Open Doors to Health Policy

Sen. Carlyle W. Begay
MMEP, Class of 2001
It didn’t take me long to understand that policy determines who, when, and how services are delivered on every level of the health care system.

Walter Begay Sr. lived to the ripe age of 84. He beat mortality odds that hover about 31 percent higher in his Navajo Nation than among Whites.

But he suffered most of his life with diabetes and congestive heart failure.

“Both diseases are so prevalent, they are engrained in our culture,” acknowledges Carlyle Begay, who credits his grandfather Walter with inspiring his path.

The youngest state senator in Arizona, Begay, 33, represents a sprawling district that includes eight tribes and Arizona’s entire Navajo Nation.

“American Indian people have little voice at the decision-making table, especially in the health policy arena,” says Begay, who wanted to become a doctor to tackle disparities afflicting his people.

What started as a path to medicine detoured to health policy, then the business of health care, and now public office.

“The road curved, but I’m sure that I am where I am today because of the many opportunities and doors that were opened.” Begay points to the Robert Wood Johnson Foundation Minority Medical Education Program (MMEP) as one of those decisive doors that opened and allowed him to enter.

A Series of Open Doors, Veering Paths

Begay describes health care as his greatest passion. He says it was stoked at an early age. Only seven when his grandfather died in 1988, he remembers the emphasis on education as his grandfather’s bequest. “I always remembered my grandfather telling me that my generation and future generations are the future of our people.”

Along the way, that road has been paved by what he calls the “four golden rules.”

“Education has always been first,” says Begay. “In general, when I look back at my career path, the road began with my grandfather. He always stressed going to college. Second, I have to make the most of every opportunity. Third, I breathe passion into my work; and fourth, it must make a difference.”

He likens his accomplishments to a series of open doors: each one leads to new opportunities, more experiences, and greater achievement. That big door opened in 2001, Begay recalls, when he was accepted to MMEP, which operated the six-week program at the University of Arizona College of Medicine and was the predecessor to the program now known as the Summer Medical and Dental Education Program (SMDEP).

Begay, prompted by a mentor and several classmates to apply to the program after sophomore year, recalls the MMEP experience as an important touchstone. Drawing upon the traditions of his ancestors, he says it was imperative to remember the story of his people and do everything possible to carry it on to his descendants.

The senator’s grandfather made his calling clear. Although he lived 12 years beyond the average life expectancy for American Indians, his ailments—chronic heart disease and diabetes—are among the most common causes of death for American Indians and Alaska Natives. Liver disease, obesity, lower respiratory diseases, poverty, malnutrition, and unintentional injury all contribute to the significantly higher mortality rates.

“My summer at MMEP sparked the first realization that improving health care in my community would be etched in my career path,” recalls Begay, who decided to gain as much experience as he could beyond the walls of University of Arizona before entering medical school.

“When I got to college I found myself asking what I wanted to do with my life,” says Begay. “I remember asking myself what was important to me. What was it that I wanted to accomplish in school and in life? What opportunities were open to me? From there, I made the most of every opportunity and let my interests guide me to where I am today.”

During his senior year, he won the coveted Barbara Jordan Health Policy Fellowship, which placed him in the Washington, DC, office of Congresswoman Donna Christensen, a medical doctor and head of the Congressional Black Caucus Health Braintrust. There, with health equity and minority health high on the agenda of the representative from the U.S. Virgin Islands, Begay says he began to connect his passions for health care to the power of health policy.

“I remember being briefly introduced to the congresswoman and having a conversation that was every bit of 15 minutes. My first assignment was to draft talking points for a speech she was to give on Medicare modernization,” he recalls. “Here I was—young, green, inexperienced, and given an opportunity to help inform policy through the voice of a member of the U.S. House of Representatives.”

Begay especially remembers the more shocking experience: the congresswoman integrated all of his talking points into her speech.

From there, a wider path and many more doors: Johns Hopkins School of Public Health Winter Institute; the Harvard School of Public Health; and new opportunities to be mentored and give mentoring focused on quality health care for the underserved and educational programs advancing technology, math, and science for American Indian school kids.

“It didn’t take me long to understand that policy determines who, when, and how services are delivered on every level of the health care system—federal, state, and tribal.” Begay says it became clear that his path to medicine was veering in a different direction.

Led by Passion + Commitment to Serve

“My decision to bypass medical school was cemented through the realization that health policy and the business of health care could facilitate my goals,” Begay explains. “Influence over how we live our lives is sealed by the people at the decision-making tables.”

His new path would take him to business development focused on American Indian Health Management, a venture that harnesses the resources of tribes, Medicaid, Medicare, and Indian Health Services to expand delivery and maximize the impact of private and public sector health delivery.

“Tribes are large purchasers of health services,” says Begay. “An important goal of the services is to modernize health care in Indian Country to keep pace with the rapidly changing industry.” Current funding provides only 55 percent of what is needed to ensure standard health care services for American Indians, according to the Indian Health Service, which is the major source of federal health services to tribal communities.

Begay’s focus on health, education, and public service did not go unnoticed. When State Senator Jack Johnson resigned from his seat in July 2013 to take a position in the Obama administration, Carlyle Begay was tapped as the successor. His appointment made him the only American Indian and youngest person to hold that position in the Arizona State Senate.

Arizona’s 7th Senatorial District, the largest legislative land mass in the country, stretches across five counties and a terrain of mountains and desert, frontier, and rural communities, with a total population of 260,000—of which 69 percent are Native Americans.

Begay says he has found his calling in public office and plans to vie for his seat, which is being contested in the November elections.

How did it feel transitioning from a would-be doctor to a hopeful elected official? 

“There was not a predictable path to my current career, but rather a series of many choices and turns that allowed me to create this path.” 

“It’s a blessing, a challenge, an opportunity,” responds Begay. He stresses that the act of campaigning, which demands meeting people and hearing the concerns of constituents, comes naturally to him. But the challenge of coupling that with fundraising adds a daunting burden.

As he heads into an election campaign, Begay is reflective. “Looking back at my life, there’s not a single moment that defined how I got here. There was not a predictable path to my current career, but rather a series of many choices and turns that allowed me to create this path.”

To young people seeking careers in health, he advises: “Whether it’s medical school, dentistry, nursing school, research, or elective office, create your own path based on your passion. If you’re passionate, you’ll be good at what you do. And then push forward using multiple points of entry.”