As a possible next step, the SPH team has offered the services of the school’s disaster preparedness training experts. McGovern says discovering this critical area of concern highlights the importance of asking the community to determine how they want the research partnership to evolve. “This is the benefit of community participatory research,” says McGovern. “In this case, we learned that tribal members wanted the focus to be more on disaster preparedness.”
Health Care Access SPH associate professors Kathleen Thiede Call and Donna McAlpine are working to understand the factors that contribute to health disparities in Minnesota. Call directed a study funded by the Minnesota Department of Human Services to illustrate the barriers to care faced by adults and children in public health care programs. From that study, Call and colleagues created a special report of the barriers to care faced by American Indians enrolled in Minnesota Health Care Programs (MHCP) such as Medicaid and MinnesotaCare. The report was funded by the Medica Foundation, the grant-making sister organization to Medica Health Plans, a Minnesota-based nonprofit HMO. The researchers surveyed 560 American Indian enrollees on the problems they experience when trying to get health care. They looked at discrimination, financial barriers, clinic hours, transportation, family and work responsibilities, trust in providers, and language and cultural issues. The researchers found that American Indians were more likely than other MHCP enrollees to cite work and family responsibilities as a problem when trying to access heath care. Trustworthiness of doctors in general appeared to be a greater barrier for American Indian children than other MHCP children. And American Indian parents were three times more likely to lack trust in their child’s doctor than MHCP parents overall. In what she refers to as an effort to “move beyond the data to make change” Call, McAlpine, and their community partners have convened a series of forums. The forums include members of the Latino, American Indian, Hmong, Somali, and African American coummunities, as well as members of more than a dozen health institutions. Funded by the Media Foundation and UCare of Minnesota, the forums offer a place for community members and health care professionals to work together on recommendations for reducing barriers to care. The “Working Together to Achieve Results” forums take place at the Powderhorn Phillips Cultural Wellness Center in Minneapolis.
American Indian community members who have participated in the forums have proposed that health organizations work with the Bureau of Indian Affairs to improve access to services among those living away from a reservation and in the city who currently cannot afford care. They have called for improvements in communication about insurance coverage — which providers accept insurance and what is covered. Community members have said that the burden of time and energy needed to get this information is especially difficult for elders, who are more likely to give up and go without services. They have also asked providers for support to increase access to elders who can teach on the traditional ways of health care, including good nutrition and cooking with herbs.
SPH students who have worked on the American Indian Community Tobacco Project (from left): Lannesse Baker, Turtle Mountain Band of Chippewa Indians; Isaiah Brokenleg, Rosebud Sioux Nation; and Melissa Boney, Bois Forte Band of Chippewa Indians.
Tobacco Control It’s well known that American Indians in some parts of the country use tobacco more than other ethnic and racial groups. This is especially true in Minnesota, where about 60 percent of American Indians smoke, a rate far higher than American Indians nationally. But little is known about why the rates are so high or what can be done to address them. Most tobacco prevention research of the past has failed to build on the strengths of American Indian culture or to truly partner with community members. Previous interventions have also failed to acknowledge the sacred use of tobacco in Indian culture, and instead have deemed all tobacco use as “bad.” (continued on page 6) 5