The Crisis in Native American Health

1. The Crisis in Native American Health By Kyra Rogers

2. Question: What is the unhealthiest group in the United States? • A. Hispanics • B. African Americans • C. Native Americans • D. Whites • E. Federal Convicts

3. Answer: Native Americans “…THE HEALTH OF INDIANS AS COMPARED WITH THAT OF THE GENERAL POPULATION IS BAD… Mariam Commission Report. (1928, February 21)

4. DESPITE AN INDEPENDENT PUBLIC HEALTH SYSTEM, THE INDIAN HEALTH SERVICE (IHS), FUNDED WITH $3 BILLION ANNUALLY, HEALTH STATUS INDICATORS SUGGEST NATIVE AMERICAN SUFFER DISPROPORTIONATELY FROM A VARIETY OF DISEASES Race and Ethnic Standards for Federal Statistics and Administrative Reporting. (1977)

5. Alcoholism Mortality RatesOffice of Native American and Indian Affairs (2002)

6. Diabetes Mortality RatesOffice of Native American and Indian Affairs (2002)

7. Tuberculosis Mortality RateOffice of Native American and Indian Affairs (2002)

8. Accidental Death RatesOffice of Native American and Indian Affairs (2002)

9. Influenza/PneumoniaMortality RatesOffice of Native American and Indian Affairs (2003)

10. HEALTH DISPARITIES EXCESSIVE BURDEN OF ILL HEALTH IN NATIVE AMERICAN COMMUNITIES, DUE GENETIC PREDISPOSITIONS, LIFE STYLE AND ENVIRONMENTAL FACTORS HEALTHCAREDISPARITIES INFERIOR, SUBSTANDARD HEALTH CARE ON TRIBAL LANDS THE RESULT OF - INADEQUATE FUNDING - LACK OF ACCESS - LACK OF PROVIDERS - DIRECT AND INDIRECT CONSEQUENCE OF RACIAL DISCRIMINATION Native American Unequal Treatment: Racial and Ethnic Confronting Disparities in Health Care (2003)

11. HEALTH CARE DISPARITIES IN NATIVE AMERICANS ARE THE RESULT OF • LACK OF ACCESS • FINANCIAL BARRIERS • CULTURALLY INCOMPETENT HEALTH PROVIDERS • LANGUAGE BARRIERS • EXCLUSION FROM HEALTH-RELATED RESEARCH • STEREOTYPING • RACIAL, ETHNIC BIAS National Institute of Medicine Report (1999)

12. HEALTH CARE SPENDING “DISPARITY” Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, (2003)

13. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN NATIVE AMERICANS, BUT A LARGE PROPORTION OF THESE DEATHS IS A RESULT OF DIABETES National Health Care Disparities Report 2003

14. DIABETES IS THE MOST SERIOUS HEALTH CHALLENGE FACING NATIVE AMERICAN AND ALASKA NATIVES WITH A GREATER THAN 50% DISEASE RATE IN SOME COMMUNITIES. Evette Roubideaux, M.D. (2004) American Journal of Public Health Volume 94:1

15. ALTHOUGH CANCER RATES ARE APPROXIMATELY 50% OF THOSE IN THE U.S. POPULATION, CANCER MORTALITY RATES APPROACH U.S. MORTALITY RATES DUE TO LATE DIAGNOSIS, LACK OF ACCESS TO CARE, AND SUBSTANDARD CARE CDC – Cancer Mortality Among American Indians and Alaska Natives 1994-98 (2003, August)

16. NATIVE AMERICANS ARE AT HIGH RISK FOR MENTAL HEALTH DISEASE DUE TO • SUBSTANCE/ALCOHOL ABUSE • DEPRESSION, RESULTING FROM - ISOLATION ON REMOTE RESERVATIONS - PERVASIVE POVERTY - CHRONIC DESPAIR - INTERGENERATIONAL TRAUMA - FORCIBLE, GOVERNMENTAL ASSIMILATION ATTEMPTS

17. GENETIC FACTORS • A study funded by the National Institute of Health demonstrated that there are genes which pre-dispose an individual to alcoholism. • An important gene is a mutation of the gene for the enzyme aldehyde dehydrogenase needed to metabolize alcohol. • This gene is found frequently in Chinese and Japanese populations but not in other pacific rim groups, Euro-Americans, Native Americans or Eskimos. Indiana Alcohol Research Center, IU School of Medicine; Purdue University

18. POSSIBE SOLUTIONS TO THE PROBLEM • INCREASE FUNDING TO THE INDIAN HEALTH SERVICE • INCREASE (SCHOLARSHIP) FUNDING FOR NATIVE AMERICAN MEDICAL EDUCATION TO PRODUCE MORE CULTURALLY SENSITIVE HEALTH CARE WORKERS • INCREASE FUNDING FOR NATIVE AMERICAN FOCUSED RESEARCH ON DIABETES ALCOHOLISM MENTAL HEALTH

19. POSSIBE SOLUTIONS TO THE PROBLEM • DEVELOP SCREENING PROGRAMS FOR DIABETES CARDIOVASCULAR DISEASE SUBSTANCE ABUSE CANCER • DEVELOP PUBLIC AWARENESS PROGRAMS TO INFORM TRIBAL GROUPS OF HEALTH PROBLEMS UNIQUE TO AMERICAN INDIANS • TRANSFER CONTROL OF NATIVE AMERICAN HEALTH, HEALTH RESEARCH, PREVENTION AND HEALTH EDUCATION FROM DHHS TO TRIBAL COMMUNITIES

20. SUPREME COURT RE-STATED THE “…DISTINCTIVE OBLIGATION OF TRUST INCUMBENT UPON THE GOVERNMENT IN ITS DEALINGS WITH DEPENDENT AND SOMETIMES EXPLOITED PEOPLES” ACCORDIINGY, THE U.S. GOVERNMENT ACCEPTED MANY OBLIGATION TO NATIVE AMERICAN TRIBES INCLUDING EDUCATION, CONSTRUCTION, LAW ENFORCEMENT AND HEALTH CARE United States Supreme Court Cherokee Nations, 30 U.S. (5Per.)at 17

21. POSSIBLE SOLUTIONS TONATIVE AMERICAN HEALTH DISPARITIES • TRAINING MORE HEALTH PROFESSIONALS TO ASSESS AND MONITOR HEALTH TRENDS IN ORDER TO BETTER DIRECT HEALTH POLICY • TRAINING MORE NATIVE AMERICAN HEALTH EDUCATORS, SCIENTISTS, RESEARCHERS, PHYSICIANS AND NURSES

22. “FOR AMERICAN INDIAN AND ALASKAN NATIVE PEOPLE, THE FEDERAL RESPONSIBILITY FOR HEALTH SERVICES REPRESENTS A “PRE-PAID” ENTITLEMENT (HMO), PAID FOR BY CEDING OF OVER 400 MILLION ACRES OF LAND TO THE UNITED STATES”Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, (2003)

23. NATIVE AMERICAN HEALTH CARE FEDERAL RESPONSIBILITY BUREAU OF INDIAN AFFAIRS (DEPT. OF WAR, 1776) BUREAU OF INDIAN AFFAIRS (DEPT. OF INTERIOR, 1849) INDIAN HEALTH SERVICE (DEPT OF HEALTH EDUCATION AND WELFARE, 1955) INDIAN HEALTH SERVICE (DEPT OF HEALTH & HUMAN SERVICES) (1966)

24. THE FEDERAL OBLIGATION TO PROVIDE HEALTH CARE SERVICES IS THE RESULT OF NATIVE AMERICANS CEDING MORE THAN 400 MILLION ACRES OF TRIBAL LANDS TO THE U.S. PURSUANT TO AGREEMENTS AND TREATIES United States Supreme Court Cherokee Nations, VS. Georgia (1831)

25. NATIVE AMERICANMEDIAN AGE vs. U.S. POPULATIONBroken Promises: Evaluating the Native American Health Care System (2004, September)

26. THE CORRECTION OF INDIAN HEALTH DISPARITIES • IS NOT JUST A BROKEN PROMISE OF THE FEDERAL GOVERNMENT • IT IS A FAILED MORAL OBLIGATION AND A NATIONAL DISGRACE!

27. WHAT CAN YOU DO? • ACCESS YOUR LEGISLATORS TO INFLUENCE HEALTH POLICY AND PROVIDE MORE FUNDING • ACCESS THE MEDIA TO GET THE WORD OUT ABOUT HORRIBLE INDIAN HEALTH CONDITIONS • VOLUNTEER TO INSURE THERE IS PUBLIC AWARENESS AND INFORMATION AVAILABLE ABOUT THE DISPARITY IN INDIAN HEALTH CARE

28. REFERENCES Institute of Medicine of the National Academy of Science. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003). Washington DC: National Academies Press U. S. Commission on Civil Rights. (2004, September). Broken Promises, Evaluating the Native American Health Care System. Chapters 1-4. United States Congress. Retrieved on May 23, 2006 from http://www.usccr.gov American Cancer Society Surveillance Research (2006) Incidence and Mortality Rates by Site, Race and Ethnicity U.S. 1998 – 2002 . Retrieved on April 20, 2006 from http://seer.cancer.gov/csr/1975_2002/,2005 CDC (2003, November 28) Health Status of American Indians Compared with Other Racial/Ethnic Minority Populations – Selected States, 2001 – 2002. MMWR Weekly 52(47) pp. 1148-1152. Retrieved May 25, 2006 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a3.htm

29. REFERENCES Kibbey, Hal (N.D.) Genetic Influences on Alcohol and Drinking . Retrieved on May 28, 2006 from http://www.Indiana.edu/~rcapub/v17n3/p18.html