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HEALTH SERVICES FOR URBAN AMERICAN INDIANS AND ALASKA NATIVES

Policy Date: 1/1/1998
Policy Number: 9811

The American Public Health Association,
Observing that more than half1 of the approximately 2.3 million American Indians, and Alaska Natives live in United States cities; and
Noting that many urban American Indian and Alaskan Natives depend upon Indian-operated urban programs for access to health services ranging from information referral and community health services to comprehensive primary health care services;9
Realizing that Congress authorizes funding for these urban programs through Title V of the Indian Health Care Improvement Act, a separate and distinct program from other Indian Health Service Appropriations;10
Recognizing that American Indian and Alaska Natives living in cities do not share equitably in assistance granted Indian people who remain on Indian reservations;11
Acknowledging that urban American Indians/Alaska Natives like their reservation counterparts, are disproportionately affected by serious health problems such as diabetes, heart disease, stroke, unintentional injuries, suicide, homicide, and alcohol and drug problems, obesity,12-13 oral diseases,14-15 mental health problems, and infant mortality;2 and
Knowing that the health of American Indian and Alaska Native people, while improving, continues to lag behind other Americans;3 and
Noting that the health status of urban American Indians and Alaska Natives has been shown to be similar to that found among those living on reservations;4 and
Recognizing that poverty, unemployment, inadequate education, and other social and economic factors play an important role in influencing the health status of both reservation and urban Indians;5 and
Acknowledging that federal health care funding for American Indians and Alaska Natives residing in urban areas is seriously inadequate;6 and
Finding that culturally-sensitive services for urban American Indians and Alaska Natives remain limited due to a lack of Federal, state, and local appropriations and support;7 and
Recognizing that due to a lack of adequate funding and poor integration with the Indian Health Service programs, that data regarding urban Indian health are severely lacking; therefore
1. Recommends that the Congress of the United States increase appropriations to the Indian Health Service to address the health care needs of urban American Indians and Alaska Natives;
2. Encourages the Indian Health Service with the assistance of American Indian and Alaskan Native community members to promote collaboration between urban programs and tribes to help build bridges between urban and tribal providers;
3. Calls upon state and local health care officials to recognize the unique health care needs of and demonstrate a cultural sensitivity to urban American Indians and Alaska Natives and the importance of including them in efforts to improve access to care and in addressing risk factors contributing to their health problems;
4. Recommends that state and local governments provide complementary funding to assure adequate levels of culturally-appropriate health care for American Indians and Alaska Natives living in their states, cities and counties;
5. Encourages managed care organizations to become culturally sensitive to American Indian and Alaska Native populations, educate these populations on access to the managed care system; and contract with urban Indian health programs as essential community providers;
6. Encourages Indian Health Service facilities to collaborate and partner with urban Indian health programs in their areas to increase access to services for urban Indians; and
7. Recommends that funding be made available to existing urban Indian health programs, to collect and analyze national data specific to urban Indian health for planning and policy development.

References


  1. Indian Health Service: FY 1999 Performance Plan. Washington, DC: US Department of Health and Human Services, February 1, 1998.

  2. Indian Health Service: Comprehensive Health Care Program for American Indians and Alaska Natives. Washington, DC: US Department of Health and Human Services, March 18, 1997.

  3. Katz S. The History and Politics of US Health Care Policy for American Indians and Alaska Natives. Am J Public Health. October 1996;86(10):1464-1472.

  4. Grossman DC, Krieger JW, Sugarman JR, Forquera RA. The Health of Urban American Indians and Alaska Natives. JAMA. March 16, 1994;271(11):845-850.

  5. Alaska Native Commission; Joint Federal-State Commission on Policies and Programs Affecting Alaska Natives. Anchorage, Alaska. May, 1994.

  6. FY 1998 Interior Appropriations-Indian Health Service.

  7. Ibid (4).

  8. Indian Health Care, Washington DC: Office of Technology Assessment, 1986. US Department of Health and Human Services publication OTA-H 290.

  9. Indian Health Service. Trends in Indian Health 1996. Washington, DC: US Department of Health and Human Services.

  10. Indian Health Design Team. Design for a new IHS: Final Recommendations of the Indian Health Design Team, Report II, January, 1997.

  11. Op. Cit. (3)

  12. Will JC, Strauss KF, Mendlein, JM, Ballew C, White LL, Peter DG, Diabetes mellitus among Navajo Indians: Findings from the Navajo Health and Nutrition Survey. J Nutr. 127:2106S-2113S, 1997.

  13. Scanlon KS, Delenius K, Parvanta I, Grummer-Strawn L. Pediatric Nutrition Surveillance, 1997 Annual Summary, Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, 1998 (in press).

  14. US Department of Health and Human Services, Indian Health Service, Office of Public Health, Division of Community and Environmental Health, Program Statistics Team. Trends in Indian Health, 1997. ISSN# 1095-2896.

  15. Indian Health Service. Oral Health of Native Americans: Summary of Recent Findings, Trends and Regional Differences. August 1994.

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