Massive hurricanes, including Katrina and Ida, have raked the area. Relief efforts struggled to meet the devastation caused in 2005 by Hurricane Katrina, which killed more than 1,800 people along the Gulf Coast, swept away coastal land, and caused more than $100 billion in damage. The island’s only road to the mainland is often impassable because of strong winds and rising water. Encroaching water has made growing food difficult.

Now, just a small number of citizens live on Isle de Jean Charles, Dardar said. “We’re losing land here in Louisiana — used to say a football field every 90 minutes,” said Dardar, a former chief of the United Houma Nation, which has about 17,000 members. “Now it’s quicker than that.”

In 2016, Louisiana’s state government received a federal grant to help resettle island residents, among them the Houma. Some people do not want to move. For many others, moving is a hardship.

Displaced by the loss of land, infrastructure, and cultural heritage along Louisiana’s southern coast, members of the United Houma Nation are among those in the region most vulnerable to climate change and its repercussions on health. Health advocates fear the consequences could be worse for Indigenous people, who experience higher rates of diabetes, heart disease, and certain other health problems than white people.

The Houma Nation is not recognized by the federal government as a tribe, but a 2015 change to federal standards could ease barriers to federal status for the tribe, more than 35 years after its initial application.

That recognition would allow the Houma to work directly with the federal government rather than through intermediaries to secure resources, said Lanor Curole, a member of the Houma Nation who oversees its day-to-day operations. Direct communication with federal officials during an emergency can save precious time in delivering critical relief to communities like the Houma, she said.

“Our people are on that front line, but we don’t have a seat at that table,” she said.

In 2010, when the Deepwater Horizon oil spill released at least 4 million barrels of oil into the Gulf of Mexico, the incident wreaked havoc on the Houma people. It polluted the region, destroyed ecosystems, threatened commercial fishing, and exposed people to toxic substances known to cause cancer. But after that environmental disaster, BP, the company using the drilling rig, wasn’t required to pay damages directly to the Houma because the tribe isn’t one of the 574 recognized by the federal government.

For federal recognition, tribes must prove they meet several criteria, including that their members descend from a historical tribe and that they are a distinct community. Dan Lewerenz, a law professor at the University of North Dakota, said the lack of federal recognition means the government does not see the Houma as a self-governing sovereign entity.

Houma leaders said the community’s status has become a barrier to getting support to tackle climate emergencies. Meanwhile, the Chitimacha, a federally recognized tribe in the region, partnered with the federal government in 2016 to develop an adaptation plan to address climate pressures.

Serious health concerns associated with climate change include water-borne infections like E. coli and diseases transmitted by mosquitoes like dengue and West Nile virus, problems that plague communities inundated with water.

The Houma are not eligible for care through the Indian Health Service, winnowing the already slim options in the region. According to a 2010 community needs assessment conducted by the tribe, more than half of Houma members have cardiovascular disease.

Health researchers and social scientists link the health inequities among Indigenous peoples to intergenerational traumas, with younger generations exhibiting poor health outcomes connected to their ancestors’ experiences. The historical traumas experienced by Native people in the U.S. include genocide and displacement.

In the vulnerable communities along the coast, people often don’t have the extra cash needed to rebuild after a storm, putting them at risk of losing their homes. The cost of repairing infrastructure can be astronomical, forcing some people to move elsewhere and leaving already resource-poor communities further choked off from necessities like schools and doctors.

“There are very few grocery stores on the bayous,” said Shanondora Billiot, who studies the effects of environmental changes on the health of Indigenous people in Louisiana. “Many people have to drive 30 to 45 minutes to get to the closest grocery store with fresh fruit, fresh vegetables because many people can no longer grow those vegetables on their soil.”

Billiot’s research on the Houma Nation found that repeated exposure to environmental disasters has taken a toll on people’s mental health, and she noticed a “sadness” among some members that she compared to symptoms of post-traumatic stress disorder. “Climate change interrupts the expression of culture and the protective factors that culture and identity have on health,” Billiot said.

Jobs are scarce, and the cost of flood insurance — a requirement in coastal areas — is so high that some people can no longer afford their homes. Pricey flood insurance premiums helped push Curole from her home in Golden Meadow, Louisiana. “I was going to spend just as much per month in insurance than I was going to spend in a house note,” she said. “And I couldn’t afford that.”

In August 2021, Hurricane Ida, a Category 4 hurricane with 150 mph winds, made landfall just 20 miles south of Golden Meadow. Almost 16 years to the day after Hurricane Katrina, Ida caused tremendous damage, overwhelming preparations and relief efforts.

For coastal residents like the Houma, every year could bring the next big storm, and with the acceleration of climate change, it is increasingly likely that it will. Hurricane season typically peaks in September and October, according to the National Oceanic and Atmospheric Administration.

“They roll up their sleeves and build, rebuild, and help their neighbors, and start over essentially,” said Billiot. “And they’re deemed resilient for it. However, citizens have talked about, ‘I don’t want to have to be resilient.’”

This article includes reporting from Taylor Cook, Zach Dyer, and Dr. Céline Gounder that first aired in the “Climate Displacement, Cultural Resilience” episode of the “American Diagnosis” podcast.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Episode 12: Indigenous and Invisible in the Big City

[Note: This is the final episode of the “Rezilience” season of the “American Diagnosis” podcast. In her recap essay for Time magazine, host Dr. Céline Gounder charts some of the forces that drive excess deaths and illnesses among Native people in the U.S.]

Over 70% of Indigenous people in the United States live in urban areas. But urban Indian health makes up less than 2% of the Indian Health Service’s annual budget.

While enrolled members of federally recognized tribes can access the Indian Health Service or tribally run health care on their reservations, Indigenous people who live in cities can find themselves without access to the care they’re entitled to.

“Even though we’re living in urban areas now, that doesn’t mean that our benefits should leave us,” said Esther Lucero, president and CEO of the Seattle Indian Health Board.

The Seattle Indian Health Board is one of many urban clinics across the United States that opened to address the discrimination and lack of services Indigenous people face in cities. These clinics work to meet the cultural and ceremonial needs of the populations they serve.

“We are much more than a community health center or place that provides direct service. We are a home away from home,” Lucero said.

Episode 12 explores the barriers Indigenous people face to accessing quality health care in cities and the efforts of urban Indian clinics to meet the needs of this population.

Voices from the episode:

• Esther Lucero, president and CEO of the Seattle Indian Health Board
• Dr. Patrick Rock, CEO of the Indian Health Board of Minneapolis
• Douglas Miller, an associate professor of Native American History at Oklahoma State University
• Richard Wright, a spiritual health adviser with the Indian Health Board of Minneapolis

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

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Episode 11: “Climate Displacement, Cultural Resilience”

Lanor Curole is a member of the United Houma Nation. She grew up in Golden Meadow, a small bayou town in Southern Louisiana. The impacts of repetitive flooding in the area forced her to move farther north.

Louisiana’s coastal wetlands lose about 16 square miles of land each year. This land loss, pollution from the 2010 BP oil spill, and lingering devastation from Hurricanes Katrina and Ida are pushing many Houma people out of their homes.

Since 1985, the United Houma Nation has been seeking federal tribal recognition status. Without this status, the tribe has fewer resources to respond to the climate crisis.

“Our people are on that front line, but we don’t have a seat at that table,” Curole said.

Gaining federal recognition would grant the Houma access to the Indian Health Service and would allow the tribe to work directly with federal agencies like the Federal Emergency Management Agency when storms strike.

“It’s not like Willy Wonka’s ‘golden ticket’ … but I think it does open some additional doors that are definitely closed to us right now,” Curole said.

Episode 11 explores the Houma people’s efforts to preserve culture in the face of the climate crisis.

Voices from the episode:

• Lanor Curole, Houma tribal administrator

• Thomas Dardar Jr., former chief of the United Houma Nation

• Shanondora Billiot, assistant professor of social work at Arizona State University

• Daniel Lewerenz, assistant professor at the University of North Dakota School of Law

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

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Click here for a transcript of the episode.

Episode 10: “Stewardship Over Biodata Rebuilds Trust”

Mending broken trust may be a first step for investigators who want to increase the participation of Native people in medical research. 

“There’s such a history of extractive research in Indigenous communities, such that ‘research’ and ‘science’ are sometimes dirty words,” said Navajo geneticist and bioethicist Krystal Tsosie.

Poor communication and a lack of transparency are among the missteps that have eroded the trust Indigenous communities have in medical research. And that mistrust has contributed to the underrepresentation of Native people in clinical trials. 

In 2018, Tsosie co-founded the Native BioData Consortium, a research institute led by Indigenous scientists. The consortium is working to improve health equity by actively engaging community members in the research process. When the group collects biological samples from Native tribes, they are stored on sovereign Native American land and made accessible only to researchers who are prioritizing Indigenous health needs.

“The benefits are directly rolled back into the people and their communities without a profit to outside entities,” Tsosie said.

Episode 10 explores the history of exploitation of Indigenous communities by outside researchers and some of the health consequences of being left out of medical trials.

Voices from the episode:

• Dr. Dakotah Lane, executive medical director of the Lummi Tribal Health Clinic
• Krystal Tsosie, co-founder and ethics and policy director for the Native BioData Consortium — @kstsosie

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

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Episode 9: “Two Paths, Two Future Physicians”

In 1890, Dr. Charles Eastman became one of the first Native people to graduate from medical school in the United States. Today, one of his descendants, Victor Lopez-Carmen, is a third-year student at Harvard Medical School. He described feeling isolated there.

“I did feel alone. There wasn’t any Native person around me I could turn to,” said Lopez-Carmen.

Less than 1% of medical students in the United States identify as American Indian or Alaska Native. That’s according to a 2018 report from the Association of American Medical Colleges and the Association of American Indian Physicians.

Lopez-Carmen is working to change that. In 2021, he co-founded the Ohiyesa Premedical Program, which provides mentorship and support to Native American students as they navigate the medical school application process.

While Lopez-Carmen is mentoring future medical students in Boston, in Oklahoma, Ashton Glover Gatewood has found community at the first medical school in the United States affiliated with a Native tribe. Gatewood attends Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation.

“I told my husband about it, and he said, ‘That sounds like they’re building you a medical school. You have to go,’” Gatewood said.

She’s noticed a “momentum” in medical training that she said could one day lessen the health care disparities Indigenous people experience.

Episode 9 explores the barriers Indigenous people face to becoming physicians and includes the stories of two medical students working to join the ranks of Indigenous health care workers in the U.S.

Voices from the episode:

• Victor Lopez-Carmen, student at Harvard Medical School — @vlocarmen

• Mary Owen, director, Center of American Indian and Minority Health at the University of Minnesota, and president, Association of American Indian Physicians

• Ashton Glover Gatewood, student at Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation — @AshtonGatewoo10

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Episode 8: “Tribal Values, Tribal Justice”

Abby Abinanti is chief judge of the Yurok Tribal Court and a member of the tribe. 

While previously working in the California court system, she was discouraged and angered by the number of cases in which Indigenous families were separated or tribal members were removed from their communities because of nontribal foster care placements or incarceration. The Prison Policy Initiative, a research and advocacy organization, found that Native people are overrepresented in jails in the United States.

Abinanti said the Yurok Tribal Court is helping to address these disparities. The court is one of roughly 400 operated by federally recognized tribes in the United States. These courts reflect the values of their communities, and Abinanti said for the Yurok that means prioritizing restoration over punishment.

“I don’t think any human being is disposable,” she said. “Our system is designed to help you return to the community and be an asset in the community.” 

Episode 8 explores the intergenerational impact of historical traumas on the Yurok people and a local tribal court’s work to meet community needs.

Voices from the episode:

• Abby Abinanti, chief judge, Yurok Tribal Court
• Ursula Running Bear, assistant professor of public health at the University of North Dakota
• Blythe George, assistant professor of sociology at the University of California-Merced

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Episode 7: Fighting for Reproductive Sovereignty

Rachael Lorenzo works to address reproductive health disparities in Native communities. In 2018, they founded Indigenous Women Rising, a fund that provides financial help for Native people seeking an abortion.

Historically, the federal government has restricted Native people’s reproductive autonomy. Between 1973 and 1976, more than 3,500 Native people were sterilized without their consent.

Today, the chronic underfunding of the Indian Health Service and the remoteness of many reservations create barriers for Native people to access testing for sexually transmitted infections, prenatal care, and contraception.

Lorenzo is determined to fight for their community.

“My people deserve accessible health care, and I will make it happen no matter what, because this is our land,” they said.

Episode 7 explores efforts to protect and expand access to comprehensive reproductive and sexual health care in the face of historical and contemporary efforts of the government to control Native people’s fertility.

Voices from the episode:

• Rachael Lorenzo, co-founder of Indigenous Women Rising — @rlorenxo; @IWRising; @IndigenousWomenRising
• Sarah Deer, distinguished professor at the University of Kansas — @SarahDeer72
• Sunny Clifford, reproductive rights advocate
• Elizabeth Rink, professor of community health at Montana State University

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Episode 6: Right to Water

In 2020, during the first wave of the coronavirus pandemic, Zoel Zohnnie was feeling restless. Growing up on the Navajo Nation, he said, the importance of caring for family and community was instilled at an early age. So Zohnnie wanted to find a way to help members of his tribe. One need in particular stood out: water.

American Indian and Alaska Native households are 3.7 times as likely to lack complete plumbing as households whose members do not identify as Indigenous or Black, according to a 2019 mapping report on plumbing poverty in the United States. 

“Climate change and excessive water use is exacerbating these struggles,” explained George McGraw, CEO of DigDeep. “Much of the western United States has been in severe drought for years. Many rivers and wells on or near the Navajo land have dried up. As groundwater recedes, people are forced to seek water from unsafe sources.”

To answer that need, Zohnnie began hauling water to people who were without, and he founded Water Warriors United. In this episode, listeners come along for the ride as he ― and his truck ― make one herculean trek across snow-covered roads in New Mexico.  

Episode 6 is an exploration of the root causes behind the Navajo Nation’s water accessibility challenges and a story about the water rights that some communities have effectively lost.

Voices from the episode:

• Dr. Ernestine Chaco, emergency medicine physician and lawyer — Twitter
• Brianna Johnson, community health representative with the Naschitti Chapter, Navajo Nation
• George McGraw, CEO of DigDeep — LinkedIn, Instagram, Twitter
• Jeanette Wolfley, assistant professor of law at the University of New Mexico — LinkedIn
• Zoel Zohnnie, founder of Collective Medicine and actor — TikTok

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Editor’s note: This episode includes descriptions of violence that some might find disturbing. Intimate partner violence, also known as domestic violence, can take the form of physical, sexual, or psychological abuse. If you or someone you know is experiencing intimate partner violence, help is available. 

StrongHearts Native Helpline provides culturally appropriate support and advocacy for Indigenous women. Call 1-844-7-NATIVE or text the corresponding number: 1-844-762-8483.

National Domestic Violence Hotline: 1-800-799-7233.

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Episode 5: Power to Police Perpetrators

Mary Kathryn Nagle is a citizen of the Cherokee Nation, an attorney, a playwright ― and an advocate working to increase protections for Native women in the U.S. justice system. 

Not long after the Violence Against Women Act, or VAWA, was reauthorized in 2013, she sat with fellow activist Lisa Brunner to talk about a new play Nagle was working on in response to the ruling. 

Brunner said she told the playwright that VAWA is just a “sliver of a full moon” of the protection Native women need.

The metaphor resonated with Nagle, and “Sliver of a Full Moon” would become the title of her play. It shares the stories of Native survivors of domestic abuse, and exposes the gaps in the justice system that often let non-Native perpetrators commit crimes without consequence. Critics say that over decades those gaps became an opportunity for abusers to flourish on Native land.

“Just imagine your own community,” said attorney Alfred Urbina, “where certain people weren’t prosecuted or arrested for crimes. If you lived in an area where certain people didn’t have to abide by the law, what does that do to a community?”

Urbina is the attorney general for the Pascua Yaqui Tribe in southwestern Arizona, one of the first tribes to begin prosecuting non-Native offenders under the VAWA 2013 rules. 

Among Native survivors of violence, more than 90% reported they had experienced violence from a perpetrator who was non-Native, according to a survey funded by the U.S. Department of Justice. 

The Violence Against Women Act was reauthorized on March 10, 2022, reaffirming tribes’ authority to prosecute non-Native perpetrators of sexual violence and certain other crimes. It expands prosecution power for tribal nations in Maine and Alaska and offers funding to support law enforcement implementation of VAWA. 

“It’s not the totality of everything that we need. Right?” said Brunner. “But, you know, the full moon is bright. And we’re just starting with the moon. I’m after the universe.”

Voices from the episode:

• Lisa Brunner, founding member of the Violence Against Women Task Force, adjunct professor at the White Earth Tribal & Community College — LinkedIn
• Mary Kathryn Nagle, playwright, partner at Pipestem Law, specializing in tribal sovereignty of Native nations and peoples, executive director of the Yale Indigenous Performing Arts Program — Twitter, Instagram
• Alfred Urbina, attorney general for the Pascua Yaqui Tribe, Arizona — Twitter

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard. Special thanks to Gina Lopez.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Episode 4: Abandoned Mines, Abandoned Health – Part II

People living on and near the Navajo Nation have been grappling with the legacy of 40-plus years of uranium mining. According to Environmental Protection Agency cleanup reports and congressional hearings, mines were abandoned, radioactive waste was left out in the open, and groundwater was contaminated.

This episode is the second half of a two-part series about uranium mining on the Navajo Nation. Part I discusses the history and economic forces that brought mining projects to Indigenous land. It also explores working conditions uranium miners faced, and the response of the federal government when workers exposed to harmful radiation spoke out.

Abandoned Mines, Abandoned Health – Part II continues the conversation with former uranium miners. It explores what a coalition of Indigenous leaders and non-Native locals are doing to force the cleanup of hazardous uranium mining sites and seek expanded recognition by the Radiation Exposure Compensation Act, which provides remuneration to former uranium workers harmed by radiation exposure.

The push for attention and recognition from Congress was difficult. Along the way, former workers and local residents formed advocacy groups focused on documenting worker health.

Former mine worker Phil Harrison was among those who went to Washington, D.C., to push for a cleanup plan.

“Seven of us testified,” Harrison recalled, “and, based on that, they gave a directive to federal agencies who said, ‘OK, EPA, BIA [Bureau of Indian Affairs], Nuclear Regulatory Commission. This is what we’re going to do.’”

Citizens have also served as volunteers helping to shape environmental research on the lasting effects of uranium mining on the land.

Today, Indigenous groups say they continue to uncover pollution from the 1979 tailings pond spill near Church Rock, New Mexico. RECA is set to expire in July of this year unless Congress acts. Meanwhile, future uranium mining projects loom as a possibility.

Voices from the episode:

• Linda Evers, president of Post 71 Uranium Workers Committee and former uranium mine worker
• Phil Harrison, president of the Navajo Uranium Radiation Victims Committee and former uranium mine worker
• Larry King, activist and former uranium mine worker
• Judy Pasternak, journalist and author of “Yellow Dirt: An American Story of a Poisoned Land and a People Betrayed”
• Ben Ray Luján, Democratic U.S. senator from New Mexico

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-Begaye, Alastair Bitsóí, and Bryan Pollard.

To hear all KHN podcasts, click here.

Listen and follow “American Diagnosis” on Apple Podcasts, Spotify, Google, or Stitcher.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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