Warne, MD, MPH, is the chair of the Department of Public
Health at North Dakota State University and an adjunct
clinical professor at the Arizona State University Sandra
Day O'Connor College of Law, where he taught American
Indian Health Policy. In addition, he serves as the
Senior Policy Advisor to the Great Plains Tribal
Chairmen's Health Board.
Dr. Warne, a member of the Oglala Lakota tribe from Pine
Ridge, SD, received his MD from Stanford University and
his MPH from Harvard University. Dr. Warne is a Certified
Diabetes Educator and a Diplomate of both the
American Board of Family Practice and the American Board
of Medical Acupuncture. He completed Fellowships in
Minority Health Policy at Harvard Medical School and in
Alternative Medicine from the Arizona Center for Health
and Medicine. His work experience includes working as a
primary care and integrative medicine physician and as a
Staff Clinician with the National Institutes of Health in
Phoenix. He serves as a member of several national
committees and boards including the March of Dimes, the
CDC Health Disparities Subcommittee, and the National
Advisory Committee for Rural Health and Human Services.
We recently discussed health disparities among American
Indians and his transition from medicine to public health
How did you get from an Indian reservation in
South Dakota to Arizona State University, where you
received your undergraduate degree in science?
I am originally from Kyle, SD, on the Pine Ridge Indian
reservation. When I was in grade school there was,
unfortunately, violence at Pine Ridge. It was the early
1970s – the Wounded Knee occupation. President
Nixon sent the National Guard and tanks. It was an unsafe
community to be in at that time. My parents decided they
wanted to find a safer place to raise their family. We
moved to Arizona. My dad had relatives there.
I grew up in the shadow of ASU. My dad went there, and my
mom got her bachelor's and master's in nursing there. I
grew up with the expectation that I would go to ASU too.
It was a bigger achievement for my mom – she
was the first person in her family to go to college. I
was fortunate to grow up in a family that had experience
attending college and that it was an expectation for my
brother and me.
What drew you to science and medicine?
I was spending the summers back in Pine Ridge with my
uncles who were traditional healers and medicine men. I
was given my grandfather's Lakota name then:
“Pejuta Wicasa,” which means
“Medicine Man.” So I was learning a
lot about traditional arts and sciences related to
healing. It was an apprenticeship without knowing it was
an apprenticeship. I was interested in traditional
medicine and my mom was a nurse. It exposed me to
different perspectives on healing arts and sciences.
What made you want to pursue an MPH after
completing your MD?
I was tired of treating preventable issues and felt like
I didn't have the tools in the clinic to focus on
prevention. That's why I decided to focus more on public
I went into medicine a little naively, thinking I could
have a big impact on American Indian (AI) health as a
primary care doctor. What I learned very quickly is that
I could have an impact one patient at a time, but the
issues related to health challenges and health
disparities occurred long before people got to the clinic
or hospital. So working upstream is also focusing on
primary prevention. The vast majority of AI health
disparities are preventable. We don't put enough effort
into community-based health promotion and disease
prevention programs. We put most of our resources into
managing issues once they become a crisis. I was tired of
treating preventable issues and felt like I didn't have
the tools in the clinic to focus on prevention. That's
why I decided to focus more on public health.
The word “diabetes” appears
more than 55 times on your CV. Why is the study of
diabetes so important to you?
It is preventable. We didn't have a problem with diabetes
until tremendous changes in lifestyle – when rivers were
dammed, wild game and herds were taken away, land was
seized by non-Indian people, and traditional farming went
away. Then the lifestyle changed
dramatically – from a healthy, organic paleo
diet to one dependent on government commodity foods.
Through the USDA there is a commodity food program that
historically was horrible food – bleached
flour, white sugar, white bread, canned meat, and pure
corn syrup. The origin of fry bread is not traditional AI
food — it's people doing the best they can with
their commodities. We call it “traditional USDA
I don't look at diabetes as a medical issue but as a
social justice issue. It's a physical manifestation of
colonization. We've had dispossession of resources, so
it's one of the outcomes. It is preventable, but it
requires systemic approaches, including things like food
sovereignty and policy.
What health disparities affect rural AI
populations? And what are some of their main
When our children grow up in adverse conditions and with
higher rates of poverty and instability in their homes
and communities, they are at higher risk for all kinds of
negative health outcomes.
In the Northern Plains, we have a higher prevalence of
diabetes, heart disease, and cancer. We also have a
higher prevalence of mental health conditions, including
PTSD, depression, addiction, and suicide. The root of
those, I believe, is unresolved trauma. We have a lot of
historical trauma. If you look at the field of
epigenetics, you see that when populations are under
tremendous stress, it can have a negative impact on their
DNA and it can be passed from one generation to the next.
But also, when our children grow up in adverse conditions
and with higher rates of poverty and instability in their
homes and communities, they are at higher risk for all
kinds of negative health outcomes. That's one of the
reasons we see higher rates of depression, hopelessness,
and suicidality. It's really because of the social
We have unique patterns of health disparities for AIs.
Our system of care historically has taken a
one-size-fits-all approach. Empirical data shows that
doesn't work. That's the reason I'm doing this work. We
need to have AI-specific interventions to address our
What can be done to immediately address these
health disparities? And what, particularly, are you
We have to focus on intergenerational solutions – working
upstream, working with communities and families to try to
eliminate adverse childhood experiences.
There's very little that can be done immediately to
resolve disparities. These are issues that have been
building for generations. We have to focus on
intergenerational solutions – working upstream, working
with communities and families to try to eliminate adverse
childhood experiences. And there are emerging practices
that appear to be effective in preventing adverse
childhood experiences and promoting stability in the
home. These are home visitation programs and parenting
skills programs. By working upstream, we have to work
with those families, but also work with young people
before they become parents. We need a whole generation
focused on parenting skills and the impact of adverse
childhood experiences. We need trauma-informed health
systems, educational systems, legal and judicial systems.
It is unresolved trauma that's causing intergenerational
health disparities and we can't just put a band-aid on
it. It's going to take a generation.
How do you define or describe this unresolved
It's ongoing discrimination. Racism is alive and well,
unfortunately. When a population feels discriminated
against or marginalized, it creates a great deal of
emotional strife. That's not just a theoretical construct
— it's a way of life for many of our people.
There are highly stressful and toxic conditions and a lot
of unresolved anger and depression based on these
traumatic experiences. It starts historically and
intergenerationally and then perpetuates through
childhood and adulthood. In the Great Plains, there's a
lot of overt racism against AIs. That has an impact on
NDSU offers an MPH degree with specialization in
American Indian public health. Why is it important? And
how is it different from other types of public
One of the frustrations I had with academic public
health, historically and at many highly respected
schools, is that we had a very good focus on
international health and global health. But what I had to
remind my colleagues is that you don't have to cross an
ocean to find Third World health conditions. It's right
here, in our reservation communities and many of our
inner cities. In truth, AI public health has been mostly
ignored by academic public health and the public health
sector, in general. I think it's because there are so few
AI leaders in public health.
The non-AI world doesn't understand the unique nature of
Indian health, the unique nature of the patterns of our
health disparities, and the impact of colonization. We
don't learn accurate history in our educational systems
in the United States. We are largely ignored as a
population. I've complained about it for years. I had an
opportunity to do something about it when I joined the
faculty here, so that's why we started it.
AIs are the only population in the U.S. that is born with
a legal right to health services. Most people don't know
that, even health experts. Based on treaties and other
legal bases, AIs have a legal right to health services –
that's why there's an IHS and Bureau of Indian Affairs.
The entire United States is AI land. We did not lose all
of our land and natural resources in a war —
they were mostly exchanged through treaties for social
services, including housing, education, and healthcare.
We talk about cultural and social determinants of health,
recognizing there are hundreds of AI cultures, not just a
single AI culture.
We wanted to do something about it, so our program
focuses on AI health policy, history, and the evolution
of the IHS, looking at health disparities through an
unresolved trauma lens, both historical and through
childhood experiences. We look at the impact of
colonization and the dispossession of resources and how
that leads to things like diabetes. We talk about
cultural and social determinants of health, recognizing
there are hundreds of AI cultures, not just a single AI
culture. There's lots of diversity within our populations
and diversity regarding our health disparities. In
addition, we have unique research issues. We have
indigenous research paradigms, but we also have to
respect tribal sovereignty when we are conducting health
research, so we have a class focused on research issues
within tribal communities. We have a lot of things that
are working well in Indian country, but most of them have
not been formally evaluated or published. We have a
course called Case Studies in Indian Health, so we know
what is working and why it is working.
In a recent talk, you said that Kyle, SD, is a
food desert, with the nearest grocery store 100 miles
away. What can be done to change government policy that
funds expensive interventions (like dialysis) but not
access to fresh and healthy food?
There's a whole area of focus on food sovereignty,
recognizing that we have options in front of us to
recapture some traditional foods. A lot of communities
are doing it on a smaller scale, but we'd like to scale
it up in terms of local gardens using modern technology,
like greenhouses. We could potentially grow crops nearly
year-round and have a local food base. In addition, a lot
of tribes are raising buffalo herds. Buffalo meat has a
higher protein concentration than beef and a better
nutritional profile. So, many communities are trying to
promote access to inexpensive traditional foods, which
actually taste incredibly good! We haven't had access to
it because of dispossession of land, but now we are at a
point where some communities are stabilizing and are
focusing on prevention and the benefits of traditional
We have a good partnership with our College of
Agriculture here, particularly the College of Plant
Sciences. They are studying traditional food profiles.
For example, there's an ancient seed line of squash that
we're studying for its nutritional profile. It's much
healthier than the type of squash you purchase at the
local grocery store. We're blending traditional culture
with modern scientific principles.
Each community is different in how they are funding this.
One of the approaches that a tribe is taking with one of
our graduates is looking at developing a co-op – a
community-owned food program where they would provide
food to the community but also sell and package
traditional foods as an economic development opportunity.
Typically, it does need some investment on the front end.
There are some opportunities for USDA small business
loans and grants to get things jump-started. But it's
potentially sustainable just through economic
You're the Chair of the American Indian Public
Health Resource Center (AIPHRC) at NDSU. How does the
Center work to address health disparities and achieve
health equity for American Indian communities?
When I started working at NDSU, I did not want to focus
only on academics. The needs in our communities for
public health resources are tremendous, and I wanted to
be sure that we are part of the solution in a direct
manner. The AIPHRC is unique in academic settings in that
we can combine the skillsets and knowledge base of
academic public health directly with community needs,
community champions, and we can do it in a culturally
relevant manner. We are focusing on public health
education, policy, research, and services, and we have
successfully worked with all the tribes in North Dakota,
South Dakota, Montana, Wyoming, and Minnesota, as well as
communities across the nation. I think the future of AI
public health looks bright – our graduates are
well prepared and are already accomplishing great things
to improve the health of our people.
Opinions expressed are those of the interviewee
and do not necessarily reflect the views of the Rural
Health Information Hub.