National rankings found North Dakota’s health care system does well in terms of overall performance, but access and affordability are problem areas, prompting more discussions about connecting more populations with quality care.

This past week, the North Dakota Voices Network hosted a forum on health equity issues.

Whitney Fear, a psychiatric-mental health nurse practitioner at Family HealthCare and member of the Oglala Lakota Nation, spoke about barriers facing Indigenous populations. She said Native Americans are underrepresented in the health care workforce. While it does not mean non-Indigenous staff cannot care for these patients, the gap still has an effect.

“There’s a pretty significant amount of research that pointed to that if somebody on your team caring for you or directly caring for you, if they look like you, they share your belief system, your traditions, whatever, that you’re more likely to experience positive health outcomes,” Fear explained.

She also feels there are broader assumptions Indigenous populations get ample support through the Indian Health Service. Fear argued the federal agency is woefully underfunded and fails to reach Natives living in urban settings.

The Commonwealth Fund scorecard ranked North Dakota 13th in the nation for health-system performance, and noted access and affordability fall below the U.S. average.

Shannon Bacon, health equity manager for the Community HealthCare Association of the Dakotas, noted while primary care in a clinical setting is important, it only accounts for about 20% of health outcomes. She said social and economic factors carry more weight in this area.

“And so, if we don’t kind of get to the root of what a patient’s basic needs are, we’re not going to be able to get very far in helping them with kind of basic chronic disease and health needs,” Bacon contended.

She added community health centers, which operate in underserved areas, are becoming more proactive in screening patients for social determinants of health.

Policy-wise, her group suggested the federal government boost access to pharmacies, and state leaders consider funding for community health centers. In 2020, the facilities served more than 30,000 patients in North Dakota. Roughly 30% were of a racial or ethnic minority.