Professional Documents
Culture Documents
Breana Floyd
various other disciplines have collaborated to create health and biomedical science pipeline
programs. The mission of the pipeline program is to enable marginalized populations to enter
health and biomedical careers; ultimately increasing diversity in the workplace. Throughout this
paper, I will define health disparities and give examples of the types of health disparities that
currently exist among American Indian and Alaska Native (AI/AN) populations. I will describe
how my current internship site , the Maya Angelou Center , is using these programs to educate
Health Problem
Health inequities such as poverty and low income, limited educational attainment, limited
access to quality healthcare and health insurance are detering AI/ANs from entering health and
(2016), the U.S. Census Bureau report showed that about 15.5% of all Americans were living in
poverty in 2014; meanwhile 28% of American Indians and Alaska Natives (AI/AN) were
impoverished. The national average for median household income was greater than $53,600
which is over $16,000 more than the median household income for AI/AN populations ($37,200)
. According to AAMC (2016), the Indian Health Service reported that American Indian and
Alaska Native populations suffer disproportionately in areas of “heart disease, intrahepatic bile
duct cancer, diabetes, alcoholism, mental health problems, asthma, and chronic liver disease”
(AAMC, 2016; IHS, 2016). These social health determinants are affecting the educational
As mentioned, social health determinants are affecting the educational pursuits of AI/AN
populations such as poverty causing these groups to lack essential needs such as health insurance
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and higher education, detering individuals from seeking medical care; ultimately causing poor
health within these populations. Nearly 25% of American Indians and Alaska Natives do not
have health insurance compared to 11.7% in the U.S. population overall (AAMC, 2016; IHS,
2016). According to IHS, AI/AN annual per capita spending (approx. $3,100) is $5,000 less than
regarding health care. 83.2 % of the U.S. population versus 71.6% of the AI/AN population
graduated with a High School Diploma in 2014-15 (AAMC, 2016). In 2014, about 20% of
AI/ANs ages 25 and older had earned a Bachelor’s degree compared to 32.5% of all adults
(AAMC, 2016). Poverty can affect community members access to knowledge as well as their
ability to acquire higher education; inadvertently affecting people's abilities to make informed
educational opportunities, depleting many opportunities for AI/ANs to pursue careers in health
and biomedical science. Thus, another health disparity for AI/AN populations is the deficiency
of AI/AN people pursuing health careers including lack of representation in the medical field and
The health and biomedical science fields are currently lacking AI/AN people ultimately
creating a disadvantage for increased care within these communities (AAMC, 2016). Health
providers that acquire the same cultural values, lifestyles, and spiritual beliefs as their patients
may increase patient care experiences and allow for strong and trusting patient- provider
relationships (AAMC, 2016). Aiming to provide service from health care professionals that
integrate cultural sensitivity into their practice and consider the traditions of the community they
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serve can ultimately improve healthcare for the AI/AN population. AI/AN providers may serve
patients belonging to this community by providing their healthcare needs as well as be able to
understand their spiritual needs. Incorporating personal care into one’s practice as a healthcare
provider may include integrating culture and belief into the patient’s care plan ( i.e. AI/AN
providers may provide options of traditional healing ceremonies into their patient’s care for those
According to AAMC, finding strategies to increase AI/ANs within the health field is
imperative (2016). The recruitment as well as retention of AI/ANs in health professions is crucial
and cannot be ignored. If the current rate continues, the number of AI/AN providers will
deplenish completely. Minority representation is vital at all levels of work; and AI/AN health
professionals serve as positive role models, mentors, and minority representation for younger
generations, especially AI/AN youth. Minority representation allows AI/AN youth the
opportunity to see someone who looks like them working in health careers and may provide
Health Disparities
The scope as well as the depth of the effects in which health inequities among AI/AN
communities occur is important to describe the lack of minorities in health careers. The pipeline
programming is used as an opportunity to recruit AI/AN youth into health careers with the
intention that the students will return post degree and assist with alleviating health disparities
within their communities. The pipeline program also educate enables students to research
disparities within their communities and allows them to create plans for health equity promotion
within and across societies. Health disparities are also dependent on social factors such as race,
geographic location, social position, ethnicity, gender, age, socioeconomic status, educational
attainment, religious affiliation, sexual orientation, disability, etc. (NCHS, 2016). People that
suffer from lack of access to healthcare, health insurance, and nutritious foods are also affected
by health disparities (Marmot et al., 2008). An increase in health disparities exists among
disadvantaged populations and directly relates to the distribution of economic, social, political,
According to the Center for Native Health (2017), CDC reports show that AI
communities carry the greatest burden of experiencing health risk factors and chronic diseases.
As an effect of the aging baby boomers, there is an increase in the number of tribal members
diagnosed with chronic diseases such as diabetes, heart disease, etc. Currently, about 35% have
been found to have diabetes; and numbers are increasing among tribal youth (CNH, 2017). In
2003 61.9% of male children (ages 6-11) were considered overweight or obese while 58.6%of
AI youth are four times as susceptible to commit suicide in the U.S. than all other racial
groups. About 12% of North Carolina residents as well as are living at or below the poverty line.
Approximately 23% of the enrolled members of the ECBI are living at or below the national
poverty line (CNH, 2017). 15% of non-natives living in western North Carolina are at or below
the poverty line. Only 65% of high school students living in Western North Carolina graduate,
including Cherokee Central Schools. In 2000, about 12% of AI earned a bachelor’s degree or
higher. Less than 2% of enrolled EBCI students are pursuing health careers.
Medicine (WFSM) is my internship site. MACHE is partnering with the Mountain Area Health
Education Center (MAHEC), Center for Native Health (CNH), and Eastern Band of Cherokee
Indians (EBCI) for the Medical Careers and Technology Pipeline (MedCat). MACHE is also
collaborating with the Wake Forest Institute for Regenerative Medicine (WFIRM) at WFSM and
North Carolina American Indian Educators for the American Indian BioMedical Sciences
(AIMS) Academy. MedCat and AIMS is health and biomedical pipeline programming for
American Indian (AI) high school students from tribal communities throughout western and
eastern North Carolina. The MedCat and AIMS programming align with the mission to counter
the effects of health inequities among this population. Specifically, the health problem includes
increasing the number of American Indians in health and biomedical careers. The programs use
Mission
The purpose of the MedCat and the AIMS Academy programming is to decrease the
health gap and increase minority representation by providing AI high school students with tools
enabling them to pursue careers in health and biomedical sciences; by building on existing
missions of each partner to enhance resources and tools available to the community. MedCat and
AIMS reaches to increase competency and knowledge, enthusiasm, and interest and ability
“Goals of the MedCat program include: “increasing AI and Appalachian high school
science careers, providing mentorship for AI and Appalachian high school students
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during undergraduate health and biomedical science education or entrance in the
workforce, increasing high school health science teacher knowledge of and ability to
mentorship for high school health science teachers to enable them to better engage
Students begin the pipeline program in high school and may return as mentors. The
pipeline is intended to be a process that occurs in stages throughout their academic career and
students should be able to develop the necessary skills to become a health professional over time
(i.e. middle school, high school, undergraduate, postgraduate, and career pipelines). The sooner
students within these populations begin the pipeline process the better. It allows students the
opportunity to realistically be able to prepare for college prerequisites and other requirements
needed to enter their chosen career path. Although students within these communities currently
begin the pipeline program in high school (for purposes of current funding) they would benefit
even more from starting in middle school. It would allow students more time to gain self-efficacy
and grant them greater opportunities toward entering health programs. The goal is for high
school students to attend an undergraduate program upon completion of the pipeline, eventually
Several reasons exist for why pipeline programs for underserved communities are
necessary. Some reasons include to provide care, to do research, and to engage communities, in
culturally relevant ways. Culturally relevant practices will allow for better care (the provider can
relate better to the patient), research accounts for population specific factors, and engagement
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tailored and led by the community; ultimately, creating better health outcomes for the target
population.
for minority health and biomedical professionals. Students joining the pipeline come with a
mission to be able to serve their communities. The pipeline provides participants with the
necessary skills, tools, education, and experience to improve individual self-efficacy and prepare
students for their undergraduate career in health and biomedical science. During their post
graduate careers, students prepare for health and biomedical careers through internships, entering
entry-level jobs, and shadowing. Ultimately, the goal of the pipeline is for students to return to
health disparities. Researchers believe that inclusion of more minorities into medical and health
careers will assist in decreasing the health gap (Duffus et al., 2004). In the Duffus et al. (2004)
article, out of all the minority students that were involved in the pipeline curriculum 100 percent
earned a bachelor’s, 53 percent earned a master’s, 11 percent earned a medical degree, 7 percent
earned a doctoral degree, and 60 percent entered public health careers. The Maya Angelou
Center hopes to reverse health disparities by creating opportunities for minority youth to become
professionals in the Health and Biomedical Sciences (MACHE, 2017); including AI/ANs.
The non-health problem is education. The Maya Angelou center focuses their pipeline
program on educating youth through learning labs. The MedCat and AIMS programs cover
various topics related to health and biomedical sciences.Many of the health disparities discussed
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through my final poper are used as health topics in which students are expected to conduct
SWOT Analysis
Figure 1 contains a SWOT Analysis of the program. After gathering research connected
to MACHE and the various aspects of the organization, I could put together an informal analysis
Problem Analysis
Racism as a system of power is a root cause for many societal issues (Hinson, Healey,
and Wiesenburg, n.d.). Structural inequities are systemic differences among groups in their
health outcomes (National Academies of Sciences, Engineering, and Medicine [NASEM], 2017).
Social identity and location are used to determine which groups will receive health resources;
such as race and ethnicity, geographic location, socioeconomic status, educational attainment,
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employment, immigration status, etc. (NASEM, 2017). Health equity influences, determines
one’s access to quality health conditions, healthcare, health insurance, healthy and nutrient dense
foods, clean water, housing, schools, a quality education, etc. (NASEM, 2017). In this analysis, I
will use the Socio-ecological Model (SEM) to analyze the health and non-health problems that
will be addressed during my internship at the Maya Angelou Center for Health Equity
[MACHE]. It will also include a concept map of the root causes of health disparities, a
changeability matrix, as well as my internship activities for the MedCat and AIMS
Socio-ecological Model
The Socio Ecological Model (SEM) can be used as a tool to explain health behavior. An
approach to addressing health behaviors can often be based solely upon the actions of the
individual, without regards to context. Although health behavior can be affected by individual
actions it is also vital to consider things that can alter one’s health that are outside of one’s
control. The SEM broadens the lens to view sources outside of the person themselves to see the
root causes of health issues. SEM provides a systematic perspective on health equity at the
framework gives a broader understanding of the social determinants of health such as social,
socio-economic, and physical environment as well as personal actions and characteristics (World
decisions whether or not to enter into health careers such as an obtained desire to serve one’s
community. The students that apply to the MedCat and AIMS programs come with a mindset of
giving back and wanting to help others. Regarding interpersonal factors, MedCat is attempting to
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recruit students to become healthcare providers and serve in their communities. Educators and
professionals of various fields are collaborating to teach the children the skills that they need to
know, both native and non-native professionals. Intentionally placing thoughts into AI youth
earlier on that they can be health professionals along with allowing them to see professional that
look like them and are a part of their culture is used as motivation and encouragement. Support
from family and friends as well as staff members (Maya Angelou Center) can provide lifetime
support for AI youth seeking to enter health careers. MedCat pipeline programming is supplying
students with the tools and education needed to navigate institutions in order to obtain their
degree and enter into the workforce. Organizational factors include health plans and insurance,
healthcare systems and academic medical institutions, tribal urban health clinics, etc. The Maya
Angelou Center at Wake Forest as well as multiple other partner organizations are working to
provide obscene amounts of resources to AI high school students as well as other students within
these rural areas in order to invest in their future careers in health and biomedical science. The
MedCat pipeline is building trust with the youth as well as the community as a whole. By
creating sustainable relationships the Maya Angelou Center is attempting to counter the effects
of low rates of health insurance, historical distrust of the government and healthcare
professionals, and low access to culturally competent and quality healthcare. Community factors
integrating needs assessments with the tribal communities. Organizations have gathered to create
collaboratives such as MedCat that will eliminate health disparities within AI communities.
Although racial inequities occur most frequently they are often the hardest inequities to resolve
(NASEM, 2017; Williams and Mohammed, 2009). Intrapersonal factors of health disparities
regarding race include racial stereotypes. The threat of one acknowledging the occurrence of
racial stereotypes toward their racial group or ethnicity may lead to health inequities (NASEM,
2017; Glossary of Education Reform, 2013). Someone can have internal misconceptions about
themselves due to societal stereotypes. An example being, performing lower than one’s potential
during testing due to low academic expectations set for the person solely because of their race
(NASEM, 2017). An interpersonal factor of health equity includes implicit bias. Racial bias
produced by behavior and attitudes without knowledge or intention of doing so can cause health
inequities such as racial profiling (NASEM, 2017; Staats et al., 2016). The MedCat pipeline
programming can help to alleviate the effects of racism, racial profiling, racial stereotypes,
implicit and explicit biases by leveling the playing field for marginalized groups and
Policies exists that can either create health inequities rooted in racism or attempt to
remedy them (NASEM, 2017). Policies and societal factors that support institutional level health
disparities include housing discrimination and redlining creating race and class differentiated
neighborhoods and schools can contribute to health inequities based on race and SES (NASEM,
2017; Woolf et al., 2007). The conditions of one’s neighborhood and school can significantly
impact one’s quality of life; especially, regarding equal distribution of resources to minority
populated communities (NASEM, 2017). Policies such as these still have an effect on minorities
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to this day. Strategies like the pipeline program are attempting to counter the effects of
historically damaging policies that account for generations of health inequalities toward entire
Structural inequities can affect other factors of health such as life expectancy (NASEM,
2017). Studies show that geographic location is a better indicator of health outcomes than genes
(NASEM, 2017; Robert Wood Johnson Foundation [RWJF], 2009). The severity of structural
inequities can impact people’s lives from birth to death (NASEM, 2017; Braveman, 2008;
Hamilton et al., 2016; Mathews et al., 2015). The effects of these racial neighborhood targeted
resources accounts for the health gap between populations. The pipeline programming will assist
to promote health equity among minority populations through equitable resources to education
Resources among AI communities are vital. Pursuit of a high school diploma and higher
education may affect one’s employment, income, and individual and intergenerational wealth
(NASEM, 2017; Olshansky et. al., 2012). The SES and household income can effects the
individual and their entire household. The pipeline program is assisting people with stepping out
of the cycle of poverty that minorities are most often placed into by structural effects.
Policy level factors, such as, implicit and explicit racial biases during the hiring process
can also inhibit persons from receiving employment (NASEM, 2017). Racially bias lending
policies can restrain people’s opportunities of home ownership, business ownership, and asset
development (NASEM, 2017; Pager and Shepard, 2008). Policy, political decision-making, and
voting imbalances are often used to inhibit people of color and underprivileged person’s voices
from being represented (NASEM, 2017; Blakely et al., 2001; Carter and Reardon, 2014). The
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pipeline programming is attempting to intentionally make sure that AI/ANs are represented at all
Health care policies can fail to integrate cultural competency. Implicit bias can cause a
differentiation both in the quality of care and healthcare delivery dependent on race (IOM and
NRC, 2003; Sabin et al., 2009). Although biases have allowed minorities to suffer health
disparities throughout history, governmental policies were created attempting to remedy health
inequities caused by racism. Some policies formed to counteract health disparities include the
Civil Rights Act of 1964, the Voting Rights Act of 1965, the Fair Housing Act, Title IX of the
Educational Amendments of 1972, and the Patient Protection and Affordable Care Act (NASEM,
2017). Although we have these policies in place the pipeline programming is needed to assist
AI/AN populations as well as all minorities and the interpersonal and community level in order
to allow them to enter into health and biomedical careers. The pipeline program does this
etc.
The concept map in tables 1 and changeability matrix in table 2 above, show ways in
which health equity can be affected among minorities and lists these things according to its
minority populations such as the AI/AN populations at each level. During my internship with
MACHE, I hope to assist with furthering strives in creating program evaluations, for the MedCat
and AIMS programs to assist with furthering the mission of increasing AI/ANs within health
careers.
During my internship with MACHE, I will be assisting with the student learning lab
screenings, and AIMS student evaluations. MedCat is a year-round program with two sessions in
the spring referred to as “Learning Labs,” in which I will be accountable for creating student
evaluations as well as data collection. I assisted Dr. Meg Hanshaw in developing the student
mixed methods evaluation for the February MedCat Learning Lab, hosted by i.b.mee and AHEC.
I also created the MedCat Partnership Process Evaluation led by Dr. Rebecca Lasher. MACHE is
developing a grant proposal for the AIMS pipeline program; in which I was responsible for
collecting research on health and biomedical pipeline programs for AI/AN populations.
Labs” this spring semester. MedCat is available to students throughout their high school career.
Depending on when students enroll for the program they could potentially participate for up to 4
years. MedCat is in process of planning a curriculum for undergraduate students in which I will
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be responsible for assisting in planning this program as well. I will also be helping review all
MedCat objectives will be met throughout the year with culturally appropriate task goals.
MedCat goals include: learning labs during the academic year (hosted by local, community-
based organizations), mentoring sessions, and AIMS summer academy. A mixed method
evaluation will be used for assessing the MedCat pipeline program. The purpose of the post-
program evaluation is to review for program effectiveness. In which, MACHE and community
partners can ensure that program objectives are being fulfilled. The evaluation is specifically
implementation. It is also looking to see if the program implementation is relevant to the health
issue being addressed; and inclusiveness regarding the intended population. It is reviewing the
providing with program participant feedback. The evaluation allows MACHE to see if their
objectives are being met, participant’s enjoyment and growth. Most importantly it allows
MACHE to see whether the program needs improvement and in which areas.
The MedCat program aims to create a versatile curriculum that can be molded to fit other
communities in need of a pipeline workforce program. Essentially, MedCat plans to alter the
curriculum and implement it within other marginalized communities. MedCat and the partner
organizations have created a strategy that will make MedCat sustainable for many years to come,
using supportive student cohorts, professional development for instructors, and nurturing
developing the curricula for both students and instructors. I will also help to engage student
cohorts with interactive activities. I will assist MACHE in brainstorming ideas to keep local
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community partnerships intact. Student cohorts can assist in creating student bonds and student
support to the program after completion. Professional development for teachers continues their
Logic Model
Figure 2 below shows the logic model for MACHE’s MedCat pipeline. It goes into detail
about the inputs, activities, outputs, and outcomes of the program. Mache’s resources include
their community partnerships, grant funding, student and high school (hs) health science teacher
participants, MACHE staff, researchers and experts, and MedCat and AIMS workforce
programs. These are the current inputs currently available that make the MedCat program
possible. The MedCAt activities, outputs, and outcomes can also be found in the logic model
below.
Figure 3 below includes the MedCat program timeline. The timeline shows the sequence
of tasks for the academic year as well as the summer. As mentioned the MedCat pipeline
program will take place throughout the academic year. The AIMS summer academy is an
extension of the MedCat program available to students throughout the summer. MACHE
performs an evaluation from inside the organization on MedCat performance while the program
is in progress. This helps with maintenance of the program and immediate changes that cannot
wait until after the program is complete. Local organizations have a role within the program by
facilitating learning labs to MedCat student participants throughout the program. Both student
and teacher participants engage in mentoring activities. Student- student and teacher- teacher
mentoring happens throughout the program to increase a positive experience for participants.
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High School health science teachers will participate in professional development session for
In my search process, I used both Google Scholar and the University of North Carolina at
Greensboro (UNCG) Library Databases. The key terms used for my research included: “health
disparities,” “race and health equity,” and “incidence and prevalence of racial health disparities.”
Some other key terms included: “education and American Indian Youth”, “health and
Appendix:
current program documents for further program insight. Current literature on the MedCat
program will prepare me to assist with program evaluation. As mentioned, I will be expected to
review MedCat’s participant applications; and program session templates for content. I am also
responsible for evaluating the program through data collection and analysis. I will assist in
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developing the MedCat and AIMs evaluation(s). Post-evaluations will grant access to participant
feedback of their program experiences and will be compared to student pre-evaluations. The
Institutional Review board for the Maya Angelou Center for Health Equity at Wake Forest
School of Medicine (WFSM) is the Clinical and Translational Science Institute (CTSI).
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https://news.aamc.org/diversity/article/native-american-health-disparities/