Marcella Ronyak has three questions for you

According to data from the Centers for Disease Control and Prevention, the 3.7 million American Indians and Alaska Natives in the United States have a higher mortality rate than other Americans, due to conditions such as liver cirrhosis, opioid overdose, diabetes, injury, homicide, and suicide—all of which have a significant behavioral component (CDC). They also live 5.5 years longer on average than all other races combined in the United States.

Marcella "Marcy" Ronyak, PhD, a psychologist, seeks to modify those statistics. Ronyak oversees a national program aimed at addressing Native Americans' health-care needs, including maternal and child health, medication, managing and treating HIV/AIDS and hepatitis C, diabetes care, opioid addiction treatment, and more, as director of the federal Indian Health Service's division of clinical and community services, housed within the agency's Office of Clinical and Preventive Services in Rockville, Maryland. The division's strategy emphasizes prevention, education, and cultural awareness, and it employs a public health framework to choose and create interventions. It also recognizes the necessity of tackling structural disparities that might lead to poor health outcomes.

Ronyak, a member of the Confederated Tribes of the Colville Tribe in Washington state, joined the IHS in 2013 after working on the Colville reservation as a tribal psychologist and subsequently as an independent consultant. She worked with families, couples, and individuals, as well as other tribe, state, and federal partners and specialists, to develop and execute culturally relevant services. Her work at the IHS, whose aim is to improve the physical, mental, social, and spiritual health of American Indians and Alaska Natives, is informed by those experiences. "It's a pretty comprehensive method to looking at a person," Ronyak says, describing it as "a very comprehensive approach to looking at a person" that is "equally compatible with her training as a psychologist and her cultural background."

Many of the public health problems that indigenous communities experience are caused by socioeconomic factors like poverty and a lack of education. The IHS, as the primary federal health-care provider and advocate for Indian people, aims to address these issues by providing a comprehensive health-care system to 2.6 million American Indians and Alaska Natives in 37 states through a network of 24 hospitals, 50 health centers, and 24 health stations delivered by more than 15,000 staff and health-care providers.

The Family Spirit Program, an evidence-based, culturally adapted intervention program given by Native American paraprofessionals who are often community members, is an excellent illustration of our holistic care philosophy. The main strategy is to provide more knowledge and skills to young Native parents in order to help them foster their children's healthy development during the preschool years.

Our paraprofessionals provide this care by visiting patients in their homes, which is especially essential because Native people frequently face major challenges to getting treatment, such as transportation and travel. They also have a hard time trusting caregivers, so providing personalized, one-on-one care can go a long way toward assisting them in learning new parenting skills and accepting that it's OK to seek medical attention if something is wrong.

The Johns Hopkins Center for American Indian Health's randomized controlled trials have found a number of positive outcomes from this program, including increased parental self-efficacy and reduced stress, decreased maternal depression and substance use, fewer behavior problems in young children, and a lower risk of substance use and behavioral health problems over time.