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By Emma Gillis


Our study of medicine through literature focuses heavily on untold stories: the women, the minorities, the aging, the dying, and the families. The Stories to Save Lives Project relies on these untold stories and their ability to create a new dialogue through the creation of a large base of oral histories on health in the rural south. In a general sense, perhaps one of the most largely uncovered and wholly misinterpreted stories is that of the Native American. The consensus in education about native Americans focuses on events done to them from an outside source: war, expulsion, rape, kidnapping, massacre, and demographic disaster; one would begin to think that the most important thing Native Americans ever did in the grand story of history was die for the purpose of white incursion.

To be indigenous today is to live in a constant state of protest to this culture of extermination. Whereas in the last two centuries, this culture of extermination was outright: killings, lynchings, and theft both of people and property, today’s extermination is subtle. Today’s policies like blood quantum and lending few resources for development in native communities seek to wait out the remaining descendants of the first Americans, until both populations and cultures become obsolete. A culmination of this is seen in unrecognized Native Tribes. North Carolina contains 9 of 63 total federally unrecognized tribes in the nation, and the largest tribal population on the east coast. North Carolina is continually enriched culturally by its indigenous population, but due to federal reluctance to recognize and support these tribes, their members find themselves in health circumstances that are far less than ideal. It is imperative to examine and create accountability for the health implications Native American people suffer as a result of combined degenerative policy, non-recognition, and racial bias. An examination of these factors for unrecognized Native Americans in North Carolina lends itself to the conclusion that while unrecognized Native Americans experience many of the same health disparities and markers of the recognized, their position within healthcare is worsened by having no admission to federal programs such as FDPIR and IHS.

Historical Racial Precedents for North Carolina’s Natives

To understand the position of unrecognized Native Americans, one must first understand the racial niche they occupy in their communities versus the racial categorization that the federal government places them within. Their federal status as unrecognized is largely based on historical precedent, phenotype, and outdated binary race systems. The Indian Reorganization Act of 1934 is perhaps the largest example of this: the anthropologists sent to Robeson County, North Carolina at this time categorized an “Indian” to be having at least one “full-blooded” parent, and fitting into a stereotypical phenotype. Testing included measuring facial features and body proportions, and included arbitrary determinants, such as disqualifying those whose skin became red when scratched. This posed a problem for these people of Robeson county, with no record-keeping on blood quantum, and, according to these anthropologists, non-“Indian” phenotypes. Few of them passed the IRA’s tests (Lowery, 117). Haliwa-Saponi Native Americans were not deemed “Indian” in history based on having perceived “mulatto” racial characteristics (Richardson 12). Continually, Native Americans in these communities and others in North Carolina are placed with in black-white binary system as “mulatto” and disallowed self-determination.

This age-old concept, known as blood-quantum, is still explicitly written into laws concerning federal Native American benefit programs. For most tribes, this cut-off for receiving schooling, housing, and other welfare programs relies on the ability to prove that one’s ancestry is greater than or equal to one-fourth Native American blood, from a single tribe. These standards are degenerative in nature, created for the purpose of allocating fewer resources with every generation, and have no place in contemporary times. Blood quantum is a creation of and for oppression.

However, these blood-quantum presumptions are rarely held by many of North Carolina’s tribes. Instead, racial identity for these groups is based on kinship within their communities. Even non-natives that live within proximity to these tribes have this understanding. One’s status as Native American in these communities is plainly apparent based on one’s surname, one’s church membership, the location where one lives, and one’s regional accent and dialect. Maynor, Emanuel, and Bedsole denote the Coharies of Sampson County, while Lumbees are often known to have the surnames Chavis, Locklear, and Lowery. The Shiloh Pentecostal Church is a known Coharie establishment, while the Meadows community in Warren County, North Carolina is known to be Haliwa-Saponi dominant. Lumbees of Robeson County are often denoted by their distinctive accent and diction. This shows very simply that while having the native experience in their communities, members of North Carolina’s unrecognized tribes are unable to reap the benefits the federal government grants their recognized counterparts.

Obesity, Farming, and Food Deserts in Native North Carolina

Barbara Brayboy is a Haliwa-Saponi woman from Warren County, North Carolina, and throughout her interview on her experiences within healthcare, she references health problems for Native Americans multiple times, mainly obesity (52:57.4-53:22.1). Native Americans die at far higher rates from obesity-related causes such as heart disease. North Carolina’s Native American population falls into high categories for obesity rates as compared to other states, and experience far higher rates than their white counterparts (Gizlice and Houston 1). Many of these are problems shared within populations that are recognized by the federal government.

Brayboy furthermore points to the style of subsistence farming that she believes attributed to her good health. Brayboy details that during her childhood, the family grew most of their diet, much of it being vegetables, on their own land and participated in a barter economy between other families in the area for food items. As a largely rural people, North Carolina’s indigenous peoples have l been involved an agricultural-based society throughout history. In earlier times, this agriculture was based in sharecropping: a tenant farming practice that prohibited the growth of generational wealth and restricted them to poverty. As sharecropping faded in the early 20th century, farming in the format of Brayboy’s persisted. Today, however, this has been replaced with a new system: that of agribusiness. Corporate farm buyouts are a trend amongst the entirety of rural America within the past century, but in Indian Country, this was bolstered by discriminatory practices. Loan requests to keep small farms afloat were either denied or arrived too late to save family farmers (Inge). Corporate farms, marked by subsidized high-energy carbohydrates, livestock feed, and high-density animal agriculture moved in and contributed to poor diet (Cho). A dependance on foods shipped from outside of the community was created.

But, in these rural areas, access to nutritious, fresh food is not readily available. For many, there are no grocery stores within a 10 mile radius, and often, the stores that are available have little selection of affordable nutritious foods to support a population in which poverty is pervasive. (Lowery) In many of these food deserts, gas stations often carry staples like milk, bread, and meat. Convenience foods, highly processed and high in added sugars, often end up poorly filling in for the low supply of nutrient-rich options. Combined with the lack of recreation and sports programs in these communities, referenced by Brayboy during her interview, childhood obesity becomes a prevalent problem that follows throughout adulthood.

By contrast, federally recognized tribes are often given assistance with these problems. The federally funded Food Distribution Program on Indian Reservations (FDPIR) is a support system that provides services reminiscent of the SNAP program for food stamps to reservations of both American Indians and Alaskan Natives. The unrecognized community in North Carolina is conversely relegated to providing mainly education-based support on health issues using state-allocated funds instead of receiving more concrete financial benefits.

Lacking Medical Services in Native America

Throughout her interview, Brayboy references the lack of medical education within her community. She explains her reluctance to be treated at many of the small number of facilities in the area, and tells about insurance disparities within these communities. (48:28.9-49:46.4) Brayboy even details that the first time she visited a doctor was at the age of 17, and the prevalence of home remedies and traditional healing methods known as root medicine that many of her neighbors practiced. (30:26.5-31:02.8) Furthermore, Brayboy speaks of how her mother and aunts were relied on as caretakers to her hospice patient grandparents in their old age. These combined experiences with health, or lack thereof, are at an intersection of low resources, poverty, race, and misogyny in these areas.

Indian Health Services, an operation providing medical and public health centered services, is available exclusively to federally recognized tribal members. Providing low or no-cost healthcare both on-reservation and off, the program maintains facilities in areas with high populations of federally recognized Native Americans. Without life-saving resources like this, experiences like Brayboy’s pervade.

Very real effects persist because of this lack of education and access. A 2004 study found North Carolina’s native population in general had higher incidences of having no primary care physician, no health insurance, and an inability to pursue healthcare due to cost. (Gizlice and Houston 9) Furthermore, North Carolina’s Native Americans were significantly more likely to have unfavorable health outcomes and disabilities than their white counterparts. (Gizlice and Houston, 9) It would be incorrect to believe that these statistics are irrelevant the conversation on unrecognized health experiences, as the vast majority of North Carolina’s native American population are members of these unrecognized tribes.


Frankly, North Carolina is experiencing an ongoing public health crisis within its Native American population.  All points considered, it should shock no one that North Carolina’s native American population has an overall higher death rate than whites. Within the past century, the United States has affirmed its obligation to protection and preservation of Indigenous people and culture. However, one would believe this to be untrue when a large portion of this population remain unprotected due to bogus precedent. As a location of great divide, North Carolina is also a setting of great potential. North Carolina’s unrecognized Native communities are highly dense, interconnected, and more than anything, willing to see shifts within their communities with a change in their federal status. Recognition of North Carolina’s indigenous peoples would set a real-world example of what recognition can do for both struggling communities, and the Native population of the nation at large.


Inge, Leoneda. “USDA Prepares to Pay Native American Farmers.” WUNC. 19 January 2012. Accessed 1 May 2021.

Interview with Barbara Brayboy11 June 2018Y-0011, in the Southern Oral History Program Collection#4007Southern Historical CollectionWilson LibraryUniversity of North Carolina at Chapel Hill.

Lowery, Malinda Maynor. “The Lumbee Table Is Equal Parts Indian, Southern, and American.” INDY Week, 23 Nov. 2016,

Lowery, Malinda Maynor. The Lumbee Indians : An American Struggle, University of North Carolina Press, 2018. ProQuest Ebook Central,

Renee Cho et al. “Rethinking Our Food System to Combat Obesity.” State of the Planet. 19 Jan. 2012, Accessed 1 May 2021.

Richardson, Marvin. Racial Choices: The Emergence of the Haliwa-saponi Indian Tribe, 1835-1971. 2016.






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