPH (Dene’) Ursula Running Bear, PhD, MA (Sicangu Lakota)
UND Indigenous Health Research
• Indigenous Trauma & Resilience Research Center• Dakota Community Collaborative on Translational Activity (DaCCoTA)
• Clinical Trials Network Great Plains AI Initiative • ND Tribal Tobacco Survey • NSF—Diabetes Smart Phone app• Practice-Based Research Network / AICoRN
Dr. David Gipp Endowed Scholarship • INMED • UTTC• AIHEC • “We do not forget the pitiful. The poor. The unsika ones. That’s why we began this effort in the first place. Because we offer something to students, and we still do, something that they could not get from mainstream institutions…we are there at the forefront to serve those in need first.”
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