The U.S. Surgeon General urged tribal leaders on Thursday to adopt more preventive health care efforts or face a new generation of unhealthy Native Americans.

At a meeting of the United South and Eastern Tribes (USET), Dr. Richard Carmona called attention to the "health care crisis" in the nation. Americans, he said, wait until they have a problem before seeking treatment.

This means the crisis is not really about health care, but about who pays for it. "We allow people to develop chronic diseases," he said. "We wait until they have a problem and then we spend extraordinary amounts of money and take all the best science in the world and focus it on that person."

As one example, Carmona said obesity -- a growing problem among American Indians and Alaska Natives -- costs the U.S. $117 billion a year.

"And just that one entity, obesity, is all preventable," he said.

Unless changes are made, Carmona said, "we'll have more diabetics, we'll have more overweight people, we'll have more problems. We're breeding a sedentary, sick society."

Coming from a poor and occasionally homeless Puerto Rican family in New York City, Carmona dropped out of high school before later earning his general equivalency degree. He went on to become a successful surgeon and said yesterday it was his 20 years of running a health care system that helped him understand the needs of Indian Country.

Going to a reservation, he said, is an "eye-opener." "Nowhere in the United States are health care disparities more manifest than in our Indian nations," he said.

As he worked with patients from the Tohono O'odham, Yaqui and other tribes in southern Arizona, he discovered that most of the problems they suffered were preventable. Changes in diet, lifestyle and behavior can mean the difference between life and death, he observed.

That's why Carmona said his number one goal as the nation's top doctor is to emphasize prevention. He cited provisions in the recent Medicare reform bill that would benefit Native Americans. Tribes, and the Indian Health Service (IHS), can get reimbursed for preventive care, he said, even for simple actions like performing physicals for elders.

Another area he is focusing on is emergency preparedness. In light of bio-terror and other threats in the nation, he said all Americans are now intimately aware of the need to be more secure. Tribes aren't treated equally when it comes to homeland security and can't tap directly into the billions available for it, but Carmona didn't address the issue yesterday.

A final goal is reducing health care disparities. Numerous studies show that Native Americans have higher rates of chronic diseases and illnesses than almost every other racial and ethnic group.

"People of color in the U.S. have less access to care," Carmona said. "And, the fact is, when you do have access to that care, the outcome is poor."

Earlier this week, the Bush administration released its fiscal year 2005 budget for IHS. The request calls for $3 billion, or an increase of 1.6 percent above current levels. Dr. Charles Grim, the IHS director, said there is a $7 million increase for preventive health services, including funds to hire more community health aids in rural Alaska Native villages.

Not everyone is convinced the request is enough. Rep. Nick Rahall (D-W.Va.), the ranking member on the House Resources Committee, which has jurisdiction over Indian affairs, said the the budget cuts Indian alcohol and drug abuse programs and money for new hospitals and clinics. He said the federal government spends just $1,900 per year on Native Americans but twice the amount on prisoners.

"Why this administration refuses to treat our first Americans as least as well as we treat our prisoners baffles and disgusts me," Rahall said yesterday. "Indian Country is entitled to more than a Band-Aid for their serious health issues."

Budget Documents:
HHS Budget in Brief | HHS Performance Plan | Secretary Thompson's Remarks