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From patient to public health leader

Spring/Summer 2010 ]

Indian Health Services Director Yvette Roubideaux is on a quest to improve American Indian health.

As a child in Rapid City, South Dakota, Yvette Roubideaux, MD, MPH’97, used to fill her bag with books whenever she went to the doctor. Visits to the Indian health clinic in her hometown—Roubideaux is a member of the Rosebud Sioux tribe—typically involved a four- to six-hour wait because of staffing shortages. She never knew which physician she would see. Her relatives complained about poor care.

Later, in high school, when Roubideaux began considering career options, “I realized that I had never seen an American Indian physician; I wasn’t even aware there were American Indian physicians,” she recalls. “I started thinking, ‘Maybe one of the solutions to the problems in Indian health is to get more American Indian doctors who understand what needs to change, and who might stay longer because they’re from the community.’ ”

Nurturing Public Health Leadership

Many of the health concerns facing American Indians and Alaska Natives are shared by other medically underserved populations in the United States, underscoring the need for common solutions. That big-picture approach resonated with Yvette Roubideaux during the one-year Commonwealth Fund/Harvard University Fellowship in Minority Health Policy she completed at HSPH in 1997.

Incorporating skills from public health, government, business, and medicine, the fellowship aims to prepare physicians for leadership roles in public health policy and practice—especially to benefit vulnerable groups. The program also offers a masters in public administration (MPA) through the Harvard Kennedy School.

Now a mentor with the fellowship, Roubideaux says that returning to campus to speak with students and faculty “reminds me of the obligation for leadership that comes with having such an incredible education. Much is expected if you were selected to be at Harvard, because someone thought you could be a leader in your career.”

“From Patient to Public Health Leader” article pdf

Personal Insight, Pressing Needs

So began Roubideaux’s quest to improve health care for American Indian and Alaska Native people—one that took her to Harvard for three degrees and inspired her to become a physician, teacher, researcher, and advocate for culturally sensitive care. Now, as director of the Indian Health Service (IHS), she leads a federal agency that serves nearly two million native people belonging to 564 tribes in 35 states.

Roubideaux, the first American Indian woman to head the IHS (part of the U.S. Department of Health and Human Services), has a daunting task in light of limited resources, clinician shortages, and deep health disparities faced by this population, including higher rates than other U.S. groups of diabetes, heart disease, stroke, dental disease, AIDS, infant death, and suicide.

Since taking office in May 2009, Roubideaux has drawn on her personal experience and grasp of the political, social, and historical factors affecting American Indian health and vulnerable populations in general, some of it honed while at Harvard.

After graduating from the College in 1985 and HMS in 1989, Roubideaux completed her residency at Brigham and Women’s Hospital in Boston. She then joined the Indian Health Service in Arizona as a clinician and administrator, spending three years on the San Carlos Apache Indian reservation and one year on the Gila River Indian reservation.

During that time, Roubideaux witnessed the power of culturally appropriate care. At San Carlos, “I wasn’t Apache, so there was no guarantee I would be accepted in the community,” she explains. “But I remember many patients saying, ‘I’m so glad you’re here. It’s good to see an Indian doctor. I feel like I can be honest with you, and I know you know what we’re going through.’ ”

On the other hand, Roubideaux also observed obstacles to wellness—whether poverty, isolation, loss of traditions, or poor housing. For example, a stray menacing dog or lack of sidewalks might discourage residents on a reservation from walking, placing them at higher risk for obesity. “It’s not that American Indian and Alaska Native people don’t like to exercise,” she says. “There are factors that pose barriers.”

Frustrated by limited resources and staff, Roubideaux revisited her original goal of improving the quality of health care for native people: “I wondered if there was a different role I needed to play. I looked around and noticed that the people doing interesting things had MPH after their names.”

From Academia to Administration

Roubideaux pursued those credentials at HSPH through the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. Convinced that more data were needed to solve lingering health problems, she spent 11 years in academia, most recently at the University of Arizona College of Medicine; her teaching and research focused on diabetes prevention and Indian health policy.

Tapped by the Obama Administration to be IHS director, Roubideaux has set goals of securing more resources, enhancing internal operations, and strengthening the agency’s partnership with tribes, who manage about half the $4 billion IHS budget.

If she could eliminate one vexing public health concern among American Indians, it would be obesity, a condition associated with heart disease, diabetes, cancer, and mental health issues. “If we could reduce the obesity problem, that would make a huge dent in health disparities,” Roubideaux says. “But we can’t do it alone. We need to partner with our communities.”

Debra Ruder is a Boston-based freelance writer and editor specializing in health care and education.

Photo by Kent Dayton