[pensive piano music] - This is the average American life expectancy and this is the life expectancy for Native Americans.

In fact, native Americans have the lowest life expectancy of any race or ethnicity in the country.

But here's the thing, the US government is legally obligated to provide healthcare to all federally recognized tribes.

Yet these disparities have been going on for decades.

So some tribes have been taking matters into their own hands and creating their own healthcare systems that actually get results.

[gentle woodwind music] [crowds chatter faintly] We're here deep in the mountains of Cherokee County, North Carolina, where an ambitious project is working to save Native American lives.

We'll ask the tough question: Can this success story be replicated elsewhere?

I'm David Hurst.

This is "ncIMPACT."

[laid-back jazz music] - All right, everyone.

- Today marks a significant milestone for the Eastern Band of Cherokee Indians.

[attendees cheer] It's the ribbon cutting of the Tsali Care Center.

The 125,000 square foot residential care facility offers 120 private rooms.

It's designed to provide a continuum of care from skilled nursing and assisted living to a specialized 20-bed memory care unit.

It blends modern healthcare with rich Cherokee traditions.

[attendees chatter] Yet this celebration stands in stark contrast to a harsh reality.

Despite their deep-rooted history and traditions, the Cherokee, like many Native American tribes, have been grappling with serious health challenges.

- Anytime you have a population that has the ill effects of intergenerational trauma and stress and then the manifestations of stress leads to high rates of chronic diseases and maladaptive coping mechanisms.

- Maladaptive coping mechanisms such as substance use through other addiction disorders.

American Indian and Alaska Native people had the highest overdose death rate of any racial or ethnic group in 2022.

They also face other alarming health disparities.

Diabetes rates are more than double the national average, tuberculosis is six times more common, and mental health issues like depression and anxiety are also widespread.

But in order to really understand the story, we need to go back in time.

The 1921 Snyder Act marked the first formal congressional authorization for Native American healthcare.

Signed into law by President Calvin Coolidge, it mandated healthcare funding for all federally recognized tribes.

Then in 1955, the Transfer Act established the Indian Health Service, also known as IHS.

It currently serves about 2.5 million Native Americans, but there's a critical issue at play: severe underfunding.

A federal report revealed that the IHS 2022 budget of nearly $7 billion covered less than half the actual patient needs.

It's one of the reasons why the Eastern Band of Cherokee Indians decided to take full control of their healthcare.

It's a concept called self-governance, and it's allowed the Cherokee to use profits from their casino and build a state-of-the-art hospital.

That hospital blends modern medicine with traditional healing practices.

Here they've implemented the Nuka System of Care.

It's an Alaskan Native model that emphasizes holistic patient-centered treatment.

Under this system, patients are assigned a comprehensive care team addressing all their medical needs in one location.

Hannah Orr is a member of the Eastern Band of Cherokee Indians and an RN case manager at the hospital.

She says that unlike traditional healthcare, this approach integrates the four domains of health: physical, mental, spiritual, and emotional.

- We have patients that come in for their doctor's appointments and things like that.

And because of the setting that we have, we're able to get them to see pharmacy, nutrition, behavioral, health.

We even have a social worker in clinic.

So while they're there, we try and knock all of those things out while they're in one visit.

That way, they're not trying to come back and forth and battle transportation needs, battle, making time out of work and doing all of those things.

- And the results?

Well, community leaders say they're starting to see a difference.

The type 2 diabetes rates among the Eastern Band of Cherokee Indians decreased from 27% in 2013 to 21% in 2023.

However, this rate still remains higher than the national average.

I imagine, despite the success, you're probably not immune to some of the challenges that the traditional healthcare system faces.

What obstacles still need to be overcome?

What keeps you up at night?

- Well, one thing that keeps me up at night is having an adequate workforce in rural parts of North Carolina, especially Western North Carolina, to be able to staff these beautiful facilities.

- Facilities like the brand new Tsali Care Center.

While there are challenges in staffing a place like this, Cooper is optimistic about a collaboration with Western Carolina University.

They developed a nursing program that emphasizes cultural competence.

- And it was based in Cherokee culture and the Cherokee language.

Because again, that is so important.

It's important to the Cherokee to be grounded that way.

And it's important to just nursing in general to really understand the culture of your patient that you're taking care of.

- This is all great news for the Cherokee, but not all tribes have the same access to resources.

Many tribal territories are in remote areas with few economic opportunities, but they still need the care.

This raises a crucial question: How can tribes that don't have casino profits or other financial resources improve their health outcomes?

Well, some recent developments may improve funding.

The federal government has proposed a 16% increase in the IHS budget for the fiscal year of 2025.

If approved, this could potentially benefit tribes that are currently unable to self-govern their healthcare systems.

Additionally, a recent Supreme Court decision requires the IHS to reimburse self-governing tribes for certain healthcare costs.

This means that some IHS funding could be used to pay for the Cherokee's own healthcare system.

Cooper thinks other tribes should give self-governance of their own healthcare system a shot if they can swing it financially.

I asked you earlier about what keeps you up at night, but when you wake up in the morning and look forward, what gives you hope for the future?

What excites you as you continue this work?

- So what really excites me is seeing what I believe are the visible symbols of a healthier community.

I see young people now who they look healthier and they look vibrant and they look like they have hope in their face.

[attendees applaud] - Tribes like the Eastern Band of Cherokee Indians have made significant strides in improving healthcare delivery through self-governance and innovative partnerships.

But big challenges still remain.

And the success story we've explored, while promising, is not yet the norm, because many Native American communities still face severe healthcare disparities, workforce shortages, and limited resources [singers chants in a foreign language] For "ncIMPACT," I'm David Hurst.