The The CrisisCrisis in in Native American Native American

HealthHealth

By By

Kyra RogersKyra Rogers

Question: What is the Question: What is the unhealthiest group in the unhealthiest group in the

United States?United States? A. HispanicsA. Hispanics

B. African AmericansB. African Americans

C. Native AmericansC. Native Americans

D. WhitesD. Whites

E. Federal ConvictsE. Federal Convicts

“…“…THE HEALTH OF INDIANS AS COMPARED THE HEALTH OF INDIANS AS COMPARED WITH THAT OF THE GENERAL WITH THAT OF THE GENERAL

POPULATION IS BAD…POPULATION IS BAD…

Mariam Commission Report. (1928, February 21)Mariam Commission Report. (1928, February 21)

Answer:Answer: Native Americans Native Americans

DESPITE AN INDEPENDENT PUBLIC DESPITE AN INDEPENDENT PUBLIC HEALTH SYSTEM, THE INDIAN HEALTH SYSTEM, THE INDIAN

HEALTH SERVICE (IHS), FUNDED HEALTH SERVICE (IHS), FUNDED WITH $3 BILLION ANNUALLY, WITH $3 BILLION ANNUALLY, HEALTH STATUS INDICATORS HEALTH STATUS INDICATORS SUGGEST NATIVE AMERICAN SUGGEST NATIVE AMERICAN

SUFFER DISPROPORTIONATELY SUFFER DISPROPORTIONATELY FROM A VARIETY OF DISEASESFROM A VARIETY OF DISEASES

Race and Ethnic Standards for Federal Race and Ethnic Standards for Federal

Statistics and Administrative Reporting. (1977)Statistics and Administrative Reporting. (1977)

Alcoholism Mortality RatesAlcoholism Mortality RatesOffice of Native American and Indian Affairs (2002)Office of Native American and Indian Affairs (2002)

1.0

7.7

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

U.S, Population

Native AmericanPopulation

Diabetes Mortality RatesDiabetes Mortality Rates Office of Native American and Indian Affairs (2002)Office of Native American and Indian Affairs (2002)

1.0

4.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

U.S. Population

Native AmericanPopulation

Tuberculosis Mortality RateTuberculosis Mortality Rate Office of Native American and Indian Affairs (2002)Office of Native American and Indian Affairs (2002)

1.0

6.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

U.S. Population

Native AmericanPopulation

Accidental Death RatesAccidental Death Rates Office of Native American and Indian Affairs (2002)Office of Native American and Indian Affairs (2002)

1.0

2.8

0

0.5

1

1.5

2

2.5

3

U.S. Population

Native AmericanPopulation

Influenza/PneumoniaInfluenza/PneumoniaMortality RatesMortality Rates

Office of Native American and Indian Affairs (2003)Office of Native American and Indian Affairs (2003)

1.0

1.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

U.S Population

Native AmericanPopulation

Native AmericanNative AmericanHEALTH DISPARITIESHEALTH DISPARITIES

EXCESSIVE BURDEN OF ILL HEALTH IN EXCESSIVE BURDEN OF ILL HEALTH IN NATIVE AMERICAN COMMUNITIES, DUE NATIVE AMERICAN COMMUNITIES, DUE GENETIC PREDISPOSITIONS, LIFE STYLE GENETIC PREDISPOSITIONS, LIFE STYLE AND ENVIRONMENTAL FACTORSAND ENVIRONMENTAL FACTORS

HEALTHHEALTH CARECARE DISPARITIESDISPARITIES

INFERIOR, SUBSTANDARD INFERIOR, SUBSTANDARD HEALTH CARE ON TRIBAL HEALTH CARE ON TRIBAL LANDS THE RESULT OFLANDS THE RESULT OF- INADEQUATE FUNDING- INADEQUATE FUNDING- LACK OF ACCESS- LACK OF ACCESS- LACK OF PROVIDERS- LACK OF PROVIDERS- DIRECT AND INDIRECT - DIRECT AND INDIRECT CONSEQUENCE OF CONSEQUENCE OF RACIAL DISCRIMINATIONRACIAL DISCRIMINATION

Unequal Treatment: Racial and Ethnic Confronting Disparities in Health Care (2003)

HEALTH CARE DISPARITIES IN NATIVE HEALTH CARE DISPARITIES IN NATIVE AMERICANS ARE THE RESULT OFAMERICANS ARE THE RESULT OF

LACK OF ACCESSLACK OF ACCESS FINANCIAL BARRIERSFINANCIAL BARRIERS CULTURALLY INCOMPETENT HEALTH CULTURALLY INCOMPETENT HEALTH

PROVIDERSPROVIDERS LANGUAGE BARRIERSLANGUAGE BARRIERS EXCLUSION FROM HEALTH-RELATED EXCLUSION FROM HEALTH-RELATED

RESEARCHRESEARCH STEREOTYPINGSTEREOTYPING RACIAL, ETHNIC BIASRACIAL, ETHNIC BIAS

National Institute of MedicineNational Institute of MedicineReport (1999)Report (1999)

HEALTH CARE HEALTH CARE SPENDING “DISPARITY”SPENDING “DISPARITY”

0

1,000

2,000

3,000

4,000

5,000

6,000

2002

Per

Cap

ita

Sp

end

ing

VeteransAdministration

U.S. Population Bureau of Prisons Medicare Indian HealthService

Unequal Treatment: Confronting Racial and Ethnic

Disparities in Healthcare, (2003)

HEART DISEASEHEART DISEASE

IS THE LEADING CAUSE OF DEATH IN IS THE LEADING CAUSE OF DEATH IN NATIVE AMERICANS, BUT A LARGE NATIVE AMERICANS, BUT A LARGE

PROPORTION OF THESE DEATHS IS A PROPORTION OF THESE DEATHS IS A RESULT OF DIABETESRESULT OF DIABETES

National Health Care Disparities Report 2003National Health Care Disparities Report 2003

DIABETES IS THE MOST SERIOUS DIABETES IS THE MOST SERIOUS HEALTH CHALLENGE FACING HEALTH CHALLENGE FACING

NATIVE AMERICAN AND ALASKA NATIVE AMERICAN AND ALASKA NATIVES WITH A GREATER THAN NATIVES WITH A GREATER THAN

50% DISEASE RATE IN SOME 50% DISEASE RATE IN SOME COMMUNITIES.COMMUNITIES.

Evette Roubideaux, M.D. (2004) Evette Roubideaux, M.D. (2004)

American American Journal of Public Health Journal of Public Health Volume 94:1 Volume 94:1

ALTHOUGH ALTHOUGH CANCER RATESCANCER RATES ARE ARE APPROXIMATELY 50% OF THOSE IN APPROXIMATELY 50% OF THOSE IN THE U.S. POPULATION, THE U.S. POPULATION, CANCERCANCER MORTALITY RATESMORTALITY RATES APPROACH U.S. APPROACH U.S. MORTALITY RATES DUE TO LATE MORTALITY RATES DUE TO LATE DIAGNOSIS, LACK OF ACCESS TO DIAGNOSIS, LACK OF ACCESS TO CARE, AND SUBSTANDARD CARECARE, AND SUBSTANDARD CARE

CDC – Cancer Mortality AmongCDC – Cancer Mortality Among

American Indians and Alaska Natives 1994-98American Indians and Alaska Natives 1994-98

(2003, August) (2003, August)

NATIVE AMERICANS ARE AT HIGH NATIVE AMERICANS ARE AT HIGH RISK FOR RISK FOR MENTAL HEALTHMENTAL HEALTH DISEASE DISEASE

DUE TODUE TO

- SUBSTANCE/ALCOHOL ABUSESUBSTANCE/ALCOHOL ABUSE- DEPRESSION, RESULTING FROMDEPRESSION, RESULTING FROM

- ISOLATION ON REMOTE - ISOLATION ON REMOTE RESERVATIONSRESERVATIONS- PERVASIVE POVERTY- PERVASIVE POVERTY- CHRONIC DESPAIR- CHRONIC DESPAIR- INTERGENERATIONAL TRAUMA- INTERGENERATIONAL TRAUMA- FORCIBLE, GOVERNMENTAL - FORCIBLE, GOVERNMENTAL ASSIMILATION ATTEMPTSASSIMILATION ATTEMPTS

GENETIC FACTORSGENETIC FACTORS A study funded by the National Institute of A study funded by the National Institute of

Health demonstrated that there are genes Health demonstrated that there are genes which pre-dispose an individual to alcoholism.which pre-dispose an individual to alcoholism.

An important gene is a mutation of the gene An important gene is a mutation of the gene for the enzyme aldehyde dehydrogenase for the enzyme aldehyde dehydrogenase needed to metabolize alcohol.needed to metabolize alcohol.

This gene is found frequently in Chinese and This gene is found frequently in Chinese and Japanese populations but Japanese populations but notnot in other pacific in other pacific rim groups, Euro-Americans, rim groups, Euro-Americans, Native Native Americans or Eskimos.Americans or Eskimos.

Indiana Alcohol Research Center, IU School of Medicine; Purdue UniversityIndiana Alcohol Research Center, IU School of Medicine; Purdue University

POSSIBE SOLUTIONS TO THE PROBLEMPOSSIBE SOLUTIONS TO THE PROBLEM

A)A) INCREASE FUNDING TO THE INDIAN HEALTH SERVICEINCREASE FUNDING TO THE INDIAN HEALTH SERVICE

B)B) INCREASE (SCHOLARSHIP) FUNDING FOR NATIVE INCREASE (SCHOLARSHIP) FUNDING FOR NATIVE AMERICAN MEDICAL EDUCATION TO PRODUCE MORE AMERICAN MEDICAL EDUCATION TO PRODUCE MORE CULTURALLY SENSITIVE HEALTH CARE WORKERSCULTURALLY SENSITIVE HEALTH CARE WORKERS

C)C) INCREASE FUNDING FOR NATIVE AMERICAN FOCUSED INCREASE FUNDING FOR NATIVE AMERICAN FOCUSED RESEARCH ONRESEARCH ON

DIABETESDIABETESALCOHOLISMALCOHOLISM

MENTAL HEALTHMENTAL HEALTH

POSSIBE SOLUTIONS TO THE PROBLEMPOSSIBE SOLUTIONS TO THE PROBLEM

D)D) DEVELOP SCREENING PROGRAMS FOR DEVELOP SCREENING PROGRAMS FOR

DIABETESDIABETES

CARDIOVASCULAR DISEASECARDIOVASCULAR DISEASE

SUBSTANCE ABUSESUBSTANCE ABUSE

CANCERCANCER

E)E) DEVELOP PUBLIC AWARENESS PROGRAMS TO INFORM DEVELOP PUBLIC AWARENESS PROGRAMS TO INFORM TRIBAL GROUPS OF HEALTH PROBLEMS UNIQUE TO TRIBAL GROUPS OF HEALTH PROBLEMS UNIQUE TO AMERICAN INDIANSAMERICAN INDIANS

F)F) TRANSFER CONTROL OF NATIVE AMERICAN HEALTH, TRANSFER CONTROL OF NATIVE AMERICAN HEALTH, HEALTH RESEARCH, PREVENTION AND HEALTH HEALTH RESEARCH, PREVENTION AND HEALTH EDUCATION FROM DHHS TO TRIBAL COMMUNITIESEDUCATION FROM DHHS TO TRIBAL COMMUNITIES

SUPREME COURT RE-STATED THE “…SUPREME COURT RE-STATED THE “…DISTINCTIVE OBLIGATION OF TRUST DISTINCTIVE OBLIGATION OF TRUST INCUMBENT UPON THE GOVERNMENT IN ITS INCUMBENT UPON THE GOVERNMENT IN ITS DEALINGS WITH DEPENDENT AND SOMETIMES DEALINGS WITH DEPENDENT AND SOMETIMES EXPLOITED PEOPLES”EXPLOITED PEOPLES”

ACCORDIINGY, THE U.S. GOVERNMENT ACCORDIINGY, THE U.S. GOVERNMENT ACCEPTED MANY OBLIGATION TO NATIVE ACCEPTED MANY OBLIGATION TO NATIVE AMERICAN TRIBES INCLUDING EDUCATION, AMERICAN TRIBES INCLUDING EDUCATION, CONSTRUCTION, LAW ENFORCEMENT AND CONSTRUCTION, LAW ENFORCEMENT AND HEALTH CAREHEALTH CARE

United States Supreme CourtUnited States Supreme CourtCherokee Nations, 30 U.S. (5Per.)at 17Cherokee Nations, 30 U.S. (5Per.)at 17

POSSIBLE SOLUTIONS TOPOSSIBLE SOLUTIONS TONATIVE AMERICAN HEALTH NATIVE AMERICAN HEALTH

DISPARITIESDISPARITIESG)G) TRAINING MORE HEALTH TRAINING MORE HEALTH

PROFESSIONALS TO ASSESS PROFESSIONALS TO ASSESS AND MONITOR HEALTH AND MONITOR HEALTH TRENDS IN ORDER TO TRENDS IN ORDER TO BETTER DIRECT HEALTH BETTER DIRECT HEALTH POLICYPOLICY

H)H) TRAINING MORE NATIVE TRAINING MORE NATIVE AMERICAN HEALTH AMERICAN HEALTH EDUCATORS, SCIENTISTS, EDUCATORS, SCIENTISTS, RESEARCHERS, PHYSICIANS RESEARCHERS, PHYSICIANS AND NURSESAND NURSES

““FOR AMERICAN INDIAN AND ALASKAN FOR AMERICAN INDIAN AND ALASKAN NATIVE PEOPLE, THE FEDERAL NATIVE PEOPLE, THE FEDERAL

RESPONSIBILITY FOR HEALTH SERVICES RESPONSIBILITY FOR HEALTH SERVICES REPRESENTS A “PRE-PAID” ENTITLEMENT REPRESENTS A “PRE-PAID” ENTITLEMENT (HMO), PAID FOR BY CEDING OF OVER 400 (HMO), PAID FOR BY CEDING OF OVER 400 MILLION ACRES OF LAND TO THE UNITED MILLION ACRES OF LAND TO THE UNITED

STATES”STATES”Unequal Treatment: Confronting Racial and Ethnic

Disparities in Healthcare, (2003)

NATIVE AMERICAN NATIVE AMERICAN HEALTH CARE HEALTH CARE

FEDERAL RESPONSIBILITYFEDERAL 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)

THE FEDERAL OBLIGATION TO THE FEDERAL OBLIGATION TO PROVIDE PROVIDE HEALTH CAREHEALTH CARE SERVICES IS SERVICES IS THE RESULT OF NATIVE AMERICANS THE RESULT OF NATIVE AMERICANS CEDING MORE THAN 400 MILLION CEDING MORE THAN 400 MILLION ACRES OF TRIBAL LANDS TO THE U.S. ACRES OF TRIBAL LANDS TO THE U.S. PURSUANT TO AGREEMENTS AND PURSUANT TO AGREEMENTS AND TREATIESTREATIES

United States Supreme CourtUnited States Supreme Court

Cherokee Nations, VS. Georgia (1831)Cherokee Nations, VS. Georgia (1831)

NATIVE AMERICANNATIVE AMERICANMEDIAN AGE vs. U.S. POPULATIONMEDIAN AGE vs. U.S. POPULATION

Broken Promises: Evaluating the Native American Broken Promises: Evaluating the Native American Health Care System (2004, September)Health Care System (2004, September)

24.2

32.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Yea

rs in

Age

Native American U.S. Population

Native American

U.S. Population

THE CORRECTION OF INDIAN THE CORRECTION OF INDIAN HEALTH DISPARITIESHEALTH DISPARITIES

IS NOT JUST A BROKEN PROMISE OF THE IS NOT JUST A BROKEN PROMISE OF THE FEDERAL GOVERNMENTFEDERAL GOVERNMENT

IT IS A FAILED MORAL OBLIGATION AND A IT IS A FAILED MORAL OBLIGATION AND A NATIONAL DISGRACE!NATIONAL DISGRACE!

WHAT CAN WHAT CAN YOU YOU DO?DO? ACCESS YOUR ACCESS YOUR

LEGISLATORSLEGISLATORS TO TO INFLUENCE HEALTH POLICY INFLUENCE HEALTH POLICY AND PROVIDE MORE AND PROVIDE MORE FUNDINGFUNDING

ACCESS THE MEDIAACCESS THE MEDIA TO TO GET THE WORD OUT GET THE WORD OUT ABOUT HORRIBLE INDIAN ABOUT HORRIBLE INDIAN HEALTH CONDITIONSHEALTH CONDITIONS

VOLUNTEERVOLUNTEER TO INSURE TO INSURE THERE IS PUBLIC THERE IS PUBLIC AWARENESS AND AWARENESS AND INFORMATION AVAILABLE INFORMATION AVAILABLE ABOUT THE DISPARITY IN ABOUT THE DISPARITY IN INDIAN HEALTH CAREINDIAN HEALTH CARE

REFERENCESREFERENCES

Institute of Medicine of the National Academy of Science. (2003). Unequal Institute of Medicine of the National Academy of Science. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003). Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003). Washington DC: National Academies PressWashington DC: National Academies Press

U. S. Commission on Civil Rights. (2004, September). Broken Promises, U. S. Commission on Civil Rights. (2004, September). Broken Promises, Evaluating the Native American Health Care System. Chapters 1-4. United Evaluating the Native American Health Care System. Chapters 1-4. United States Congress. Retrieved on May 23, 2006 from http://www.usccr.govStates Congress. Retrieved on May 23, 2006 from http://www.usccr.gov

American Cancer Society Surveillance Research (2006) Incidence and Mortality American Cancer Society Surveillance Research (2006) Incidence and Mortality Rates by Site, Race and Ethnicity U.S. 1998 – 2002 . Retrieved on April 20, Rates by Site, Race and Ethnicity U.S. 1998 – 2002 . Retrieved on April 20, 2006 from 2006 from http://seer.cancer.gov/csr/1975_2002/,2005http://seer.cancer.gov/csr/1975_2002/,2005

CDC (2003, November 28) Health Status of American Indians Compared with CDC (2003, November 28) Health Status of American Indians Compared with Other Racial/Ethnic Minority Populations – Selected States, 2001 – 2002. Other Racial/Ethnic Minority Populations – Selected States, 2001 – 2002. MMWR Weekly 52(47) pp. 1148-1152. Retrieved May 25, 2006 MMWR Weekly 52(47) pp. 1148-1152. Retrieved May 25, 2006 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a3.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a3.htm

REFERENCESREFERENCESKibbey, Hal (N.D.) Genetic Influences on Alcohol and Drinking . Retrieved on May 28, 2006 Kibbey, Hal (N.D.) Genetic Influences on Alcohol and Drinking . Retrieved on May 28, 2006

from from http://www.Indiana.edu/~rcapub/v17n3/p18.htmlhttp://www.Indiana.edu/~rcapub/v17n3/p18.html