HEALTH and ILLNESS in the American Indian and Alaska Native Population ■ 229
recognized tribes grew out of the special government-to-government relation- ship between the federal government and Indian tribes. This relationship was established in 1787. It is based on Article I, Section 8, of the Constitution and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and executive orders. The IHS is the principal federal health care provider and health advocate for American Indian people. Its goal is to raise their health status to the highest possible level.
Between 1990 and 2007, the U.S. AI/AN population increased by 65% from 2.0 to 3.3 million people. The IHS service area population comprises approximately 56% of the U.S. Indian population and increases at a rate of approximately 1.9% per year. The Indian health system is challenged to meet even 65% of the health needs of Indian country. The increase in the IHS service population is the result of natural increase (births minus deaths) and the expansion of the IHS service delivery area, as the result of the federal recognition of tribes. It must be noted that 43% of the Indian population resides in rural areas (U.S. Department of Health and Human Services, IHS, 2007). The principal legislation authorizing federal funds for health services to recognized Indian tribes is the Snyder Act of 1921. It authorized funds for “the relief of distress and conservation of health . . . [and] for the employ- ment of . . . physicians . . . for Indian tribes throughout the United States.” Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) to provide tribes the option of either as- suming from the IHS the administration and operation of health services and programs in their communities or remaining within the IHS-administered di- rect health system. Congress subsequently passed the Indian Health Care Im- provement Act (P.L. 94-437), which is a health-specific law that supports the options of P.L. 93-638. The goal of P.L. 94-437 is to provide the quantity and quality of health services necessary to elevate the health status of Ameri- can Indians and Alaska Natives to the highest possible level and to encour- age the maximum participation of tribes in the planning and management of health services.
The IHS provides a comprehensive health services delivery system for American Indians and Alaska Natives with an opportunity for maximum tribal involvement in developing and managing programs to meet health needs. The IHS goal is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all Ameri- can Indian people.
In order to carry out its mission, attain its goal, and uphold its founda- tion, the IHS
1. assists tribes in developing their health programs through activities, such as health management training, technical assistance, and human resource development and
2. assists tribes in coordinating health planning, in obtaining and using health resources available through federal, state, and local programs, and in operating comprehensive health care services and health programs.
230 ■ Chapter 9
Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures into a single national health system. Within these broad categories are special initiatives in traditional medi- cine, elder care, women’s health, the care of children and adolescents, injury prevention, domestic violence and child abuse, health care financing, state health care, sanitation facilities, and oral health. Most IHS funds are appropri- ated for American Indians who live on or near reservations. Congress also has authorized programs that provide some access to care for American Indians who live in urban areas.
IHS services are provided directly and through tribally contracted and operated health programs. Health services also include health care purchased from private providers. The federal system consists of 28 hospitals, 58 health centers, 31 health stations, and 5 school centers. There are also 17 tribal hospitals, 235 tribal health centers, 166 Alaska village clinics, 92 tribal health stations, and 28 tribal school health centers. In addition, 34 urban Indian health projects provide a variety of health and referral services. Approximately 600,000 American Indians and Alaska Natives reside in counties served by urban Indian health programs. IHS serves the members of 565 federally recognized tribes and 2 million American Indians and Alaska Natives residing on or near reservations.
BillingsBillings
AlaskaAlaska
Portland
Phoenix
Albuquerque
Aberdeen
Nashville
Bemidji Portland
California
California
Phoenix
Albuquerque
Aberdeen
Nashville
Bemidji
Oklahoma City