Native American Healthcare Lagging Behind the Rest

THE EXPECTED LIFE SPAN OF THE NATIVE AMERICANS is nearly
five years less than for the general population of the United
States and stands around 72. In 1972-1974, infant and
maternal mortality rates were, respectively, 25% and 82%
higher than those in the general US population. The figures
for diarrhea and dehydration were 138%, for tuberculosis
600%, and for unintentional injury 264% higher.
Although this disparity narrowed considerably over the
next two decades—most dramatically, by 1991-1993,
gaps in infant and maternal mortality rates reduced to 4%
and 12% higher, respectively—new statistics reveal that
the gap has been widening again. Native American infant
mortality rate, for example, shows a 44% increase over a
decade ago while the rate for the population has
decreased. The causes of these alarming statistics need to
be explored in detail but most experts agree that, in the
last decade, much less federal money has been allocated
to the health care of the Native Americans compared to
other groups.
Native Americans have also less access to quality health
care. The difference between Native American clinics and
hospitals and their counterparts in general areas is
appalling. The waiting times for getting appointments are
longer than the average for the general population. Diagnostic
tests and medical procedures are not readily available
and the quality of care is deplorable because of the
shortages of doctors, funding, and equipments and the
low quality of facilities.
HISTORY OF NATIVE AMERICAN HEALTH CARE
Federal health care services for American Indians were
first established in 1824. Federal policy towards Indians at
that time was primarily aimed at military containment.
Army physicians took measures to control the spread of
infectious diseases among Indian tribes located near military
posts, and they were not focused, in particular, on
improving the Natives’ health care or conditions. In 1849,
military control of Indian affairs ended and the Bureau of
Indian Affairs (BIA), which assumed responsibility for
health care, was transferred to the Department of the Interior.
Since then, health care, as well as education and other
federal services, have been provided to the members of
federally recognized tribes, as a result of treaties signed
between the tribes and Congress, giving the federal government
the role of a trustee.
In late nineteenth century, the policy of the federal government
towards Indians was one of assimilation and Indian
tribes were no longer viewed as separate nations. At the
beginning of the 20th century, during the Hoover administration,
the BIA was reorganized into five divisions: health,
education, agricultural extension, forestry, and irrigation.
Each division had a professional or technical director in
Washington who had a direct relationship with the reservation
superintendents. It was believed that improving
services would lead to Indians’ assimilation with the general
US population and the government support could be
eventually withdrawn. In 1955, in an effort to dismantle
the BIA, the Division of Indian Health, later renamed Indian
Health Service (IHS), was formed within the Public
Health Service.
In 1975, the Indian Self-Determination and Educational
Assistance Act (PL 93-638) was passed. It provided tribal
governments with a way to contract with the Secretaries of
the Interior and of Health, Education, and Welfare to
develop new services or assume control over services previously
run by the federal government. A year later, the
Indian Health Care Improvement Act (PL 94-437) was
passed. The purpose of this law was to improve health care
facilities, create new and needed services, and to attract
more Native Americans to the health care profession.
These pieces of legislation allowed for increased community
involvement and, along with the federal policy of
Indian preference in hiring, allowed for Native Americans
to take positions of control in both the tribal and federal
systems. The IHS is becoming less centralized and tribal
governments are taking over control of health care services
from the federal government.
TRADITIONAL HEALTH AND HEALING
Historically, there have been many conflicts between the
IHS and the people it serves. The initial attitude of IHS
was one of disregard for native beliefs and traditions to the
detriment of the health of the Native Americans. Each of
the over 500 tribes in the US, though similar in some characteristics
and experiences, has very different traditions
and practices. The preservation of these individual identities
is vital to them and their mental and physical wellbeing.
As with any community, it is important to view the
heath and health care of Native Americans from a cultural
perspective as well as a purely medical one.
Use of traditional healers, for example, is still widespread
among the Native American population. Each tribe
has its own sacred rituals and ceremonies, much of which
are known only to members of the tribe. Medicine and
religion are strongly linked in traditional native culture. It
is believed that one must follow specific paths in order to
maintain optimal health (physical, mental, and spiritual).
All things are believed to have life and spirit and are intricately
related in the universe. Illness is perceived to be a
disruption in the delicate balance between individual
beings of the universe. The restoration or maintenance of
health is achieved by correcting these imbalances. Traditional
healers help in restoring balance. This may be
achieved through simple ceremonies involving prayers or
chants, herbal remedies including salves, ointments, and
teas, or dances. Many Native Americans use both traditional
and Western medicine. It is important for physicians
and health care providers working with the Native American
population to be aware of the vital role traditional
medicine still plays in native culture. Collaboration
between traditional healers and Western practitioners is an
important step towards providing more holistic care to
everyone. This may be especially true in areas of mental
health. With the lack of health care in most areas, if it
weren’t for the traditional practices there would be no
health care at all.