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ISMTE / Editorial Boards and Diversity

Published onFeb 08, 2022
ISMTE / Editorial Boards and Diversity

Introduction 

She was not a natural fit for the job. Dr. Mindy Kurzer had previously co-authored articles on nutrition intervention studies and cancer with titles such as “Effects of green tea catechin extract on serum lipids in postmenopausal women: a randomized, placebo-controlled clinical trial.” However, when the Shakopee Mdewakanton Sioux Community issued a grant to the University of Minnesota as a part of the Seeds of Native Health campaign with a request to organize the first ever Annual Conference on Native American Nutrition, Dr. Kurzer was invited to lead the project because of her background in nutrition and her experience organizing conferences.  

“Always interested in social justice and making the world a better place, this work fit into my personal values. Once I got into it, I was completely captivated by the issues,” said Dr. Kurzer. “I began to feel that in some ways, this topic is more urgent, and working on it could have more impact than the kind of research that I’ve done most of my career,” she continued. “I realize that Indigenous people are invisible in many conversations. For example, we have conversations in Minnesota about disparities in health and education. Native people are not even in the statistics – partly because the numbers are so low.” 

“As I learned more about the effects of colonization on Native peoples,” Dr. Kurzer continued, “I realized that the health of Native peoples has been affected by generations of trauma. On a personal level, I felt extremely connected to Indigenous peoples. As a Jew born a few years after the Holocaust, I feel like my people and I have experienced inter-generational trauma. Not everyone understands this. People say ‘just get over it.’ Now we know about epigenetics. Studies suggest that trauma can induce epigenetic changes passed on to the next generation. There can be biological, not just mental and emotional transmission of trauma. When it comes to genocide, and a people who have experienced this, I felt an emotional, personal connection to this.”   

Issue 

In addition to the conference, Dr. Kurzer became interested in promoting academic research on the topic of Native American nutrition. Executing this task would not be easy though. The need to publish about nutrition of Indigenous peoples was dire. As Seeds of Health reports on their website, 

“Extreme poverty and the loss of traditional foods have caused many Native Americans to suffer from poor or inadequate diets. This has led to increased obesity, diabetes, and other profound health problems on a large scale. Nearly 16% of Native Americans suffer from type 2 diabetes, more than double the percentage of Caucasians. More than 30% of Native Americans are obese. Native Americans are 1.6 times more likely to become obese than Caucasians. Experts agree that 80% of the battle in addressing these health issues is creating access to healthy food. Yet the federal government spends less than $1 million annually on Native American nutrition education.”  

However, there was not an academic journal that was a natural fit for this research. The International Journal of Indigenous Health already published some of this research, but was broader in scope. Meanwhile, although nutrition journals are by nature inter-disciplinary, frequent areas of overlap include medicine, epidemiology, public health and the behavioral sciences such as psychology, political science and economics. Food and nutrition of Indigenous Peoples overlaps with countless other fields, such as social science, anthropology, economics, language, and sociology. Dr. Kurzer was faced with the daunting task of launching a new journal without financial support. 

In a chance conversation with Karen King, then Vice President for Publications for the American Society for Nutrition (ASN) journals, Dr. Kurzer learned that ASN had recently set up a new open access journal, with the goal of expanding the scope of research published by the society. Could a partnership with its new journal, Current Developments in Nutrition (CDN), be the answer? 

Goals 

While CDN’s goals for the partnership were quite simple – attract content to a new journal – Dr. Kurzer’s goals were more complex. Western science approaches research differently from ways of knowing and research methods used by Native peoples. As Dr. Kurzer explained, “when you submit a grant proposal to NIH, they want to see a statistical analysis. This is not what Native communities do. Their work is much more qualitative and descriptive.” Evaluations are conducted via conversations with Elders and other stakeholders. The lack of understanding of Indigenous research and evaluation methods is a barrier both to obtaining USDA and NIH grant funding for these initiatives, and to publishing this work in traditional nutrition journals.  

CDN is an author-supported open access journal. However, publication fees can be prohibitive for under-funded authors. The Shakopee Mdwakanton Sioux Community generously agreed to underwrite publication costs for authors without funds, making the papers more accessible to both publish and access as a reader. This allowed Dr. Kurzer to pursue a partnership with ASN to establish a discrete section on Food and Nutrition of indigenous Peoples.  

In her partnership with CDN, Dr. Kurzer hopes to elevate Indigenous ways of knowing within the academic context. Papers are reviewed rigorously to ensure that Indigenous peoples hold leadership roles in research conducted in their communities. Indigenous peoples should be not just the subject of experimentation but also leaders in planning, designing, and evaluating studies and data, as well as making sure that the process is implemented correctly. She wants top people from this field to publish with CDN. Finally, she hopes that this work can shift thinking of stakeholders to allow for increased funding on such projects.  

Parameters/ Challenges 

When CDN launched in 2017, there were already plans to publish the Proceedings of the First Annual Conference on Native American Nutrition, with Mindy Kurzer as a Guest Editor. The main goal of this conference was to bring together Western, academic researchers with Indigenous wisdom and research. Launching a conference and a new journal section at the same time was quite a challenge, and by the time the proceedings were published in August 2019, they were combined with content from the 2nd annual conference and Dr. Kurzer had been appointed as a CDN academic editor. A special section of CDN was created for these articles called Food and Nutrition of Indigenous Peoples

Peer review of this section is not simple. Dr. Kurzer strives to use at least one Indigenous researcher as a reviewer on every paper, in addition to non-Indigenous reviewers. Says Dr. Kurzer, “It's critically important to make sure that reviewers of peer reviewed articles understand the methods and approaches used in a paper. Just as it's important to have someone who understands statistics review quantitative scientific papers, it's important that folks who review papers focused on Indigenous communities have a deep understanding of Indigenous communities and Indigenous research...They can make sure that there is an appreciation for non-Western/conventional academic research methods that may be viewed negatively by some conventionally-trained scientists, such as qualitative and descriptive methods. They will also be sensitive to nuances of racism that can slip into papers unknowingly. This might show up as patronizing language, focusing on the negative (you're so sick and we'll come in and fix you) vs. the positive (emphasizing the strengths of Indigenous culture that can be used to improve health), or a lack of true partnership/collaboration in the research (is there a community IRB/oversight committee?).” 

Other challenges include the need to obtain community tribal IRB Board approval for publication after manuscript peer review. In addition, because this section of the journal has grant funding not available to the rest of the journal, administering fee waivers appropriately for the section has been a logistical challenge.  Similarly, categorizing and reporting on articles in the Food and Nutrition of Indigenous Peoples section creates challenges, since it includes content as diverse as Original Research, Reviews, and even Editorials. 

Reaching Indigenous peoples is a separate challenge. Indigenous Peoples are spread throughout the world, on every inhabited continent. They have suffered remarkably similar consequences because of colonization, including traumas from the forced removal from their lands, and profound disruptions to social systems and cultural traditions. There is a history of exploitation of Indigenous peoples by academia, resulting in justifiable mistrust. Publishing this work in an open access journal removes one major hurdle for readers. 

Outcomes 

As of July 2021, dozens of articles have been submitted to this journal section and the proceedings of all 4 Annual Conferences on Native American Nutrition have published in CDN. It takes significantly longer to review this content than other journal content, and it is cited less than the average content. However, full-text usage is above average.  

Qualitative assessments are encouraging. Feedback on the conference has been extremely positive. As hoped, attendees are a mix of Native and non-Native peoples, including researchers and students, tribal leaders and community activists, leaders of non-profits, funders, and public health and nutrition practitioners. The conference has attracted between 500-600 attendees. Because the nature of Indigenous community collaboration is based on relationships, the conference is not just a place to get information. It’s a place to create community, network, and collaborate. It’s an experience, and meeting in person is core to that experience.  

There have not yet been efforts to systematically survey authors, readers, or reviewers of the Food and Nutrition of Indigenous Peoples section of CDN. However, one recent author commented in CDN’s annual survey, “I appreciate the ability to contribute to the section on Indigenous nutrition that is unique to Current Developments in Nutrition.” This is typical of the feedback that Dr. Kurzer has received. Researchers who work with Indigenous Peoples are grateful that this new venue is available, and researchers without funding are especially appreciative of the funding support available.  

As for whether she has had success in changing the way that conventional academics work, Dr. Kurzer noted that a few people have shifted, but this is a long-term effort. Just as Indigenous Peoples of today suffer inter-generational effects of trauma that their parents, grandparents, and ancestors suffered, change will also be generational--a decade or 2 in the making. Notably however, with the rise of importance of Diversity, Equity, and Inclusion, even people resistant to change are opening up. 

Next Steps 

Dr. Kurzer predicts that meaningful change will happen as new researchers come in. She hopes to open up opportunities for graduate students, especially Indigenous persons who may not otherwise have been open to academia. It would be especially helpful to assist training of Indigenous Peoples in dietetics. The USDA has a Higher Education Grant program meant to bring more people into food and agriculture sciences. Dr. Kurzer hopes to apply for this grant program in collaboration with other institutions such as tribal colleges. 

There is growing realization of the importance of the social determinants of health. Faith Spotted Eagle gave a talk in the First Annual Conference on Native American Nutrition on trauma in Indigenous peoples and their relationship to food. She noted that when someone with diabetes or another nutrition-related illness comes to a dietitian or doctor, having experienced poverty and significant trauma (such as having family and community members who have taken their own lives, spent time incarcerated, struggled with drug addiction), giving them a piece of paper with instructions for a diabetic diet is not what this person needs. A different approach is seen with Māori nutrition educators in New Zealand. They actually talk very little about nutrition, and certainly it is not the opening conversation. It’s important to meet the person where they are, to deal with the most critical needs first. For example, if the patient does not have enough money to buy shoes for their children, that’s what you talk about. The diabetic diet is a later discussion point. If you want to improve nutrition status, you must deal with whole person, the whole family, and even the whole community. American Society for Nutrition journals and leadership are also coming to this realization, with a growing emphasis on nutrition and behavior. 

In the meantime, CDN continues to work hard to attract content as it awaits its inaugural Impact Factor. It also continues to support some of the really pivotal issues of our day, with an emphasis on sustainability of food systems, implementation science, and an open call for papers on the Impacts of Community Participation in Unlocking the Potential of Nutrition Interventions. 

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