Transcript The Crisis in Native American Health

The Crisis in
Native American Health
By
Kyra Rogers
Question: What is the unhealthiest
group in the United States?

A. Hispanics

B. African Americans

C. Native Americans

D. Whites

E. Federal Convicts
Answer: Native Americans
“…THE HEALTH OF INDIANS AS COMPARED
WITH THAT OF THE GENERAL
POPULATION IS BAD…
Mariam Commission Report. (1928, February 21)
DESPITE AN INDEPENDENT PUBLIC
HEALTH SYSTEM, THE INDIAN
HEALTH SERVICE (IHS), FUNDED
WITH $3 BILLION ANNUALLY,
HEALTH STATUS INDICATORS
SUGGEST NATIVE AMERICAN
SUFFER DISPROPORTIONATELY
FROM A VARIETY OF DISEASES
Race and Ethnic Standards for Federal
Statistics and Administrative Reporting. (1977)
Alcoholism Mortality Rates
Office of Native American and Indian Affairs (2002)
10.0
9.0
7.7
8.0
7.0
U.S, Population
6.0
5.0
Native American
Population
4.0
3.0
2.0
1.0
0.0
1.0
Diabetes Mortality Rates
Office of Native American and Indian Affairs (2002)
10.0
9.0
8.0
7.0
U.S. Population
6.0
4.2
5.0
Native American
Population
4.0
3.0
2.0
1.0
0.0
1.0
Tuberculosis Mortality Rate
Office of Native American and Indian Affairs (2002)
10.0
9.0
8.0
6.5
7.0
U.S. Population
6.0
5.0
Native American
Population
4.0
3.0
2.0
1.0
0.0
1.0
Accidental Death Rates
Office of Native American and Indian Affairs (2002)
2.8
3
2.5
2
U.S. Population
1.5
1.0
1
0.5
0
Native American
Population
Influenza/Pneumonia
Mortality Rates
Office of Native American and Indian Affairs (2003)
5.0
4.5
4.0
3.5
U.S Population
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1.5
1.0
Native American
Population
Native American
HEALTH DISPARITIES
EXCESSIVE BURDEN OF ILL
HEALTH IN NATIVE AMERICAN
COMMUNITIES, DUE GENETIC
PREDISPOSITIONS, LIFE STYLE
AND ENVIRONMENTAL
FACTORS
Unequal Treatment: Racial and Ethnic
Confronting Disparities in Health Care (2003)
HEALTH CARE DISPARITIES
INFERIOR, SUBSTANDARD
HEALTH CARE ON TRIBAL
LANDS THE RESULT OF
- INADEQUATE FUNDING
- LACK OF ACCESS
- LACK OF PROVIDERS
- DIRECT AND INDIRECT
CONSEQUENCE OF
RACIAL
DISCRIMINATION
HEALTH CARE DISPARITIES IN NATIVE
AMERICANS ARE THE RESULT OF
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


LACK OF ACCESS
FINANCIAL BARRIERS
CULTURALLY INCOMPETENT HEALTH
PROVIDERS
LANGUAGE BARRIERS
EXCLUSION FROM HEALTH-RELATED
RESEARCH
STEREOTYPING
RACIAL, ETHNIC BIAS
National Institute of Medicine
Report (1999)
HEALTH CARE
SPENDING “DISPARITY”
6,000
Per Capita Spending
2002
5,000
4,000
3,000
2,000
1,000
0
Veterans
Administration
U.S. Population
Bureau of Prisons
Medicare
Indian Health
Service
Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare, (2003)
HEART DISEASE
IS THE LEADING CAUSE OF DEATH IN
NATIVE AMERICANS, BUT A LARGE
PROPORTION OF THESE DEATHS IS A
RESULT OF DIABETES
National Health Care Disparities Report 2003
DIABETES IS THE MOST SERIOUS
HEALTH CHALLENGE FACING
NATIVE AMERICAN AND ALASKA
NATIVES WITH A GREATER THAN
50% DISEASE RATE IN SOME
COMMUNITIES.
Evette Roubideaux, M.D. (2004) American
Journal of Public Health Volume 94:1
ALTHOUGH CANCER RATES ARE
APPROXIMATELY 50% OF THOSE IN
THE U.S. POPULATION, CANCER
MORTALITY RATES APPROACH U.S.
MORTALITY RATES DUE TO LATE
DIAGNOSIS, LACK OF ACCESS TO
CARE, AND SUBSTANDARD CARE
CDC – Cancer Mortality Among
American Indians and Alaska Natives 1994-98
(2003, August)
NATIVE AMERICANS ARE AT HIGH RISK
FOR MENTAL HEALTH DISEASE DUE TO
SUBSTANCE/ALCOHOL ABUSE
- DEPRESSION, RESULTING FROM
- ISOLATION ON REMOTE
RESERVATIONS
- PERVASIVE POVERTY
- CHRONIC DESPAIR
- INTERGENERATIONAL TRAUMA
- FORCIBLE, GOVERNMENTAL
ASSIMILATION ATTEMPTS
-
GENETIC FACTORS

A study funded by the National Institute of Health
demonstrated that there are genes which predispose an individual to alcoholism.

An important gene is a mutation of the gene for the
enzyme aldehyde dehydrogenase needed to
metabolize alcohol.

This gene is found frequently in Chinese and
Japanese populations but not in other pacific rim
groups, Euro-Americans, Native Americans or
Eskimos.
Indiana Alcohol Research Center, IU School of Medicine; Purdue University
POSSIBE SOLUTIONS TO THE
PROBLEM
A)
INCREASE FUNDING TO THE INDIAN HEALTH SERVICE
B)
INCREASE (SCHOLARSHIP) FUNDING FOR NATIVE
AMERICAN MEDICAL EDUCATION TO PRODUCE MORE
CULTURALLY SENSITIVE HEALTH CARE WORKERS
INCREASE FUNDING FOR NATIVE AMERICAN FOCUSED
RESEARCH ON
DIABETES
ALCOHOLISM
MENTAL HEALTH
C)
POSSIBE SOLUTIONS TO THE
PROBLEM
D)
DEVELOP SCREENING PROGRAMS FOR
DIABETES
CARDIOVASCULAR DISEASE
SUBSTANCE ABUSE
CANCER
E)
DEVELOP PUBLIC AWARENESS PROGRAMS TO INFORM
TRIBAL GROUPS OF HEALTH PROBLEMS UNIQUE TO
AMERICAN INDIANS
F)
TRANSFER CONTROL OF NATIVE AMERICAN HEALTH,
HEALTH RESEARCH, PREVENTION AND HEALTH
EDUCATION FROM DHHS TO TRIBAL COMMUNITIES
SUPREME
COURT
RE-STATED
THE
“…DISTINCTIVE
OBLIGATION
OF
TRUST
INCUMBENT UPON THE GOVERNMENT IN ITS
DEALINGS WITH DEPENDENT AND SOMETIMES
EXPLOITED PEOPLES”
ACCORDIINGY,
THE
U.S.
GOVERNMENT
ACCEPTED MANY OBLIGATION TO NATIVE
AMERICAN TRIBES INCLUDING EDUCATION,
CONSTRUCTION, LAW ENFORCEMENT AND
HEALTH CARE
United States Supreme Court
Cherokee Nations, 30 U.S. (5Per.)at 17
POSSIBLE SOLUTIONS TO
NATIVE AMERICAN HEALTH DISPARITIES
G)
TRAINING MORE HEALTH
PROFESSIONALS TO ASSESS
AND MONITOR HEALTH
TRENDS IN ORDER TO
BETTER DIRECT HEALTH
POLICY
H)
TRAINING MORE NATIVE
AMERICAN HEALTH
EDUCATORS, SCIENTISTS,
RESEARCHERS, PHYSICIANS
AND NURSES
“FOR AMERICAN INDIAN AND ALASKAN
NATIVE PEOPLE, THE FEDERAL
RESPONSIBILITY FOR HEALTH SERVICES
REPRESENTS A “PRE-PAID” ENTITLEMENT
(HMO), PAID FOR BY CEDING OF OVER 400
MILLION ACRES OF LAND TO THE UNITED
STATES”
Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare, (2003)
NATIVE AMERICAN
HEALTH CARE
FEDERAL RESPONSIBILITY
BUREAU OF INDIAN
AFFAIRS
BUREAU OF INDIAN
AFFAIRS
(DEPT. OF WAR, 1776)
(DEPT. OF INTERIOR, 1849)
INDIAN HEALTH SERVICE
(DEPT OF HEALTH EDUCATION
AND WELFARE, 1955)
INDIAN HEALTH SERVICE
(DEPT OF HEALTH & HUMAN SERVICES)
(1966)
THE FEDERAL OBLIGATION TO
PROVIDE HEALTH CARE SERVICES IS
THE RESULT OF NATIVE AMERICANS
CEDING MORE THAN 400 MILLION
ACRES OF TRIBAL LANDS TO THE U.S.
PURSUANT TO AGREEMENTS AND
TREATIES
United States Supreme Court
Cherokee Nations, VS. Georgia (1831)
NATIVE AMERICAN
MEDIAN AGE vs. U.S. POPULATION
Broken Promises: Evaluating the Native American
Health Care System (2004, September)
32.9
35.0
30.0
Years in Age
25.0
24.2
20.0
Native American
U.S. Population
15.0
10.0
5.0
0.0
Native American
U.S. Population
THE CORRECTION OF INDIAN
HEALTH DISPARITIES

IS NOT JUST A BROKEN PROMISE OF THE
FEDERAL GOVERNMENT

IT IS A FAILED MORAL OBLIGATION AND A
NATIONAL DISGRACE!
WHAT CAN YOU DO?

ACCESS YOUR
LEGISLATORS TO
INFLUENCE HEALTH POLICY
AND PROVIDE MORE
FUNDING

ACCESS THE MEDIA TO GET
THE WORD OUT ABOUT
HORRIBLE INDIAN HEALTH
CONDITIONS

VOLUNTEER TO INSURE
THERE IS PUBLIC AWARENESS
AND INFORMATION
AVAILABLE ABOUT THE
DISPARITY IN INDIAN HEALTH
CARE
REFERENCES
Institute of Medicine of the National Academy of Science. (2003). Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care (2003). Washington DC:
National Academies Press
U. S. Commission on Civil Rights. (2004, September). Broken Promises, Evaluating the
Native American Health Care System. Chapters 1-4. United States Congress.
Retrieved on May 23, 2006 from http://www.usccr.gov
American Cancer Society Surveillance Research (2006) Incidence and Mortality Rates by
Site, Race and Ethnicity U.S. 1998 – 2002 . Retrieved on April 20, 2006 from
http://seer.cancer.gov/csr/1975_2002/,2005
CDC (2003, November 28) Health Status of American Indians Compared with Other
Racial/Ethnic Minority Populations – Selected States, 2001 – 2002. MMWR Weekly
52(47) pp. 1148-1152. Retrieved May 25, 2006
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a3.htm
REFERENCES
Kibbey, Hal (N.D.) Genetic Influences on Alcohol and Drinking . Retrieved on May 28, 2006 from
http://www.Indiana.edu/~rcapub/v17n3/p18.html