Figure 1.
American Indian/Alaska Native (AIAN) health policy hasn’t kept pace with the demographic and social changes of the last 50 years, and the result is that people are suffering needlessly.
The recently announced plans by the Indian Health Service (IHS) to dramatically reduce services at its Albuquerque facilities owing to budget deficits exemplify the outdated health financing policy in Indian country. Albuquerque has one of the largest concentrations of urban Indian populations and yet vital services are being terminated. For reservation-based populations, the level of per capita funding is less than half of what is provided to those on Medicaid and in prison.
Contrary to popular portrayals of American Indians as a vanishing people, the latest US census shows that the American Indian and Alaska Native population has reached a high point of more than 3 million people. In addition, indigenous people from Central and South America have immigrated to the United States in record numbers. Many of the 109 tribes that were terminated in the 1950s are fighting for federal and state recognition.
When the IHS was established in 1955, more than 95% of Indian people lived on or near their home reservations. Now, more than 60% of members of US tribes reside outside their home reservations at least part of the year, but only 1% of the IHS budget is earmarked for urban Indian health care. AIAN per capita funding does not follow individuals off the reservation. Another major problem is that many local and state governments believe the responsibility for Indian health and social services lies solely with the federal government, even though local and state governments benefit as much or more from the land succession upon which those service provision agreements are based.
Indian health problems are both structural and behavioral, and some level of accountability must also rest with tribal governments and individuals. In response, there has been a strong Indian wellness movement, which for several decades has been addressing alcohol and other drug problems, mental health, diet, and sedentary lifestyle issues with some success.
In this era of evidence-based public health practice, reforms to AIAN health policy are essential steps toward remediation and reconciliation. Here are some facts and policy recommendations.
Fact: Native American health professionals provide the most culturally competent care in rural areas.
Recommendation: Fund more native-specific health career opportunity programs.
Fact: Native rural and urban communities are poised to conduct community-based participatory research with native scholars and enlightened others in academia.
Recommendation: Fund more community-based participatory research efforts such as the Native American Research Centers for Health initiative.
Fact: Native communities propose and test culturally sound and evidence-based public health policy if given sufficient resources, space, and time.
Recommendation: Increase IHS funding to 100% of the level of need to support Indian self-determination efforts.
Arizona republican senator and chairman of the Senate Indian Affairs Committee John McCain recently charged, “The federal government has continually reneged on its trust and moral obligations to meet the educational, health care, and housing needs of Indians, and these needs far outweigh the imperceptible contribution that the proposed cuts will make to reducing the deficit.” It is time to meaningfully reform AIAN health policy to act in concert with other needed educational and housing reforms to eliminate the egregious disparities in health suffered by Indian peoples.