A photograph of Donald Warne, MD, MPH.

‘The Long Game’: Building a Strengths-Based Approach to Indigenous Health

Indigenous health scholar Donald Warne lifts up the next generation of researchers to deliver future solutions.

Interview by Brian W. Simpson • Photo by Nedahness Rose Greene

Historically, public health research in Indigenous communities has dwelled on the negatives—the disparities and deficits. Donald Warne, who became co-director of the Johns Hopkins Center for Indigenous Health last September, champions another way. “We also need to take a strengths-based approach to the data collection and identify what are the factors that are promoting health, not just what are the factors leading to disparities,” says Warne, MD, MPH, a member of the Oglala Lakota tribe from Pine Ridge, South Dakota. Warne notes, for example, that language preservation, cultural connectedness, and participation in ceremonies have all been linked to better health outcomes.

Reframing research is just one goal for Warne, who created the first Indigenous health-focused MPH and PhD programs in the U.S. or Canada. His other priorities include forging partnerships with Indigenous peoples around the world and building generations of Indigenous public health researchers.

How will you know you’ve had an impact at the Center?

I don’t see an endpoint. I’m just part of a thread linking previous generations and the challenges to future generations and the solutions. Those solutions aren’t going to come in my lifetime. I’m fully aware that this is an intergenerational approach. So my goal is to do as much as I can to build that foundation from which future generations will have better outcomes.

Being “a thread in the continuum” seems very different from what academics would traditionally say—in terms of “We’re gonna do this” and “We’re gonna set this up.”

Oh, yeah. The logic model is very linear with endpoints. But thinking of it more comprehensively, it feels like there’s a million days of work to do. And if I’m lucky, I’ve got maybe 6,000 left. That’s why education is so important. We need the next generation. We need to be to the point where it’s not unusual to have American Indian principal investigators. I’m 56 and relatively healthy—I’m fortunate. But this is a long game. There’s not any short-term solution. And yes, I think it’s very different than a typical academic or even Western type of approach.

What does it mean for the Center that you and co-director Melissa Walls are from Indigenous communities?

One of the factors that I think is not well appreciated is that in Indian Country and with other Indigenous populations, the messenger really matters. We need to have Indigenous people really leading the outreach and engagement with our communities. Historically, Indigenous peoples have been seen as community members but not as academics. That’s not the case. We can be in both of those arenas very effectively.

Is Indigenous health entering a new era of prominence in public health?

Yes, absolutely. We’re seeing the arena of Indigenous health being recognized and treated as an academic discipline. It’s wonderful to see. Historically, we just haven’t had enough Indigenous public health academics. So, I think the field of public health just didn’t know what it didn’t know. And quite honestly, not having an Indigenous voice at the decision-making table when curricula are developed, has been a shortcoming of public health education since its inception.

One of the factors that I think is not well appreciated is that in Indian Country and with other Indigenous populations, the messenger really matters.

The Center is now working more internationally. The $27.8 million grant from the LEGO Foundation is just one example. It must be a challenge to work across so many different cultures.

Mostly, it’s a lot of good cooperation and excitement among Indigenous leaders worldwide. The one area where we find some challenge is with terminology. Some nations, some cultures find the word “native” acceptable, and some find it offensive. Some even don’t like the word “Indigenous.” What I find really ironic is that, as Indigenous peoples, we’re having challenges identifying the right English word.

How does historical trauma affect health, and what are the best ways to address it?

Trauma has an impact on everything that we deal with. If we’re not addressing trauma, we’re not addressing the root cause. And if we’re not addressing the root cause, we’re wasting our time. So trauma has to be at the core of what we’re doing.

One of the things we’ve been looking at is the need for an Indigenous school of healing arts and sciences that has a more trauma-informed and culturally relevant approach to higher education. I think we can do a lot of that type of work through places like Johns Hopkins. But I think there’s room for being even more creative and developing the educational systems, workforce development approaches that are much more culturally relevant.

Tell us about your path to medicine and public health.

My uncles are traditional healers and medicine men. So, my first exposure to medicine was traditional Lakota medicine. When I was in medical school, I was meeting with one of my uncles, and he asked what they were teaching us and said, “So if you have a patient with diabetes, what do they tell you to do?” I had just learned our interview process. It’s very linear: the chief complaint, history of present illness, past medical history, etc. I memorized the steps and was proud of myself, but my uncle said, “No, no, that’s all wrong. The most important thing you can ask a patient who has diabetes is, ‘Do you believe you can manage this?’” That was brilliant because if a patient believes they can manage it, they’re at a completely different starting point than if they believe they cannot. (We take this one-size-fits-all approach in medicine, which is ineffective.) That wasn’t from Stanford Medical School. That was from my uncle Rick Two Dogs in Porcupine, South Dakota. That changed my whole approach to how I work with patients.

What’s another of your important career lessons learned?

Anytime you do something new, there’s always pushback. Systems don’t like change. The lesson learned is you have to have the right platform to do this work because it is innovative, it is new. And you have to be surrounded by people who are excited about innovation.