This episode focuses on providers “shock” when they begin working for Indian health. Healthcare providers often report experiencing a large number of patients with high rates of diabetes, high blood pressure, substance use, depressions and more. Our conversation with epidemiologist Delight Satter, MPH, describes how genocidal policies create a missing cohort of people, that in turn create pro-birth policies. Additionally, Satter discusses the effects of “weathering” the premature aging effects on populations who experience systematic racism and trauma. These unusual distributions in age lead to healthcare needs that the infrastructure was not designed to support. Along with the legacies of policies that were intended to physically and culturally eliminate Native Americans, the consequences of termination policies on the health care infrastructure in inland southern California, and turnover of physicians in the health system among other structural practices have led to a lack of continuity in care and a constant struggle to address high rates of diseases. Notably, Satter also discusses how the tribes in California have consistently taken the lead in addressing their healthcare needs.

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