Bridging the Gap: Urban Indian Health Equity and Leadership with Nanette Starr

Welcome back to Impact Unfiltered! In this episode, host Philippe is joined by Nanette Starr, MPH, Director of Policy and Planning for the California Consortium of Urban Indian Health. Nanette shares her personal journey from tribal epidemiology to advocating for Native health in California’s urban centers. You’ll hear about the origins and importance of urban Indian health organizations, the innovative ways they serve their communities, and the unique challenges Native people face in accessing care. Nanette also offers insights on leadership, cultural healing, and making a real impact. This is an inspiring, honest conversation you won’t want to miss.1. Introduction to the Episode and GuestNanette Starr’s background: Choctaw nation, career in tribal and urban Indian healthOverview of work experience:California Consortium of Urban Indian Health (CCUIH)Tribal epidemiology centers in California, Portland, and AlaskaRole during COVID under Governor Newsom and rural county public health2. Urban Indian Health Centers vs. Tribal Health FacilitiesStructure of the Indian healthcare system (three prongs):Indian Health Service (IHS)Tribal health programsUrban Indian Organizations (UIOs)Historical context:Federal Indian Relocation Act and its aftermathCreation of urban Indian communities and organizationsGrowth and function of UIOs:Resource and referral originsInter-tribal make-up and community focusNumber and type of organizations in California (10 UIOs)Range of healthcare services (outpatient, inpatient, dental, screenings, etc.)Community activities and ceremonies (e.g., healing for veterans)3. The Concept of “Impact”Nanette’s perspective on “impact” in her roleThe importance of enabling service access rather than self-attributionThe need for visibility and acknowledgment of urban Native communitiesDispelling myths about Native healthcare and demographicsImportance of community presence in urban areas4. Examples of Consortium Impact and AdvocacyOrganizational structure and leadership at CCUIHCase study: Advocacy to save the Indian Health Program in California budget cutsCollaboration with tribal and urban leadersImportance of education and communication with policy makersBroader themes of health equity, trust responsibility, and ongoing presence5. Team Alignment and Community OutreachStrategies for staying connected to member needs:Social media (Instagram, Facebook)Community presence and listening (showing up in spaces)Regular communication with member organizations (calls, texts, ad hoc meetings)Importance of direct feedback from UIO leaders and CEOsExample of rapid response:Social media campaign regarding potential Medi-Cal cuts and misinformationCoordinated efforts to clarify timelines and eligibility6. Innovative Tools, Partnerships, and Expanding AccessSpecific innovations by member organizations:Mobile mammography van in Santa BarbaraTelehealth as a strategy for broader access, especially for vulnerable populationsThe “Redline” resource hotline for assistance and supportCollaborations and partnerships:Involvement in numerous steering committees focused on health equityResource sharing through California Primary Care Association7. Leadership and Legacy: Advice for Emerging LeadersProfessional advice to younger self and new leaders:Recognizing that systems may not change overnight; working within and understanding existing frameworksBalancing passion with practical, informed approaches8. Evolving Perspectives on LeadershipInfluence of Nanette’s mentor and boss, Virginia HedrickLeading with humility and community groundingImportance of advocacy, listening, and making inclusive, nonpartisan decisions9. Getting Involved, Resources, and Upcoming InitiativesEncouragement for community feedback and involvementAnnouncement of recent and future initiatives:Native-led messaging workshop and workbook release for community advocacy