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Stanford researchers and local American Indians team up to prevent diabetes

Sit with Al Cross outside a San Jose coffee shop, and former mayor Tom McEnery might say hi as he passes by.

"We belong here," says Cross, a Hidatsa/Mandan Indian who grew up on the Fort Berthold reservation in North Dakota.

He ought to know. In 1960, at the age of 25, Cross opted into a federal program that relocated American Indians from reservations to certain designated cities in the West and Midwest. Before relocation began, 8 percent of American Indians lived in cities. Today, at least 70 percent do.

Relocation was, in Cross's words, "really disruptive." Many who relocated found themselves coping with isolation. Others were hesitant about assimilating into urban life and returned to their reservations, sometimes journeying back and forth repeatedly. Family and community ties frayed, and tribal nations suffered.

Cross himself proved resilient: The bricklayers' union he had planned to join was unwelcoming, so he found work in a detergent factory. He went to night school at San Jose City College, then finished his bachelor's degree and earned a master's in social work at the University of California, Berkeley. He devoted the bulk of his career to the American Indian community in San Jose, working with children and families in the foster-care system.

So if you want to conduct research among urban American Indians on diabetes — a disease that American Indians and Alaska Natives develop at twice the rate of non-Hispanic whites — it makes sense to have someone like Al Cross on your team.

Cross is one of the elders on the American Indian Community Action Board, a group of 15 local American Indians working with Stanford and San Jose State University researchers. Together, they have developed an enhanced diabetes prevention program that incorporates cultural practices like talking circles and storytelling, aiming to address American Indians' historical trauma from events like relocation. They hypothesize that their enhanced intervention will be more effective in warding off diabetes than a standard intervention. In the most recent issue of Stanford Medicine, I write about why their collaboration is so rare:

It was initiated by the American Indian community, which can have reason to be wary of medical studies. It is a research partnership with urban American Indians, an invisible majority of the indigenous population, and one with understudied and underfunded health-care needs. And after almost six years of hard work — building trust, seeking funding, surmounting challenges — it is as close to success, in the form of full enrollment in a randomized controlled trial, as any project that aims to examine the root causes of diabetes in American Indians has ever been.

Those who work in the field of American Indian health have already taken note of the project, and are looking forward to results. "Are we going to make a difference?" Cross asks. "I think we’re all feeling, yes, we will. We’re anxious to see."

Previously: Strive, thrive and take five: Stanford Medicine magazine on the science of well-beingBroken promises: The state of health care on Native American reservations, Responses to Rosebud Indian Reservation story: "Nobody cares because nobody realizes these people exist" and Getting back to the basics: A student's experience working with the Indian Health Service
Photo of American Indian Community Action Board members Paul and Orena Flores by Gregg Segal

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