Why Indigenous Health Needs More Culturally Grounded Practitioners

When Dr. Julie Smith-Yliniemi logs on to teach a case studies course in Indigenous health, her mission is to prepare practitioners to help people on reservations achieve a better quality of life.

“When the health of Indigenous people is better, the health of all people is better,” Smith-Yliniemi told The EDU Ledger regarding the course, which she teaches online at a site not far from the White Earth Reservation in northwestern Minnesota.

That is why, Smith-Yliniemi said, she is eager to pore over   the applications that students have been submitting to join what the Johns Hopkins Bloomberg School of Public Health describes as “the only DrPH program in the world dedicated specifically to leadership training in Indigenous health.”

The Bloomberg School developed the Doctor of Public Health Program in collaboration with the school’s Center for Indigenous Health, which has offices serving tribal communities throughout the U.S. The program began accepting applications in August for the 2027-2028 year, but some students have already begun their studies.

“I think it’s just great and I’m excited to be reviewing applications and be part of the program,” Smith-Yliniemi said.

The $20,500 Problem

But whatever excitement Smith-Yliniemi and her colleagues at the center have for the new DrPH program is tempered by a policy shift that could restrict financial aid and how much students can borrow if they pursue careers in public health.

Thanks to a new definition of “professional degree programs” under the Department of Education’s Reimagining and Improving Student Education, or RISE rule, public health degrees – including the MPH and DrPH – are excluded, along with several other health professions.

A federal court temporarily blocked the RISE rule in June, and the department updated its list of programs deemed eligible for federal student loans, but MPH and DrPH programs were still not included.

“As a result, MPH and DrPH students remain subject to the lower annual federal loan limit of $20,500, compared with $50,000 for students in recognized professional degree programs during the court’s stay,” observes the Association of Schools & Programs of Public Health, or ASPPH.

“At a time of growing threats to public health, failing to recognize these degrees as professional credentials is both short-sighted and dangerous,” ASPPH states.

The organization states further that excluding public health degrees from the professional degrees category would increase financial barriers for students from diverse and historically excluded communities and weaken the nation’s public health workforce pipeline.

Dr. Donald Warne, a professor in International Health and co-director of the Johns Hopkins Center for Indigenous Health, said absent a rule change, the RISE rule is “further disrupting access to education.”

“Much like cutting Medicaid is a bad idea for impoverished people who need health care, cutting financial aid is a bad idea for students who need tuition [assistance],” Warne said. “If you don’t have financial aid, then only people who can write checks for school can go. So we’re just basically allowing the wealthier populations to take advantage of educational opportunities. So it really is a social justice issue.”

Preventable Disparities, Unfilled Jobs

Warne said the rationale for a DrPH with a concentration in Indigenous health is to better ensure that people who work in the field understand the unique challenges that Indigenous people face.

Federal statistics from 2023 show the average estimated life expectancy at birth for American Indian / Alaska Native individuals was 70.1 years – significantly less than the 78.4 years for all races.

In some regions, Warne noted, the life expectancy for American Indians is even shorter. He cited a statistic that shows the median age at death for American Indians in South Dakota is 58.

“So half the population is dead by 58,” said Warne, who is a member of the Oglala Lakota tribe from Pine Ridge, South Dakota. “So most American Indians won’t live long enough to enroll in Medicare.”

The five leading causes of death in American Indian / Alaska Native people in 2023 were heart disease, cancer, unintentional injuries, chronic liver disease, and diabetes, according to the Office of Minority Health within the U.S. Department of Health and Human Services, or HHS.

In 2024, nearly one in four American Indian / Alaska Native adults reported being in fair or poor health – “the highest rate among all racial groups,” according to HHS.

“Across the board, we have health disparities,” Warne said. “We have higher rates of diabetes, higher rates of suicide, higher rates of maternal mortality, higher rates of infant mortality basically across the board. And most of these are preventable issues.

“That’s where we need good public health programming and good resources and services,” Warne continued, “but we need the workforce to adequately implement the programs that are needed.”

Looking to the Community for Answers

Workforce turnover on the reservation is one of the issues that Smith-Yliniemi discusses in her case studies class. She lamented that some people work on reservations simply to take advantage of student loan forgiveness programs for people who work a certain amount of years on a reservation.

Lack of familiarity with tribal history and culture is also a problem, Smith-Yliniemi said.

“Maybe they just graduated from college, they drive an hour from the city to get on the reservation and they don’t know about our community, some of them don’t know the history, they don’t know about tribal sovereignty,” Smith-Yliniemi said.

In her case studies class, Smith-Yliniemi guides her students through a discussion of how to help people who work on reservations get a firmer grasp of tribal culture and how to help people on the reservation avoid slipping through the cracks of bureaucracy. They explore whether it should involve some sort of mandatory orientation as a condition of employment on the reservation.

“We’re looking at trying to save lives from a health perspective of having employees trained in really understanding and knowing the community that they work with,” Smith-Yliniemi said.

Cultural connectedness is often the difference-maker for the well-being of Indigenous people, Smith-Yliniemi and Warne say.

Smith-Yliniemi is currently researching the role of the making of cultural items, such as moccasins, beaded earrings, drums and regalia to dance at powwows.

“What we’re finding in the research is when people are feeling connected to their community, that can really help with their sobriety, with their recovery and prevention as well,” Smith-Yliniemi said. She said such cultural item making represents a strength and an alternative to a Westernized approach of sending people to treatment facilities off the reservation.

“We’re trying to understand that the answers lie in the communities,” Smith-Yliniemi said.


This story originally ran in The EDU Ledger's November 5, 2026 edition. Subscribe here for full access.