Centuries of conflict and mistrust have created a frail landscape for the healthcare provided to American Indians and Alaska Natives
The United States has a federally funded healthcare program for American Indians and Alaskan Natives (AI/AN). It is called the Indian Health Service (IHS) (ihs.gov). As part of the United States Department of Health and Human Services, the program provides facility based care and services to over 567 nationally recognized tribes, over 2.2 million AI/AN (ihs.gov). There are 35 hospitals, and over 500 health centers, stations, and clinics throughout the country (ihs.gov). Services not provided at these centers may be referred to partnering public facilities (ihs.gov).
The goal of the program is to provide comprehensive, appropriate care for AI/AN that is sensitive to culture and strives to protect the sovereign rights of the Tribes (ihs.gov). However, the program is not delivered without challenges (Warne & Frizzell, 2014). Most significantly, the IHS is chronically underfunded and the appropriation of funds is not guaranteed year-to-year, as it is voted on by Congress (Warne & Frissell, 2014). For example, federal healthcare expenditure per capita comparing programs like Medicare with IHS shows a glaring disparity, revealing per capita spending on Medicare recipients at approximately $11, 000 /year, whereas IHS per capita spending at about $2500/year (Warne & Frizell, 2014). It is not that the AI/NA population does not need the healthcare, but the budget to do so is not existent ((Warne & Frizzell, 2014).
The AI/NA population has significantly higher rates of many chronic diseases than their white counterparts (Denny, Holtzman, Goins, & Croft, 2005). Studies show AI/NA have a rate 2.5 times that of the white population to develop diabetes (minorityhealth.hhs.gov). Other chronic diseases that such as cancer, respiratory conditions, liver, and kidney disease all have higher rates of affliction in AI/NA than other races in the US (ihs.gov). AI/NA also have a higher incidence of suicide, unintentional injuries (such as car accidents), and drug use than the general population (ihs.gov).
As a result of the lack of funds for the program, services are prioritized to life threatening conditions so there is less money to be spent on preventative care and treatment of chronic disease (ihs.gov, Warne & Frissell, 2014). Social determinants of health such as poverty, lack of education, discrimination and cultural differences play roles in the health disparities and lower life expectancy in AI/NA than the rest of the US population (ihs.gov).
So I am not thrilled at what I uncovered as far as health care provided to AI/NA, but I am encouraged that there are some facilities that cater only to the needs of AI/NA, therefore the care delivered should be culturally appropriate. Also, the Centers for Disease Control (CDC) is funding a program called “Good Health and Wellness in Indian Country”, which is a $78 million initiative to help develop community based programs to reduce the rate of smoking, obesity, diabetes, heart disease and stroke incidence in the AI/NA population (CDC.gov). This is good news to help fight chronic diseases from an “upstream” perspective.
References
Centers for Disease Control: https://www.cdc.gov/chronicdisease/tribal/factsheet.htmhttps://www.cdc.gov/chronicdisease/tribal/factsheet.htm
Denny, C. H., Holtzman, D., Goins, R. T., & Croft, J. B. (2005). Disparities in Chronic Disease Risk Factors and Health Status Between American Indian/Alaska Native and White Elders: Findings From a Telephone Survey, 2001 and 2002. American Journal of Public Health, 95(5), 825–827. http://doi.org/10.2105/AJPH.2004.043489
Indian Health Service: https://www.ihs.gov
Minority Health: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=33https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=33
Warne, D. & Bane Frizzell, L. (2014). American Indian Health Policy: Historical trends and contemporary issues. American Journal of Public Health. (S3), s263-s267. doi: 10.2105/AJPH.2013.301682