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Health Innovation: Transcending 638 Donald Warne, MD, MPH Oglala Lakota Associate Dean, Diversity, Equity & Inclusion Director, INMED & Public Health Programs
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Transcending 638 Health Innovation

Jun 08, 2022

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Page 1: Transcending 638 Health Innovation

Health Innovation: Transcending 638

Donald Warne, MD, MPHOglala Lakota

Associate Dean, Diversity, Equity & Inclusion Director, INMED & Public Health Programs

Page 2: Transcending 638 Health Innovation

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. 

Page 3: Transcending 638 Health Innovation

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

Page 4: Transcending 638 Health Innovation

US Health System

Page 5: Transcending 638 Health Innovation

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 

Page 6: Transcending 638 Health Innovation

Traditional View of Public Health

Page 7: Transcending 638 Health Innovation

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 

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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  

Page 9: Transcending 638 Health Innovation

Indians Into Medicine (INMED)

Page 10: Transcending 638 Health Innovation
Page 11: Transcending 638 Health Innovation

IHS Workforce Shortages by Area

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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%

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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

Page 14: Transcending 638 Health Innovation

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

Page 15: Transcending 638 Health Innovation

MEDICINE WHEELStudent Support

SPIRITUAL

MENTAL

PHYSICAL

EMOTIONAL

Page 16: Transcending 638 Health Innovation

MEDICINE WHEELStudent Support

CULTURAL

ACADEMIC

FINANCIAL

SOCIAL

Page 17: Transcending 638 Health Innovation

INMED Programming• Summer Institute • Med Prep • INMED MD Cohort – CLIMB • Indigenous Health MPH • Indigenous Health PhD  

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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

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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

Page 20: Transcending 638 Health Innovation

• 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

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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 

Page 22: Transcending 638 Health Innovation
Page 23: Transcending 638 Health Innovation

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)

Page 24: Transcending 638 Health Innovation

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 

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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.”