American Indian Health Disparities, Where’s The Moral Outrage?

Where is the outcry, outrage and outpouring for various tribes with the highest levels of diabetes in the world where a baby boy born today has an average life expectancy in the 40s where death rates are more than double than for U.S. all races rates to age 44 where there is unprecedented violence against women and where TB is alive and well at 850% the rate for U.S. all races? One does not need to leave U.S. borders to find nations living in poverty, fear, sickness and desperation. And yet, they remain largely unfound.

Why does the picture look so bleak for certain tribes? There is a lack of comprehensive, accessible healthcare inclusive of the whole life span. There are the multitudinous disparities seen in the social determinants of health. And finally, U.S. policies over 200 hundred years have likely contributed to the health status of federally recognized tribe members and by ethnic Indians.

The Indian Health Service is charged with providing health services for members of federally recognized tribes. They state on their “About Us” page that, “The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 564 federally recognized tribes in 35 states.”

Having worked for several years at an IHS hospital, I have nothing but praise for those providing care to American Indians with a lot of “making do” and workarounds. They are earnest and talented. However, services are in fact shrinking rather than becoming more comprehensive as is IHS stated goal. For example, in 1991 the Santa Fe Indian Hospital was a “full service” hospital. It had an emergency room, intensive care unit, a step-down unit, labor-and-delivery, a 29 bed medical pediatric service, surgery and outpatient clinics. By 1995, critical care levels had decreased to urgent care and step down only. Today its size, level, operational hours and services provided are almost unrecognizable by comparison. This facility serves nine Northern Pueblo Tribes in New Mexico. It is but one example of shrinking services.

My interest is largely in aging. IHS has had little funding or focus for eldercare beyond swing bed demonstrations and small grant programs. Tribes themselves have had some innovative programs and can fill some gaps. Culturally, elders are treasured and one would hope for more solid efforts by the IHS. The Indian Health Care Improvement Act has been folded into the Affordable Care Act new provisions for eldercare have been authorized, but unfunded. On the one hand this was a coup as the IHCIA was previously left to languish for years and years without re authorization. However, no one can say what the health law will look like in practice, let alone the American Indian provisions.