Sometimes, after writing an article or a blog post, I end up with a lot of loose ends—thoughts and feelings about the writing, or the topic, or the people encountered—that rattle around in my head, as if to say, “Please let us out!” But, mostly, they never do get out, except in little snippets of conversation. What is a blog for, though, if not to say things that otherwise would never be said?
So: I just wrote an article for the Reno News & Review (the local alt-weekly) on race, wealth, and health in Washoe County, and, for various reasons, the loose ends really got out of hand this time. And I think some of those wayward threads might be worth mentioning, because they add some unexpected twists and a bit more depth to the story.
The gist of the article is that health in Washoe County is strongly tied to race and wealth, as it is for the U.S. as a whole, and that the differences are mostly caused by how people live—what they eat, how much exercise they get, how stressed they are—and are not, for instance, connected to genetic differences among groups. Right off the bat, I can say that I completely left out two relevant, huge topics—exposure to industrial toxins and access to healthcare. And the toxins thing I’m going to leave untouched, except to say that it probably is not nearly as important as living habits. Healthcare, though, I’ll get back to.
I began the story with the example of the high rate of diabetes among the Paiute (Numu) on the Pyramid Lake Indian Reservation. Actually, the original plan was to write a story entirely about health issues on the reservation, but at some point I became uncomfortable with that idea. I came to feel that a gloomy picture entirely focused on the reservation Paiute would give an inaccurately bleak image of that place and people. I did end up painting a dark picture of diabetes on the reservation (although I noted in passing that the situation appears to be improving), but at least I ended up spreading the pain around to other groups.
Even with the change in focus, I still felt very uneasy writing this story. Part of me feels that it’s worthwhile—in fact, critical—to let people know about the difficulties faced by various racial and ethnic groups. Where would we be if nobody ever did that? But another part of me wonders if some issues are best dealt with by members of those particular groups. I know that, as a Japanese-American, while I am usually grateful for whites who bend over backwards to publicize racism against “my” people (World War II internment camps are often the focus), at times I can feel annoyed, spoken down to, by those same well-intentioned folks. Maybe it’s irrational to feel that way, but there it is.
Adding to my discomfort in writing this story was my monumental ignorance of Native American experience. That came home to me at various times, but maybe especially when talking with Stacey Montooth, the Community Information Officer for the Reno-Sparks Indian Colony. Montooth, who is a member of the Walker River Paiute, was extremely outgoing and helpful, getting me in touch with people and giving me a tour of the colony’s health center, and in those ways was what you’d expect of a PR person. But she began our interview by giving a whirlwind history of Native American-European interactions, including plans by Europeans to completely wipe out Native Americans, the attempt to erase Indian culture by forcing kids into Indian boarding schools, and the fact that reservation Indians are even now constrained by not being able to own the land their houses are built on. Talking with her, I was thinking, “Wow, for a PR person, she’s pretty radical.” And then it occurred to me that probably almost all Native Americans, by the usual standards, are pretty radical.
(Another thought on radicalism: Check out the Pyramid Lake tribal newspaper. It makes The Washington Post look like a mouthpiece for Donald Trump.)
Montooth had a lot of illuminating things to say. For instance, she mentioned that the doctors that serve Native Americans are often connected to the military, and wear military uniforms, and that those uniforms promote mistrust. In that context, she said, “You’d be hard pressed to find any Native American who trusts the federal government. If you just looked at our history, it’s pretty clear why…”
And, talking about education, she said that her family had moved from the Yerington Reservation to Fallon, so that she and her sister could go to a better school. (Fallon, I should point out, is a town about an hour east of Reno, and is not really known for having great schools.) More positively, she also mentioned that she hears about kids from the high school at Pyramid Lake, which is run by the tribe, going to places like Stanford and Harvard.
These things were not on my radar, and that lack of knowledge, and lack of understanding made me wonder about my right to speak of Native American problems, even in a very limited way. Well I went ahead, I wrote the story, but I still feel a little weird about it.
Stacey Montooth introduced me to Stacy Briscoe, the Diabetes Program Manager at the Reno-Sparks Tribal Health Center. Briscoe is white, is trained as a diabetes educator, and said that, when she was looking for a job, she was especially interested in finding a position to work with Native Americans, because she knew about the seriousness of the diabetes problem in those communities. Talking with her, I felt very much like the pie-in-the-sky writer, wondering how we might rid the world of diabetes, while she is actually making things happen, educating people about living healthily, running all sorts of programs to make it easier for them to exercise more and eat better. It was inspiring to talk with her. Like Jeff Davis and Rita Romo at the Pyramid Lake Tribal Health Clinic, Briscoe struck me as dedicated and compassionate, dealing with the concrete, doing what can be done.
Another person I talked with was Joseph Grzymski, a scientist at the Desert Research Institute (DRI) who is the head of the Healthy Nevada Project, a collaboration between DRI and Renown Health that has the aim of gathering a large amount of data on socioeconomic variables, genetic make-up, and other factors that might be tied to health outcomes. Going into the interview, I knew that the Healthy Nevada Project involved getting genomic sequences from thousands of Nevadans, and I was thinking that Grzymski might try to convince me that genetics held the key to solving society’s health problems. But, in fact, he didn’t do that at all. Instead, he stated very clearly that he does not believe that the big health differences among racial or other groups are based on genetic differences. In that context, he said, “It would be nonsense to say that genetics explains, you know, deep-seated issues…the past history of the United States and how we’ve dealt with certain things.” (My thoughts exactly!)
He went on to say that the main, immediate benefit of collecting the genetic data will be to identify people who have relatively rare genetic alleles that make a person especially susceptible to certain diseases. (The BRCA alleles that put one at extreme risk of developing breast and ovarian cancers are a good example, made famous by Angelina Jolie.)
Grzymski also said that health outcomes are not primarily about the quality of healthcare, but instead are “teed up very early on with behavior, patterns of understanding…and of course a lot of that is driven by socioeconomic status.” And he continued, “Traumatic things that happen to children have massive impact on health outcomes in adulthood…much more so than whether or not you saw a good pediatrician.”
His words lead me to the biggest loose end of the story, which is the significance of the healthcare system. Like a lot of people, I am completely behind universal healthcare; it seems criminal that this country does not have it. But Grzymski’s thoughts about quality healthcare, which are backed up by a lot of research, imply that if, by some miracle, good healthcare for all suddenly became a reality, the profound disparities in health among racial and other groups would not disappear. Those disparities are tied to inequalities that run far deeper than access to doctors, medicine, and other aspects of healthcare.
I was mulling those thoughts as I wrote the ending to the RN&R story. And those thoughts are part of why I said what I did about the change required to close the health gap, about the need for a seismic shift in society.