interviews
The Federal Government and Native American Health
by Sarah Stern
July 7, 2020
This interview with Sarah Stern, a Health Educator at John Hopkins American Indian Health (JHCAIH), was conducted and condensed by franknews.
frank | Native American populations have been disproportionately impacted by COVID. I am curious about what the current reality of tribal healthcare infrastructure looks like and the history that has played a role in shaping it?
Sarah Stern | The reality is that tribal healthcare infrastructure has been and remains underfunded and understaffed.
The Indian Health Services (IHS) has been vastly underfunded since it’s creation in 1955. The Snyder Act of 1921 was the first federal agreement to even allow Native people to receive medical care. We see facets of American history that are not even 100 years old. I stress this as a reminder that while Native people have always existed in the United States, there are far more years of physical and cultural genocide against Native people within American history than years of serving, protecting, and advocating for Native lives.
IHS remains the last in line to receive federal funding to aid the health and wellbeing of Native people. The National Indian Health Board (NIHB) released tribal budget recommendations showing that the IHS spends on average only $3,332 per capita on each patient, compared to a national average of $9,207. In comparison to the Veterans Administration (VA), which is also underfunded, the VA remains about 14 times as funded than the IHS. Highlighting these gaps creates dialogue for both Native people and allies to engage in political pressure to increase funding for healthcare and save lives.
From my understanding there was a "Self-determination Era," which came about in the 1960s, giving tribal governments greater control over local government operations, including healthcare and health clinics. Can you go into the history of that era?
The “Self-Determination Era” allowed Native people to use federal funds as they wanted, but the caveat was (and remains today) that Native people had to report how they wanted to use funds and keep records of the cash flows using systems developed by non-Native people. This created a newer opportunity to add in ‘western’, or non-Native educational programs. School-based teachings of Native cultural values or language were not allowed until 1975, which is less than 100 years ago. Public services, workforce creation, and health care facilities were more developed as Native people were granted the federal ability to allocate funds into these things, alongside education.
It is important to recognize Native people have always utilized the act of self-determination to keep community members, especially children and elders, safe from harm’s way, even before the “Self-Determination Era”. We have worked persistently to protect our land, people, and allies since time immemorial. As Native people proved in many ways to survive physical and cultural genocide, the United States eventually allowed Native people to use federal funding as they saw fit, which was not the case before the 1960s. Basically, the onslaught of Native people cost the United States so much time, money, and non-Native causalities that they eventually folded and decided to stop murdering on stolen land.
Native people also began to have more rights for self-governance, which allowed for leadership among the facets the people wanted funding applied to.
As we see in successful public health initiatives today, when communities have voices at the table representing what the needs and realities are, more positive opportunities take place.
Without Native leadership, the “Self-Determination Era” would not have been as successful nor propelled us to where Native communities are presently.
How can the federal government effectively help in this crisis while also ensuring levels of continued self-determination?”
The federal government can listen to Native leadership directly. Native community leaders have the means to communicate what their people need during this time. This is the most direct way for the federal government to help.
Another way that the federal government can help is to increase public health funding to health programs and educational opportunities. JHCAIH is committed to providing national leadership in training Indigenous scholars in health care and public health science. JHCAIH has awarded over 1,500 scholarships to people representing 45 tribal communities around the nation. Linked below is more information on the public health training programs and online application for scholarships.
Online Application for Scholarships
Is there a specific piece of that history and its effects that you are thinking about most right now?
Treaty rights, and the broken treaties this country participates in.
Broken treaties impact all aspects of Native American communities. Broken treaties account for the fact that some Native people are not federally or state recognized, which in turn impacts the ability to apply for education, housing, health, and infrastructure assistance. Broken treaties have taken away Native lands and water rights.
Broken treaties have created health disparities we see across Indian Country.
Broken treaties have fueled stereotypes against Native people and treaties continue to be broken to this day. For example, in February, the current administration demolished Tohono O'odham Nation’s sacred burial lands without consulting the tribe. Members of the Mashpee Wampanoag community are currently battling the federal administration for seizure of land granted by a federal trust. Land has life. Land connects to Native creation stories, it holds memories, it gives protection, and when land is seized, people hurt. I encourage you to find out what Native land you live on, who the Native people are in your area historically and presently, and how you can show allyship to Native people during this time. Allyship can help combat broken treaties.
How do the economic crisis and health care crisis particularly feed off of each other?
Both crises increase panic. Health care requires money. Lack of economic opportunities diminishes ability to pay for health care costs and decreases the ability to fund health care initiatives.
Collapse of economic ventures impacts everyone, regardless of whether the business is run by Native people or not. This will vary by community, but Native leadership works diligently to ensure that community members have the means to purchase essentials, like food and water, and as they are able, they create plans for how business can run with social distancing procedures at the foreground. Protecting the health and lives of people is the best practice to begin re-opening businesses during the pandemic.
interviews
New York City Housing Authority with Polina Bakhteiarov
by Polina Bakhteiarov
May 3, 2018
This interview with Polina Bakhteiarov, the Deputy Director for Real Estate Development at NYCHA [New York City Housing Authority], was conducted and condensed by frank news. It took place April 24, 2018, in New York City.
Can you tell us about yourself and how you found yourself at NYCHA?
I was born in Moscow, Russia, came to the States as a child and grew up in Massachusetts. I ended up going to MIT and doing a five year program where I did double undergraduate degrees in Urban Planning, City Planning and Civil Engineering, and then a master's in City Planning.
I came to MIT wanting to do bioengineering, having no idea what that was. My freshman year was the year after Katrina, and I was walking down the hallway at school one evening, and this flier caught my eye. It was a discussion about recovery and resilience in New Orleans post Katrina, hosted by a professor named J. Philip Thompson. I was like, wow! I had been interested in what happened, what was going on in New Orleans at the time and wanted to go down there, but my mother was like, “no, you're not going anywhere”, I was 17. So I went to this forum to see what it was all about.
Phil ended up being my adviser and longtime mentor. He just got elected Deputy Mayor for strategic policy initiatives across the street. So we're looking to partner in a new way at this new stage of the game.
Tell us about NHYCA.
New York City New York City Housing Authority, NYCHA, we call it the acronym, is a huge organization, about 10,000-11,000 employees. We're technically part of the city of New York government, but we're also federal, so we’re in this strange purgatory of being funded by the Feds, but then reliant on City Hall.
NYCHA is the largest residential landlord in North America. We have about 2,000-2,500 buildings, and about 2,500 acres of land that comprises around 320 developments of various sizes. Small developments can be a walk up, then the largest development is Queensbridge, which has 3,000-4,000 units and about 7,000 people who live there. The scale is vast. We also corner about 8 percent of the rental market in NYC. We have a lot of untapped power which is very interesting for me because my I'm starting to get into the area of public asset management, and public finance, and how we can better leverage our public assets to generate additional income. Not just within the NYCHA world, but in government in general.
It's really started to pique my interest, especially because of the federal conversation, for better or worse, around infrastructure. Regardless of the motives, and even the mechanics of that conversation, there is still a legitimate point around the fact that we don't leverage our public assets, bridges, roads, airports convention centers etc.
How you would like to leverage NYCHA's assests?
One of the ways we do it now is through our infill program. We have two programs. We have what we call "100 Percent Affordable Program", and then we have the, "NYCHA Next Generation Action Neighborhoods Program", or the "50/50" program. In both of those programs we identify underutilized or vacant land within our development campuses for a new construction project. On the 100 percent affordable side, we build a building and all the units are up to 165 percent AMI [area median income], so there's different levels of affordability there.
On the 50/50 side, same concept. Identify a plot of land that’s developable, and when we construct a building, 50 percent of the units are affordable, and 50 percent are market rate. We take the revenue from the deal and reinvest a portion into the development on which the new building has been constructed, and then the other portion goes to the highest need development. The ones in the worst conditions, and in need of investment in systems, grounds etc.
That's like putting our toe in the water. Taking the intrinsic value of our developments and figuring out how to extract that value, and then reinvest it back in.
In order to be truly able to put any type of dent into that huge number, that keeps on rising, we have to get creative.
Is the 50/50 housing model working?
We have not actually constructed the building yet. That was rolled out in 2015 under the Next Gen NYCHA strategic plan, which is a 10 year initiative. The mayor is very aggressive in his housing goals, and he wanted to pilot this new structure, and this new framework.
What were the main points of anger towards the 50/50 idea?
The biggest fear is gentrification. You're bringing folks who can afford a market rate apartment in some of the hottest neighborhoods in New York City (Upper East Side, Prospect Heights, Williamsburg, Lower East Side). So gentrification is the biggest issue. The fear of rising rents and displacement, although that still bleeds into the new construction side, because residents oftentimes see a new building as an indicator that change is coming and folks are going to be pushed out.
The other issue is the destruction with the construction. The destruction of folks daily lives and how the new building will impact the lay out of the development, the neighborhood, what these new folks coming to live there bring. The cultural implications. There are a lot of considerations we're working through with residents in that process.
We're trying to continue to expand our thinking. One of the areas that we are now exploring preliminarily is selling air rights because it would really, really change the game for us.
How does that work, and how do you go about getting that approved?
A couple of things. One is the federal process. We have to figure out if HUD will allow us to do this, because it is still a transaction. We've been talking with with HUD about how to do that. It seems like everyone is fairly excited about it. Residents like that strategy because there's no construction, it doesn't disturb their daily lives. Politically, I think that it could really be a win for both the legislative and executive branch because again, it's really a cash cow for NYCHA with a very minimal administrative burden.
Do you anticipate backlash with that program, because you would in essence be throwing an issue onto another person? The idea of changing the New York City Landscape, the idea of environmental impact? The buildings you sell to, exceeding what they should be exceeding.
The buyer of the rights would only be able to use them to the extent that the zoning for their parcel, or parcels, allows. They would still have to go through every process on the city and state level with regard to environmental review. Every other type of testing that needs to get done in order for them to pull their permit. They would not be able to bypass any of that.
Okay, got it.
I want to talk about what I do, which is on the preservation side of things.
Sure!
The purpose of our team is to structure public-private partnerships in order to preserve public housing in the long term. The main tool that we use is Rental Assistance Demonstration. It's an Obama administration initiative that began around 2011, and is really a way to open up new avenues of capital, coming into a development that's prohibited within the public housing framework.
What RAD allows us to do is switch the funding for public housing developments from public housing, what we call Section 9, to Section 8 housing choice vouchers.
What that allows us to do, is go to the markets and bring in additional capital for that development, which was previously prohibited from us.
Our program focuses, once we get that financing package, on three pillars. The first one is a very substantial rehabilitation of the development under the federal guidelines. We have to address the 20 year capital needs of that development. We also switched the management to a private property management company which allows for streamlined property management, and also allows residents to revisit the conversation around house rules, which is something that NYCHA used to enforce very strictly back in the day. Over the past couple of decades it's really deteriorated. A lot of residents, in the forms that I've engaged with them, complain that there are no standards for how these communities are supposed to function. The last piece is around social services delivery. With the conversion we also bring in an onsite social services provider to really increase the services that folks are receiving in the development, tailored to the needs of that particular community.
Where does this work fit in under the larger umbrella of “planning”?
The great thing about planning is that it can be defined in so many different ways. For me, I see us focused on the housing aspect of planning. We are definitely very implementation focused. We obviously rely on planning studies and analyses that are done by our colleagues at the Department of City Planning, housing preservation, and development, and even internally have folks that do planning oriented analyses. But we're really focused on the implementation. We're looking at how we choose the developments that go through the Section 8 conversions.
We do look at it from a planning lens. We're looking at neighborhood context. One of the things that I've been looking to to add to that particular planning process, for our preservation pipeline, is that particular piece. When we first started the pipeline planning for RAD, it was really based off of financial feasibility. What we were doing was taking developments that were in some local proximity to each other geographically, and figuring out how to make them work financially. Because we're bundling developments together, we're not doing one at a time in order to get efficiencies. That's a great baseline, but there are other factors that we have to take into account when we do this planning.
There's also the piece around political planning.
What is NYCHA’s ultimate goal?
Our ultimate goal is to dig ourselves out of the $17 billion hole. We've lost our identity as a landlord, because that's really what we are. We house 1 in 14 New Yorkers. We have about 400,000 people in public housing, an additional 200,000-250,000 via the Section 8 program. We really need to get back to that identity, of being a strong landlord.