Cherokee Nation Health Plans Analysis

Fitzsimmons 1 Emily Fitzsimmons Dr. Laura Harjo NAS 5970 5 April 2022 Project 2: Plan Analysis Introduction The last two years have resulted in dramatic changes for everyone: Some have lost loved ones; some now have disabilities; some now work and learn remotely; some have gained connections and opportunities that would not have been possible before. The pandemic has affected everyone differently, but the change occurred, nevertheless. In particular, the COVID19 pandemic has resulted in major shifts in government, including public relations, function, services, and planning. This report specifically analyzes this change in the Cherokee Nation’s public health planning by discussing two strategic public health plans from 2014 and 2020 – the State of the Cherokee Nation Health Report and Plan 2014 and the Respond, Recover, Rebuild Plan. The report includes a brief summary of each but focuses largely on the analysis of each plan’s values, relationship to Indigenous planning literature, and relationship with each other.

State of the Cherokee Nation Health Report and Plan 2014 The State of the Cherokee Nation Health Report and Plan 2014 is a strategic plan that assesses the current state of public health within the Cherokee Nation and presents strategies to achieve public health-related goals (Red 1). The tribe did not have the technical expertise to the complete the plan in-house; however, they clearly did have enough to contribute to it and control the creation process. At the time of this report, the Cherokee Nation Public Health (CNPH) had recently achieved accreditation from the Public Health Accreditation Board; they also worked

Fitzsimmons 2 with many stakeholders – the Cherokee Nation Public Health Committee, community organizations, and professionals from healthcare, non-profits, academia, and both tribal and nontribal governments – to help create this report and the ones leading up to it. They did, however, hire the consulting group Red Star Innovations – now Red Star International, Inc. – to prepare this plan.

In the creation of this plan, the consultants used the planning model Mobilizing for Action through Planning and Partnerships (MAPP), which emphasizes participatory planning and community engagement. As this is a strategic plan, the time frame is relatively short: The plan is meant to last the subsequent four years at the time of publication in 2014 (Red 3). The goal is to provide a systems-based guide towards improving health, quality of life, and selfdetermination for individuals and communities within the Cherokee Nation – including mental and physical health, environmental well-being, and social well-being – by assessing and providing recommendations for the top five public health challenges Cherokee Nation members are facing (1, 15). This plan is meant to be utilized by not just tribal officials or non-tribal governments but by “everyone interested in improving the health and well-being of our friends, family, and our communities” within the Cherokee Nation (1).

Respond, Recover, Rebuild COVID-19 Relief Plan Similarly, the Respond, Recover, Rebuild Plan is also a public health strategic plan for the Cherokee Nation, but this plan was established in May 2020 in response to the COVID-19 pandemic and the $411 million of federal aid that the Cherokee Nation received from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The goal of this plan is to support Cherokee citizens through the COVID-19 pandemic and mitigate long-term damage to

Fitzsimmons 3 the people, communities, and culture through direct financial aid and programmatic services (Respond).

There is no indication of a consultant in the creation of this plan, which likely means it was done entirely in-house. This makes sense considering the nature of this plan compared to the 2014 plan. Both plans are based on public health, quality of life, and comprehensive solutions that incorporate both; however, the provided solutions of the Respond, Recover, Rebuild Plan focus more heavily on quality-of-life issues that can exasperate or mitigate COVID-19 health threats whereas the 2014 plan’s solutions emphasize medical and healthcare solutions more.

Because of this divergence away from the more scientific solutions toward community development, services, and budgeting, the expertise needed for this plan can be more easily met from within the Cherokee Nation government.

Due to the nature of the funding sources for this plan’s projects, the Respond, Recover, Rebuild Plan has a much shorter time frame than the 2014 plan. Tribes receiving CARES Act funding must allocate the money by December 31, 2022, or they must return the unused funds to the United States federal government (“Senate”). Because this plan was used to garner these funds, the audience not only includes Cherokee Nation citizens but the US federal government as well.

Analysis Values For the State of the Cherokee Nation Health Report and Plan 2014, the authors clearly state a vision, a mission, and guiding principles that all heavily incorporate tribal values, including respect for ancestors, responsibility to current and future generations, systemsthinking, collaboration (Gadugi), sovereignty and self-determination, social justice, equity, and

Fitzsimmons 4 inclusivity. Ultimately, the report concludes by stating that “promoting and supporting healthy families and communities is a cultural value of the Cherokee Nation”; this concept is really a culmination of the previously listed values, which all interact and work with each other to meet that ultimate goal of public health (Red 15).

In analyzing the 2014 plan, however, three particular values were foundational throughout: collaboration, systems-thinking, and social justice, equity, and inclusivity.

Collaboration, or Gadugi, is particularly prevalent in this plan because of the authors’ emphasis on community engagement and partnership with stakeholders of all kinds in the preparation process. Specifically, they used the MAPP planning process that has a philosophical foundation of collaboration and participatory planning (Red 4). Community members who participated in the community meetings decided what public health issues should be prioritized and discussed in this plan (14). The purpose of the plan is also described as a guide for anyone – not just planners, all kinds of stakeholders – interested improving the public health of their community and tribe.

Additionally, the CNPH department makes a clear point to thoroughly thank all those who participated in the process and contributed their knowledge, efforts, and support (1-2).

Systems-thinking is also a dominating value throughout this plan as the Cherokee Nation not only applies systems-thinking to analyzing community well-being – the plan considers social, economic, environmental, and educational influences on public health – but also applies systems-thinking to community engagement. The plan considers the many stakeholders involved in public health as a system itself that, therefore, requires systems-thinking in order to ensure comprehensive analysis and implementation (Red 3-4). Lastly, social justice, equity, and inclusivity are seen repeatedly throughout the plan, especially in conjunction with the systemsthinking that considers the variety of socioeconomic and environmental factors related to public

Fitzsimmons 5 health, such as income, educational attainment, living conditions, and employment. Taking into consideration these factors allows the plan to have a more equitable and inclusive assessment that is then used to make justice-oriented solutions (6).

Unsurprisingly, the values noticed with the Respond, Recover, Rebuild Plan partially overlap with the 2014 public health plan. Values directly and indirectly discussed in this plan include compassion, learning, sovereignty, equity, collaboration, cultural preservation, comprehensive health, and multigenerational support (Respond). For this plan, the top three values consisted of equity, multigenerational support, and comprehensive health. Equity is seen throughout this plan as much of the funds have been used to either directly or indirectly support those most affected by the pandemic, such as elders, youth, disabled people, those in abusive homes, and those who lost their jobs. For instance, funds were diverted to public programs and community organizations that specifically help people disproportionately affected by shelter inplace challenges through domestic abuse victim support, internet access aid, provision of food, house repair and construction, etc. Providing funds to those programs specifically ensured that the services critical to those most in need could continue safely. Another strategy has been direct financial, utility, and rental assistance given to Cherokee households, amounts of which varied according to family size (Respond). Overall, funds were distributed proportionally so that those most affected – whether due to income restrictions, disability, or age – could continue to stay safe and healthy.

Multigenerational support is also particularly prevalent throughout the Respond, Recover, Rebuild Plan because it addresses the different struggles and needs that different age groups have during this time. For instance, safe access to health services and protection against COVID-19 has been particularly important for elders whereas education and technology assistance has been

Fitzsimmons 6 necessary for children and young adults, and utility, rent, and food assistance as well as retraining and employment services has been necessary for the general adult population.

Likewise, comprehensive health is also foundational to this plan as it focuses on many facets of public health and a variety of impacts from the COVID-19 pandemic, including socioeconomic and environmental factors that affect personal health. Specifically, this plan diverts funding physical health, mental health, safe access to healthcare, access to technology that allows for virtual education, work, and doctors’ visits, decent housing and working utilities that allows for sheltering in-place, access to nature for isolated hunting, gathering, and recreation, food assistance, retraining, income assistance, etc. (Respond).

Applying Indigenous Literature One of the strengths of the State of the Cherokee Nation Health Report and Plan 2014 is the methodology. Not only is the plan data-driven and states that as new data is collected, the nation will make necessary adjustments to plan, but also what kind of data is included makes the plan more accurate to the community. The plan makes evidence-based assessments and decisions based on quantitative data and information collected through western methods, but the authors also sought community knowledge and qualitative data and used it as a foundation for the plan.

This reminded me of Walter and Andersen’s re-conception of research methodology that asserts that all methodologies – not just ones that differ from western methodologies developed by white men – are heavily influenced by one’s place in life. In particular, one’s research standpoint is determined by one’s social position, epistemology, axiology, and ontology, all of which are shaped by your life experiences and culture. Additionally, the researcher’s standpoint is intertwined with the researcher’s theoretical framework and their research methods (Walter and Andersen 44-52).

Fitzsimmons 7 In contrasting this plan that was created by Indigenous officials, community members, and consultants with the typical non-tribal plan that is usually created by older white men, one can clearly see the differences in researcher standpoint, theoretical framework, and methods. For instance, many non-tribal plans are based on quantitative data collected through the longestablished western means that were designed to be exclusive. Community engagement is still uncommon and poorly executed in planning because the old white men running planning offices believe that their opinions and ways of knowing are fact. This selective information and data are then used to support plans that prioritize the wealthy over the impoverished, the white over people of color, the individual over the collective. The planners’ values of capitalism, white superiority, and hyper-individualism determine their research methodology and the plan’s impacts on the community. In the 2014 Cherokee Nation Health Report and Plan, the researchers are part of a marginalized group that has been through a long-term genocide and whose culture is communal rather than individualistic. Similarly, these factors influence social position, epistemology, axiology, and ontology, which, in turn, influence researcher standpoint, theoretical framework, and methods. As a result, this plan heavily emphasizes community partnerships, local knowledge, inclusivity, systems-thinking, and equity in their assessment of public health issues and proposed solutions.

For the Respond, Recover, Rebuild Plan, the multigenerational support that is particularly relevant in this plan harkens back to the Jojola article about the Indigenous seven generations planning model. The seven generations planning model has multiple meanings in different contexts, but in Jojola’s article, it means planning for three generations before and after the current, or middle, generation, so this would include great-grandparents, grandparents, parents, yourself, children, grandchildren, and great-grandchildren. The goal of this type of planning is

Fitzsimmons 8 not only to provide the support that each of those generations need to thrive but also to foster meaningful connections between the generations. For instance, in Jojola’s article, he talks about listening to and learning from the elders so that culture and values can successfully be passed on; he also discusses how tribal communities need to support the education of their children and provide higher education and job opportunities for young people so that they don’t have to choose between an unfulfilling life on their tribal lands and separation from their tribe in urban life (Jojola 458, 469).

In addition to that, the article discusses how Indigenous planning seeks to create connections between the seven generations in order to sustain a tribe’s way of life and better their community in the long-term. Jojola emphasizes the role that parents, grandparents, and great-grandparents need to play in order to support the younger generations and help them grow into knowledgeable and positive tribal members (Jojola 463). Meanwhile, the younger generations have the responsibility of learning from the elders, carrying on their vision for the community, and improving it as that vision is implemented. To illustrate this concept, Jojola gives the example of the construction of Pueblo Bonito, which was built across seven generations of Anasazi people. Even though this community project was passed on from the older to the younger generations over the course of a century, the ultimate product was cohesive and fulfilled the original vision, allowing the community to benefit in the long-term because they were able to work together to complete a major multigenerational project (458).

This planning framework is a foundational value in the Respond, Recover, Rebuild Plan and can be seen in every section of the plan. Specifically, the plan includes a lot of programming to support elders because they are one of the high-risk populations within the COVID-19 pandemic, are knowledge keepers, and make up many of the Cherokee language speakers. Some

Fitzsimmons 9 of the services for elder generations include food assistance, house repair, virtual medical care, and virtual teaching sessions with younger generations. The plan also includes support for younger generations, especially support that is education-focused due to the interruptions that COVID-19 had on education. Specifically, services for the three younger generations include technology assistance, clothing scholarships, and virtual sessions with elders to learn about Cherokee language and traditions. Lastly, for the middle generation, services include income assistance, job placement, retraining, rental and utility assistance, as well as several of the services provided to elders and youth. Another realization of seven generations planning model in the Respond, Recover, Rebuild Plan is the focus on long-term multigenerational betterment of the community. The plan largely focuses on meeting emergency needs of Cherokee citizens to help combat immediate threats, but the overall goal of this plan is also to mitigate the long-term effects of the pandemic. By delegating funding to these critical services – housing, mental and physical healthcare, education, job safety, food – the nation is helping mitigate the loss of Cherokee knowledge from elders passing, the long-term health effects and disabilities that come from contracting COVID-19, and the trauma associated with losing one’s job, house, income, food, friendships, etc.

Compare and Contrast Although both plans are public health-centered strategic plans with many of the same values as the State of the Cherokee Nation Health Report and Plan from 2014, they still have considerable differences regarding in content, organization, and audience. For instance, the 2014 plan was meant to address the top five public health issues for Cherokee citizens and was organized with sections for each of those problems so that the reader – any Cherokee Nation citizen – could fully understand the effects that particular issue was having on the Cherokee

Fitzsimmons 10 Nation. These sections were then followed by a solutions section with some general goals to combat the five public health threats. By contrast, the Respond, Recover, Rebuild Plan obviously focused on one medical threat – COVID-19 – and the quality-of-life issues that resulted from the pandemic. Although the plan is still very accessible to the average reader and would be a helpful source for a Cherokee citizen, the Respond, Recover, Rebuild Plan does seem to prioritize the US federal government as the audience in order to receive the funding for these necessary programs. For example, this plan is organized based on the solutions the nation has been providing and hopes to continue providing rather than the issues in order to convey accomplishments over the negative impacts of COVID-19 in the community.

Conclusion To summarize, the COVID-19 pandemic has wrought many challenges and changes within government, particularly how government responds to and plans for public health. In the case of the Cherokee Nation, this shift can be clearly observed by comparing the State of the Cherokee Nation Health Report and Plan from 2014 and the Respond, Recover, Rebuild Plan from 2020. Naturally, these plans still carry many similarities in values as they are both for the Cherokee Nation, but they also have major differences in how they were prepared, who they were written for, what problems and solutions were discussed, and how they relate to Indigenous planning literature.

Fitzsimmons 11 Works Cited Jojola, Ted. “Indigenous Planning: Towards a Seven Generations Planning Model.” Canadian Journal of Urban Research, vol. 17, no. 1, 2008. PDF. Red Star Innovations. “State of the Cherokee Nation Health Report and Plan 2014.” Cherokee Nation Public Health, 2014, http://cherokeepublichealth.org/wpcontent/uploads/2015/08/State-of-The-Cherokee-Nation-Health-Report-and-Plan2014_Lo-Res.pdf.

Respond, Recover, Rebuild. Cherokee Nation, 2022, https://www.respondrecoverrebuild.com/.

Accessed 2 April 2022.

“Senate Passes One Year Extension for Tribal Governments to Utilize COVID Relief.” United States Senate Committee on Indian Affairs. United States Senate, 20 Oct. 2021, https://www.indian.senate.gov/news/press-release/senate-passes-one-year-extensiontribal-governments-utilize-covidrelief#:~:text=3684%2C%20the%20Infrastructure%20Investment%20and,under%20the %20American%20Rescue%20Plan. Accessed 3 April 2022.

Walter and Andersen. “Conceptualizing Quantitative Methodologies.” Indigenous Statistics: A Quantitative Research Methodology. Left Coast Press, Inc., 2013. PDF.