Sanford doctor focuses on American Indian health

By Patrick Springer
Fargo, North Dakota (AP) November 2010

Dr. Donald Warne, who heads a new Sanford Health initiative to improve the health of American Indians, began his medical career as a primary care physician.

But the native of South Dakota’s Pine Ridge Indian Reservation became convinced that prevention and better public health provide the keys to improving the health of American Indians.

As director of the Sanford Office of Native American Health, Warne is focusing on addressing the many long-standing health disparities between American Indians and the general population.

“There’s a lot of work to be done,” he said.

The effort already has been given a boost through a $7 million federal grant to help establish a National Center for Minority Health Disparities Exploratory Center of Excellence.

To cite a few examples of the disparities: Native Americans are almost three times as likely to die of diabetes as the general population, more than six times as likely to suffer alcohol-induced death, and almost twice as likely to commit suicide, according to the Indian Health Service.

Underlying those stubborn problems: high rates of poverty throughout Indian country and what tribes have complained is chronic underfunding of the Indian Health Service.

Colon cancer afflicts Native Americans at high rates, yet the financially strapped Indian Health Service isn’t equipped to perform colonoscopy screens, a mainstay of prevention, or pay for the procedure at private clinics, Warne said.

“So the result is we can’t screen for a screenable cancer,” he said.

His strategy calls for working on four fronts: better clinical care, research, education and policy development.

To do that, the Sanford program will work collaboratively with partners, including the medical schools in South Dakota and North Dakota, and the Indian Health Service, where Warne has served as an adviser.

“It’s a unique public-private partnership,” Warne said. “This type of partnership doesn’t exist anywhere else in the country.”

The Aberdeen (S.D.) Area Indian Health Service, with a service that largely overlaps the Sanford Health service area, welcomes the new initiative.

“The Indian Health Service looks forward to the potential of creating meaningful partnerships with Sanford Health that increase access to affordable health care options,” said Constance James, public affairs liaison for the IHS.

Jacqueline Gray, an assistant professor at the University of North Dakota Center for Rural Health in Grand Forks, said Warne, who has a medical degree from Stanford and master’s of public health from Harvard, has an impressive vision of what can be done.

“He’s a big thinker,” she said. “He’s got lots of good and innovative ideas.”

There’s talk, for instance, of having universities and colleges along the Interstate 29 corridor from Grand Forks to Omaha, Neb., meet collectively to recruit American Indian students to health fields.

The sprawling service area of Sanford Health based in Fargo and Sioux Falls, S.D. covers parts of five states and includes 28 tribes and an estimated 250,000 American Indians.

Among its priorities, Warne’s new center will work to recruit more American Indian students to pursue careers as health researchers and professionals, increase public awareness of the health disparities, and promote more tribally driven medical research.

Since launching the initiative in August, Warne has identified 40 projects to pursue.

One of those topping the list is a proposal for grant funding to study cancer outcomes based on the patient’s funding source: private health insurance versus Indian Health Service, for example.

Warne believes that by preventing disease or treating it adequately, public and private health payers would be saving money in the long run as well as saving lives and preventing suffering.

“My educated guess is we would save a huge amount of money over time,” he said, especially if lost productivity is counted.

Preventing or treating diabetes, for example, can prevent kidney failure, sparing the time and expense of dialysis.

“If we invest in better medicine now,” he said, “we’ll save lives.”