Poor Indian health blamed on federal failures
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American Indians and Alaska Natives receive substandard health care in part because the federal government has refused to acknowledge its responsibility to tribal nations, a report released on Wednesday concludes.

Despite having signed treaties promising health care and other medical provisions, the federal government failed to provide even meager funding and assistance until well into the 20th century, the report by an academic panel states. As a result, "health conditions on most reservations remained deplorable" until the Bureau of Indian Affairs was stripped of its health duties in the 1950s, according to the report.

Even then, Native people have low life-expectancy rates and continue to suffer from diseases typically experienced by older populations, according to data cited. Native American death rates for diabetes, alcoholism, suicide and accidents are greater than all other races and ethnic groups, the report states.

"The U.S. government is obligated through treaty and federal statues to provide healthcare to members of federally recognized American Indian tribes," reads the document. "This trust, however, has not been fully met, for several reasons."

"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" confirms for many the substandard services provided in Indian Country. Access to services is limited both on and off the reservation and spending is below stated need.

But for those American Indians and Alaska Natives with private health insurance, there are also problems, researchers found. Prejudice, cultural barriers and limits on health plans are among the factors contributing to treatment unequal to that received by white Americans, they said.

The report comes as Congress moves forward on a fiscal year 2003 budget that could break the bank. The Senate Budget Committee yesterday approved an additional $1 billion for the Indian Health Service (IHS) -- bringing the agency to an historic $3 billion, a 50 percent increase above the level requested by President Bush -- amid complaints by Republican leaders of fiscal irresponsibility.

"Currently, medical care for American Indians and Alaska Natives is being rationed – in spite of federal-tribal treaties guaranteeing the provision of health care," Senate Majority Leader Tom Daschle (D-S.D.) said in a statement.

According to a section of the report authored by Dr. Jennie Joe of the Native American Research and Training Center at the University of Arizona, the rationing is based on a dispute on the extent of the trust responsibility. "In contrast to the conviction shared by many tribal leaders," she writes, "the federal government has maintained that federal support for American Indians/Alaska Natives is not an entitlement but is voluntary."

"Because federal funding for Indian healthcare has historically been discretionary, improvement in healthcare resources . . . has continued to be piecemeal and void of conscious long-range planning," she concludes.

The policy of self-determination, under which tribes can contract health services, has resulted in improvements, according to interviews and research cited by Joe.

Get the Report:
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Institute of Medicine March 2002)

Get Budget Documents:
IHS Budget Justification [HHS] | IHS Budget Authority Chart [HHS] | IHS Profile [HHS] | HHS Budget [HHS] | HHS Budget [OMB]

Relevant Links:
The Web Source for IHS Budget Documents -
Indian Health Service -
Department of Health and Human Services -

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