E vents such as the COVID-19 pandemic, police brutality, and climate change have exposed how structural factors such as politics, economics, and infrastructure impact human health, particularly the health of Black, Indigenous, and People of Color (BIPOC). Structural racism is defined as "the totality of ways in which societies foster racial discrimination, through mutually reinforcing inequitable systems (in housing, education, employment, earnings, benefits, credit, media, health care, criminal justice, and so on) that in turn reinforce discriminatory beliefs, values, and distribution of resources." 1,2 Numerous studies have demonstrated the blatant yet pernicious nature of structural racism in human medicine-across the scale from individual clinical decisions to broad institutional policies-and how structural racism leads to adverse patient outcomes. [2][3][4][5][6][7] For example, at the individual, clinical level, Black and Hispanic/Latino patients presenting to the emergency room are less likely to receive analgesia compared to White patients, despite no difference in patient pain level or physicians' ability to assess pain. 8-10 At a broader institutional level, until this past year, 11 the standard of practice has been to use race-based, estimated glomerular filtration rate (eGFR) equations to assess kidney function. These eGFR equations use a higher coefficient for Black patients, assuming higher kidney function than white patients with equivalent blood chemistry (ie, serum creatinine) and consequently delaying time to diagnosis of kidney failure and dialysis. 12,13 The above are only a sampling of the numerous examples of how structural racism transcends scales of care and can lead to health inequalities and poor patient outcomes in human medicine. 14,15 Cerdeña et al 14 write, "It is increasingly
Management strategies for chronic wasting disease (CWD) across tribal lands have varied in response to changing dynamics of CWD risk. As CWD continues to spread across the United States, concerns associated with the disease are increasing. We interviewed 19 natural resource managers representing Anishinaabe and Dakota tribes in Minnesota, Michigan, and Wisconsin with goals of understanding needs and opportunities for CWD engagement, surveillance, and outreach on tribal lands; the implementation of natural resources policy and management across tribal nations; and opportunities for tribal partnership‐development to control CWD. Qualitative data analyses of interview responses revealed substantial variation in the number of tribal hunters, hunter regulation, and huntable tribal lands across our study area. Proximity of tribal lands in relation to CWD detections impacted tribal agency management strategies for CWD. Our results indicate a desire for CWD outreach and surveillance, mutually beneficial collaborations, and a need for incorporating cultural knowledge into CWD management strategies. We conclude that tribal CWD management and surveillance plans will be enhanced through strategic and thoughtful CWD outreach methods. Moreover, partnerships must recognize tribal sovereignty and respectfully integrate tribal values, knowledge, and worldview.
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