On April 13, the Senate Indian Affairs Committee held an oversight hearing on Indian health care.
Director of the Indian Health Service (IHS) Dr. Charles Grim discussed the status of Indian health, focusing on health disparities, urban Indian health, Indian health care facilities, Indian self determination, and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Dr. Grim noted that “Indian people continue to experience health disparities and death rates that are significantly higher than the rest of the U.S. general population.” For example, in 2000, the death rate from alcoholism was 517 percent higher; the death rate from diabetes was 208 percent higher, and the death rate from suicide was 60 percent higher. “For FY2006, IHS is requesting a total budget of $3.8 billion, including an increase of $80 million for inflation and population growth which will allow for a renewed focus on health disparities,” stated Dr. Grim.
Stating that a primary area of focus is on health promotion and disease prevention, Dr. Grim outlined some devastating statistics. “American Indians and Alaska Natives have the highest prevalence of type 2 diabetes in the world. The prevalence of type 2 diabetes is rising faster among American Indian and Alaska Native children and young adults than in any other ethnic population, increasing 106% in just one decade from 1990 to 2001.” He continued, “What is most distressing however about these statistics is that type 2 diabetes is largely preventable. Lifestyle changes, such as changes in diet, exercise patterns, and weight can significantly reduce the chances of developing type 2 diabetes. Focusing on prevention not only reduces the disease burden for a suffering population, but also lessens and sometimes eliminates the need for costly treatment options.”
Additionally, cardiovascular disease is the leading cause of mortality among Indian people. Dr. Grim told the committee that IHS is working with the Centers for Disease Control and Prevention and the National Institutes of Health’s National Heart, Lung, and Blood Institute to develop a Native American Cardiovascular Disease Program. “Our primary focus is on the development of more effective prevention programs for American Indians and Alaska Natives communities. The IHS has begun several programs to encourage employees and our tribal and health program partners to lose weight and exercise, such as ‘Walk the Talk’ and ‘Take Charge Challenge’ programs.”
Kathryn Power, director of the Center for Mental Health Services (CMHS) at the Substance Abuse and Mental Health Services Administration (SAMHSA), discussed SAMHSA’s role in serving American Indian and Alaska Native populations. She told the committee that “suicide is now the second-leading cause of death (beyond unintentional injury and accidents) for American Indian and Alaska Native youth aged 15-24.” Additionally, “injuries and violence account for 75% of all deaths among Native Americans ages 1 to 19.”
Stating that “SAMHSA’s direction in policy, program and budget is guided by a matrix of priority programs and crosscutting principles that include related issues of cultural competency and eliminating disparities,” Ms. Power said that SAMHSA provides roughly $42 million to American Indians and Alaska Natives annually. “CMHS is transferring $200,000 to IHS to support programming and service contracts, technical assistance, and related services for suicide cluster response and suicide prevention among American Indians and Alaska Natives. One example is the development of a community suicide prevention ‘toolkit.’ This toolkit will include information on suicide prevention, education, screening, intervention, and community mobilization, which could be readily available to American Indian and Alaska Native communities via the Web or other digitally based media for ‘off the shelf’ use.”
H. Sally Smith of the National Indian Health Board (NIHB) detailed tribal needs, touching on a host of issues. In terms of health disparities, she said, “While we know a great deal about these disparities, little action has been taken to address the inequity in available prevention capacity for all communities and governments.” Stating that Indian health programs are “grossly under funded,” she said, “With decreased public funds at state and county levels, Tribal public health agencies will be increasingly overlooked for funding opportunities made available by the DHHS [Department of Health and Human Services] agencies as well as numerous philanthropic organizations that specialize in improving health and quality of life for all peoples.”
Speaking to the challenges tribes face with preparing and sustaining a well-trained public health workforce, Ms. Smith told the committee that “funds can be wisely allocated to support comprehensive public health service delivery systems operated by Tribal Public Health Departments and Wellness Centers that can recruit and train staff in: establishment of Tribal public health departments and wellness centers; community health assessment systems, which require trained epidemiologists; communicable disease management systems (STDs, etc.); preventive health screening services (cardiovascular screening programs, etc.); occupational safety/injury prevention programs; healthy worksite initiatives; parent education programs; substance abuse prevention (tobacco, alcohol, methamphetamines, and other drugs); domestic violence prevention; suicide prevention; teen health promotion; restaurant and facility inspections, and animal/livestock control, which requires trained sanitarians.”
Executive Director of the Navajo Division of Health Anslem Roanhorse, Jr. also discussed a variety of health issues facing the Navajo Nation. Mr. Roanhorse said that “the Navajo Nation has faced an increasing challenge with the transmission of syphilis, which continues to increase and may only worsen…The increased number of syphilis cases presents a greater risk for HIV transmission…HIV cases on the Navajo Nation now number 198 cases with 23 cases occurring since January 2004.” Mr. Roanhorse said that the “greatest need for the Navajo HIV/AIDS program is funding for a prevention program.” Additionally, he noted that housing, adequate medical services, training for health care providers, and transportation are also needed in their fight against HIV/AIDS.
Mr. Roanhorse also pointed to a number of unique barriers facing Native Americans, including depressed economic conditions, social stress, lack of adequate facilities, transportation, information technology, health care recruitment, and infrastructure. “The Navajo Nation urges the Federal government to meet its federal trust responsibility and treaty obligations to provide adequate healthcare funding to the Navajo Nation.”
