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Federal Policies Impacting American Indians and Alaska Natives

Policy Date: 1/1/1999
Policy Number: 9904

The American Public Health Association,
Understanding that federal policies greatly impact the health of American Indians and Alaska Natives (AIAN), and that the Indian Health Care Improvement Act, PL 94-437 (IHCIA), is scheduled for reauthorization in the year 1999 (IHCIA directs the Department of Health and Human Services (DHHS) to make grants and to provide scholarships to encourage AIAN to enroll in health-related training programs, authorizes the Secretary to expend funds to better meet Indian health care needs and to provide hospitals and other health facilities, and to supply unmet needs for safe water and sanitary waste disposal facilities. The Act requires the Secretary to contract with urban Indian organizations to assist such organizations to establish and administer health programs to benefit urban Indians); and
Observing that approximately 1.34 million AIAN belong to the more than 554 federally recognized tribes and qualify for Indian Health Service (IHS) and Bureau of Indian Affairs (BIA) services, and that AIAN health status is lower than that of the general US population;1-4 and
Finding that the AIAN high school graduation rate is lower than the general United States population (at fifty-six percent in 1980 to sixty-six percent in 1990, compared to sixty-seven to seventy-five percent), and that there are decreased opportunities for AIAN scholarships, programs, and fellowships;5 and
Finding that AIAN students are for the most part enrolled in schools operated and/or funded through the Department of Education (DOEd) or the Department of the Interior (DOI), which are operated by the DOEd/DOI or Tribes; and
Affirming that the federal responsibility for AIAN health care is grounded in treaty obligations, case law, the Snyder Act of 1921 (PL 83-568), IHCIA, etc.;6 and
Acknowledging tribal sovereignty and the unique Government-to-Government relationship between Tribes and the United States, including The President's Memorandum of April 29, 1994, titled, "Government-to-Government Relationship with Native American Tribal Governments;" and
Finding that the current IHS authorization ceiling does not meet the health needs of AIAN;7 and
Believing that no AIAN from any Tribe should be without identifiable and realistic access to the benefits of health care and public health protection; therefore
1. Recommends and supports the reauthorization of IHCIA, including provision for independent evaluations to be conducted that will measure the extent to which elements of IHCIA are carried out, with subsequent reports to be given to Congress and Tribes;
2. Urges the Secretary of DHHS to make grants to public and nonprofit private health entities of Tribes or Tribal organizations to identify and train health and public health professionals, and to provide fellowships and internships within the Department which specifically recruit and retain AIAN; and
3. Urges the Secretaries of the DOEd and the DOI to implement with Tribes, AIAN culturally competent health promotion and disease prevention curricula in their schools, and urges federal, state, local and Tribal public health communities to build working relationships, including additional funding support, to improve and promote public health for AIAN.

References


  1. Bush JK. Legal, Historical and Political Context in which Tribes Make Health Care Decisions. National Indian Health Board, Denver, CO: 1996.

  2. APHA Policy Statement 9811: Health Services for Urban American Indians and Alaska Natives. APHA Policy Statements: 1948 to present. cumulative. Washington, DC: American Public Health Association; current volume.

  3. APHA Policy Statement 9812: Diabetes among American Indians, Alaska Natives, and Native Hawaiians (AI/AN/NH). APHA Policy Statements; 1948-present, cumulative. Washington, DC: American Public Health Association; current volume.

  4. APHA Policy Statement 9810: Health Services for American Indians and Alaska Natives. APHA Policy Statements; 1948-present, cumulative. Washington, DC: American Public Health Association; current volume.

  5. National Indian Education Association: Statement of the National Indian Education Association Submitted to the Senate Committee on Indian Affairs on the President's Fiscal Year 2000 Budget, March 3, 1999.

  6. See 1.

  7. Bauman D: Tribal Perspectives on Indian Health, Self-Determination and Self-Governance. National Indian Health Board, February 3, 1998.

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