On September 8, 2021, the UNC Lineberger Cancer Network will host a lecture where Ronny Bell, PhD, MS, and Marc Emerson, PhD, MPH, will jointly discuss the cancer inequities and efforts to address these disparities for American Indians and Alaska Natives across the US.
I spoke with both recently to learn more about the lecture and some of the disparities Indigenous communities face.
Dr. Emerson, how will your collaboration with Dr. Bell and the work you are doing benefit indigenous people in NC and nationally?
American Indian (AI) populations face unique challenges to access and receive quality cancer care in the US. One key difference involves AI individuals living on tribal lands or in urban settings. Part of my research is specifically looking into cancer-related issues unique to urban-dwelling natives.
What do you hope to accomplish because of your work?
In practice, I hope this research will contribute towards improving American Indian/Alaskan Native cancer outcomes. In my research and pedagogy, I aim to prioritize Indigenous methods, analytic frameworks, and community partnerships to help mitigate environmental and psychological harm associated with Western science applications.
Is transportation to medical appointments a problem? If yes, what community support groups are available?
Yes, a big problem among AI individuals residing in more remote tribal lands. For example, from my personal perspective, as a caretaker for my father, who had cancer, I would transport him from our tribal land, the Navajo Nation, to Albuquerque, NM, which is an over 3-hour drive for his surgery consultations, surgery, and follow up appointments. Hearing from my community sadly, this is a common experience. Even for radiation and chemo treatments, border towns are often where Navajo residents will receive specialty care, like cancer care.
What roles do nutrition and health care literacy play?
Nutrition and cancer care education play a huge unique to AI role! As a cancer control and education postdoc at Lineberger Comprehensive Cancer Center and as a postdoc at the Center for American Indian Health at Johns Hopkins University, we have been working to create better points of care/cultural relevance that are created by the community for cancer care literacy/education.
What are some of the barriers that indigenous communities face that non-indigenous populations may not encounter?
Among the majority of AI who do not have private health coverage, cancer care is typically accessed through Indian Health Services (IHS), contracts with other providers, or Medicaid. However, delivery of care via IHS is complex, fragmented, and limited due to historic IHS underfunding. Many AIAN are ineligible for referred cancer care services because they are not enrolled in a recognized tribe, or they do not reside on or near established tribal lands or within the Purchased/Referred Care Delivery Area. This results in delayed or disrupted care services in a period where timing is paramount. Additionally, many AI individuals do not participate in health care systems due to historical medical mistrust and dissatisfaction with culturally congruent cancer care.
Lastly, among AIAN who live on tribal lands, geographic barriers, including the remoteness of tribal lands, transportation, time/financial costs to travel to access cancer care and provider availability/scheduling are all additional factors that may increase these disparities.
Does telehealth/telemedicine play a role in getting health care to rural indigenous communities? If yes, how?
This is a super relevant question facing my home community, the Navajo Nation, right now. With COVID and online schooling, we have seen in our communities the disparities in the infrastructure for this. This also highlights how underlying social determents affect health.
Dr. Bell, I will ask you the same question; how will this collaboration and your work benefit indigenous people in NC and nationally?
The Community Outreach and Engagement programs at Duke, UNC, and Wake Forest have come together to create the Southeastern American Indian Cancer Health Equity Partnership (SAICEP), with a mission to understand and address the cancer-related needs of American Indian communities in our state. This presentation is the inaugural presentation of a new Speakers’ Series as a part of SAICEP that will highlight our partnership.
What do you hope to accomplish?
To educate researchers, clinicians, and policymakers on cancer-related research, treatments, and education issues that affect the tribal communities in our state.
What cancers are most prevalent in the indigenous communities?
The cancers most common in Indigenous communities (lung, breast, prostate, colon) are fairly similar to those seen in other populations. Cancers of the GI system appear to be more prevalent compared to non-Hispanic whites. The more concerning issues are the late state diagnosis of cancers among American Indians and the misclassification of race in cancer registry data that impact cancer rates in this population.
What are some of the factors contributing to delayed diagnosis of cancer within the indigenous communities?
Access to care, insurance/poverty, medical mistrust, and concern about receiving “bad news.”
Dr. Emerson, what else would you like to share with our subscribers?
I am excited about my transition to a (tenure-track) faculty because there is not much Native representation there.
Dr. Bell?
My work largely focuses on non-federally recognized tribes. There are challenges that tribes that don’t have federal recognition have with regards to understanding cancer burden and implementing evidence-based cancer prevention strategies.
Thank you both for participating in this interview and for the work you are doing for underserved communities.
People can register to attend this lecture featuring Dr. Bell and Dr. Emerson on the UNC Lineberger Cancer Network Learning Portal.