Over 70% of Indigenous people in the United States live in urban areas. But urban Indian health makes up less than 2% of the Indian Health Service’s annual budget.

While enrolled members of federally recognized tribes can access the Indian Health Service or tribally run health care on their reservations, Indigenous people who live in cities can find themselves without access to the care they're entitled to.

“Even though we're living in urban areas now, that doesn't mean that our benefits should leave us,” said Esther Lucero, president and CEO of the Seattle Indian Health Board.

The Seattle Indian Health Board is one of many urban clinics across the United States that opened to address the discrimination and lack of services Indigenous people face in cities. These clinics work to meet the cultural and ceremonial needs of the populations they serve.

“We are much more than a community health center or place that provides direct service. We are a home away from home,” Lucero said.

Episode 12 explores the barriers Indigenous people face to accessing quality health care in cities and the efforts of urban Indian clinics to meet the needs of this population.

Click here for a transcript of the episode.

Voices from the Episode:

• Esther Lucero, president and CEO of the Seattle Indian Health Board 
• Dr. Patrick Rock, CEO of the Indian Health Board of Minneapolis 
• Douglas Miller, an associate professor of Native American History at Oklahoma State University
• Richard Wright, a spiritual health adviser with the Indian Health Board of Minneapolis

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Lanor Curole is a member of the United Houma Nation. She grew up in Golden Meadow, a small bayou town in Southern Louisiana. The impacts of repetitive flooding in the area forced her to move farther north.

Louisiana’s coastal wetlands lose about 16 square miles of land each year. This land loss, pollution from the 2010 BP oil spill, and lingering devastation from Hurricanes Katrina and Ida are pushing many Houma people out of their homes.

Since 1985, the United Houma Nation has been seeking federal tribal recognition status. Without this status, the tribe has fewer resources to respond to the climate crisis.

“Our people are on that front line, but we don't have a seat at that table,” Curole said.

Gaining federal recognition would grant the Houma access to the Indian Health Service and would allow the tribe to work directly with federal agencies like the Federal Emergency Management Agency when storms strike.

“It's not like Willy Wonka’s ‘golden ticket’ … but I think it does open some additional doors that are definitely closed to us right now,” Curole said.

Episode 11 explores the Houma people’s efforts to preserve culture in the face of the climate crisis.

Click here for a transcript of the episode.

Voices from the episode:

• Lanor Curole, Houma tribal administrator
• Thomas Dardar Jr., former chief of the United Houma Nation
• Shanondora Billiot, assistant professor of social work at Arizona State University
• Daniel Lewerenz, assistant professor at the University of North Dakota School of Law

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.  

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.  

Mending broken trust may be a first step for investigators who want to increase the participation of Native people in medical research. 

“There's such a history of extractive research in Indigenous communities, such that ‘research’ and ‘science’ are sometimes dirty words,” said Navajo geneticist and bioethicist Krystal Tsosie.

Poor communication and a lack of transparency are among the missteps that have eroded the trust Indigenous communities have in medical research. And that mistrust has contributed to the underrepresentation of Native people in clinical trials. 

In 2018, Tsosie co-founded the Native BioData Consortium, a research institute led by Indigenous scientists. The consortium is working to improve health equity by actively engaging community members in the research process. When the group collects biological samples from Native tribes, they are stored on sovereign Native American land and made accessible only to researchers who are prioritizing Indigenous health needs. 

“The benefits are directly rolled back into the people and their communities without a profit to outside entities,” Tsosie said.

Episode 10 explores the history of exploitation of Indigenous communities by outside researchers and some of the health consequences of being left out of medical trials.

Click here for a transcript of the episode.

Voices from the Episode: 

• Dr. Dakotah Lane – Executive medical director of the Lummi Tribal Health Clinic
• Krystal Tsosie — Twitter – Co-founder and ethics and policy director for the Native BioData Consortium

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.