‘We don’t have a say’: Siobhan Wescott wants to elevate the voices of Native Americans in public health

As the first endowed professor and director of American Indian health at the University of Nebraska Medical Center’s College of Public Health, Siobhan Wescott wears many hats and, often, a pale yellow flower behind her ear.

She was raised by a single mother, herself an academic, in a small cabin in Fairbanks, Alaska. But throughout her career, Wescott has found herself navigating prestigious, predominantly white institutions far different from her rural upbringing. As an Alaskan Athabaskan, she has often been the only Native American or American Indian person in the room — though these labels, overly broad and imposed by the government, are misnomers she is trying to fix.

Wescott previously co-directed INMED, a University of North Dakota program that has trained more than 250 Native American physicians. She is still working to make sure Native American medical students are properly accounted for and given adequate funding and resources. On the national level, she is a frequent advocate for ground-up public health work that includes Native leaders and communities in collective decision-making. She helped create the American Medical Association’s Task Force on Health Equity to push forward such policy initiatives.

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Wescott is a physician, a professor, an advocate, a researcher, and a 2022 STATUS List honoree. STAT spoke to her recently via Zoom. This interview has been edited for clarity and brevity.

You’ve been through a lot of elite institutions and you’ve explained your skill at being sort of a chameleon in lots of different settings. After college, you briefly worked for a U.S. senator from South Dakota and as a fellow on the Senate Committee on Indian Affairs. Why was that a tough environment to stay in for long?

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I didn’t like what politics brought out in my personality. To succeed in politics, you really — not to sound harsh — but you can’t be true to one thing only. So if you have a cause, for instance, that’s not necessarily going to work for you as you try and make it as a congressional staffer, for instance. Now, sometimes it can be, if you have the right office that you’re working for, with an elected official who’s interested in that same topic. But if you’re championing a really underdog issue, it’s very tough. To survive politics and to get ahead, you have to bend, and in ways that I don’t like.

Your mother, Elizabeth, attended Harvard and Stanford, and she became one of the first Alaska Natives to earn a Ph.D. How did that upbringing, of watching her pursue her education, impact you and shape you?

It felt like it was attainable. There’s so many first-generation students who are like, “I’m trying to navigate this unknown system,” and that wasn’t the case for me. I feel like my mom made that possible for me. Especially for her, but even when it was my time to consider educational options, the system isn’t set up for minorities. … I went to a public high school in Fairbanks, Alaska, and I got into Dartmouth. That isn’t the normal way that one does that, but I just felt like I shouldn’t tamp down my expectations of where I might be able to go to school because that isn’t the normal.

What made you want to study government at Dartmouth?

Well, I’m just fascinated by collective decision-making and, certainly, the last couple of years have been a master class in how to do it wrong, just unfolding right before our very eyes. It’s the same with why I love public health, as opposed to practicing clinical medicine. With clinical medicine, you could have very sincere moments with your patients and it’s just the two of you, and that is incredibly powerful. Sometimes there’s nothing better. However, if you can change policy that is harming those patients and they don’t have to have the terrible moment that you comfort them in a one-on-one doctor’s visit, then that’s powerful too.

Is it difficult for you to merge multiple paths — your several identities, jobs, priorities — into one?

Absolutely. I’ve actually just been struggling with this recently, because if you look in the news, in South Dakota there was a Rapid City hotel owner who decided to ban all Native Americans because there had been an incident. And the response of the tribe was to hold a rally in their parking lot. And there’s an obscure piece of law — and we’ll see how it all plays out — that actually you cannot have white settlers if the tribes do not agree to them. You know, at what point do you continue to try and find common ground with people you disagree with and at what point do you protest? … If you never try to find common ground, then you’re just a zealot. But are there points when the other side is so far off that there’s no point in trying to find common ground? And I guess that’s where my experiences in D.C. really helped me, because you quickly figure out who’s saying something that they mean and it’s coming from a place of authenticity, and someone who’s saying something to advance a career or some sort of deal that is beneficial to them.

There is a lot of diversity within the Native American/American Indian populations, but there are also shared histories and cultural norms and context. How do you see that as an opening for your work?

One of the articles that I’m working on is a study of the terms that are used for our population in PubMed-listed articles. So are we American Indian, Alaska Native, Native American, Indigenous, Amerindians (that’s a term)? But what was most fascinating about it is we ran through all the analyses and there was something not sitting right, and then we realized, well, let’s count how many of the terms were imposed or have unclear meaning, and how many were clearly meaningful. Over 90% were imposed. Even the term, or the legal name of the Navajo Nation, the term “Navajo,” is Spanish, it’s not their term. So it shows, even in the simplest things — what do we call ourselves? — we don’t have a say in that. And the legal term used by the federal government in all reporting of data is American Indian, which is based on a 500-year-old mistake. So what I’d like to see is for Native leaders to get together and provide some guidance, perhaps new terms, and then for there to be legal changes in what the federal government uses.

When you received your Covid vaccine from an Indian Health Service clinic, you had the opportunity to “smudge,” which is a traditional Native cleansing ritual. How can we develop more culturally sensitive approaches to public health and medicine, taking into account how many people don’t consider science and spirituality or natural medicine to be at odds with one another?

So, let me give you my summary of med school: You never know when a baby’s going to be born … you never know when someone is going to die. There are a lot of mysteries in between. And I don’t think we have the answers. Now, I don’t think that we should abandon Western medicine. There’s some really profound advances, and with proper care, there’s a lot of things that can be treated and are not deadly, that have killed thousands of people over the ages, where there’s a simple intervention, whether antibiotics or even an appendectomy. What works for the patient? … There are a lot of people who really cling to Western medicine, who work in Western medicine and if you try and go outside of this, you’re “wrong.” Now, should everybody go out and do some sort of sweat lodge because they heard that that’s what Natives do and that seems to be healing? No. Nothing should be absolute. There’s lots of room for informed decisions and exploring what might be right, but I just think clearly Western medicine is not enough.

What else is piquing your curiosity right now?

The Department of Education has, just like the Census, for U.S. students, they’re asked their ethnicity and then they’re given six choices for race. And you can check as many boxes as you want, or as apply to you, but if you tick more than one box, none of your race data is reported. You’re only considered in racial data if you selected one race and that’s it. Everyone else is lost in a category called “two or more races” and there’s no further analysis. And that’s required, so I’d like to change it. For Native med students, there are 1,010 currently in med school. But only 177 of those report being only American Indian/Alaska Native. So 83% of them under these requirements are lost entirely, and that affects funding decisions to help support new students. That’s one of the things that I’m trying to change, and then there’s more broad things, where I’d really like to hear from communities what they want, and then to be able to match researchers with them. There’s a whole movement called community-based participatory research, where there’s a researcher who has an interest area, they approach communities and say, “Would you like to be involved?” so that they have community feedback even before they apply for funding, and not, like, a week or a couple days before it’s like, “Hey, can you send a letter of support?”

A lot of medicine is built on this foundation of a hierarchy, with the physician at the top and the patient at the bottom, which can feel very paternalistic. You’re trying to flip that paradigm, beginning with community and building up from there. How simple is that?

It’s very difficult. And I’m laughing because the question really reminds me, there was a time I took a motivational interviewing course for physicians. It’s not about you coming in and saying, “Well, here’s what I think your problems are, how we’re going to manage those.” It’s coming in and largely listening to the patient, however you’re also, essentially, putting a mirror up to them. So that’s, on a macro level, what I’m trying to do is include tribes, include Native leaders, include Native communities in decision-making.

You seem to always be wearing a flower behind your ear. Is it symbolic or just a decorative flourish?

My pandemic delusion is I’m actually in Hawaii. … Hawaii is such a tourist destination, it’s forcing out a lot of Native Hawaiians – they just can’t afford to live in their homeland. They don’t want tourists coming there, and so it’s even better in some ways that I’m wearing the flower but I’m not in Hawaii or planning to go to Hawaii. I am paying homage to the aloha spirits.