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September 08, 2003

Contact: HHS Press Office
(202) 690-6343

ELIMINATING HEALTH DISPARITIES IN THE AMERICAN INDIAN AND ALASKA NATIVE COMMUNITY


    Overview :

Improving the health of American Indian and Alaska Native communities, and providing individualized health care throughout Indian Country are vital and challenging goals. The Indian population is diverse, geographically dispersed and economically disadvantaged. Evidence has shown that the overall health and well being of American Indians and Alaska Natives has improved dramatically due to increased medical care and expansive public health efforts. However, major health disparities still exist and place these individuals at high risk for cardiovascular disease, diabetes, alcoholism, injury, suicide and homicide.

The Department of Health and Human Services is undertaking key initiatives to eliminate health disparities among ethnic minorities, including American Indians and Alaska Natives. In 2001, HHS Secretary Tommy G. Thompson launched Closing the Health Gap, a national grassroots initiative to mobilize resources within minority communities in order to combat some of the most pressing health disparity concerns, including obesity, cardiovascular disease and diabetes. Closing the Health Gap reflects key elements of HHS' Steps to a HealthierUS campaign, designed to encourage all Americans to incorporate physical activity and healthy lifestyle choices into their daily routine.

Further demonstrating HHS' commitment to improving the health and welfare of individuals in Indian Country, Secretary Thompson reactivated the Secretary's Intradepartmental Council on Native American Affairs and convened the inaugural meeting on November 21, 2002. The council serves to develop and promote an HHS policy of providing greater access to quality health care for American Indians and Alaska Natives.

Within HHS, the Indian Health Service (HIS) is the principal federal health care provider for an estimated 1.6 million American Indians and Alaska Natives who belong to more than 560 federally recognized tribes in 35 states. In April 2003, HIS issued its 10-year strategic plan, which reflects an increased emphasis on eliminating health disparities through lifestyle change and healthy behaviors, access to care, quality and innovation.

The President's budget request for HIS in fiscal year 2004 is $3.6 billion, an increase of $97 million over fiscal year 2003 funding. Additional funds are requested for diabetes treatment and prevention, sanitation construction and improvement, staffing of new health facilities, and to purchase health care from non-HIS facilities and providers.

Background :

The Indian population is diverse, geographically dispersed and economically disadvantaged. Disease patterns among Indians are strongly associated with adverse consequences from poverty, limited access to health services and cultural dislocation. High rates of unemployment, discrimination and cultural differences all contribute to unhealthy lifestyles and disparities in access to health care for many Indian people:

  • Cardiovascular disease is now the leading cause of mortality among Indian people, with a rising rate that is significantly higher than that of the U.S. general population.
  • American Indians and Alaska Natives have the highest prevalence of type 2 diabetes in the world. The incidence of type 2 diabetes is rising faster among American Indians and Alaska Native children and young adults than in any other ethnic population, and is 2.6 times the national average.
  • Rates of substance dependence and abuse among persons age 12 and older is highest among American Indians and Alaska Natives (14.1 percent). Rates of illicit drug use (10.1 percent), alcohol (44.7 percent) and binge alcohol use (27.9 percent) are among the highest in the nation.
  • American Indians and Alaska Natives die at higher rates than other Americans from alcoholism (770 percent), tuberculosis (750 percent), diabetes (420 percent), accidents (280 percent), homicide (210 percent) and suicide (190 percent).
  • American Indians and Alaska Natives born today have a life expectancy that is almost 6 years less than the U.S. population (70.6 years to 76.5 years).
  • Infants in American Indian and Alaska Native communities die at a rate of 8 per every 1,000 live births, as compared to 7.2 per 1,000 for the U.S. population.
  • Injuries cause 75 percent of all deaths among American Indians and Alaska Natives age 19 and younger, and are the leading cause of death for American Indians and Alaska Natives 1-44 years of age. Deaths from car crashes, pedestrian accidents, fire and drowning have decreased over the last decade, but the overall death rate from preventable injuries remains nearly twice as high for native people than it is for the general population.

LEADERSHIP ON INDIAN HEALTH

The Bush administration and HHS are strong partners in the movement to reduce and ultimately eliminate health disparities in American Indian and Alaska Native communities.

  • White House Initiative on Tribal Colleges and Universities. On July 3, 2002, President Bush issued Executive Order 13270 to establish the White House Initiative on Tribal Colleges and Universities (TCUs), mandating that each agency within the federal government develop a five-year plan of its efforts to provide TCUs access to federal funding opportunities and to boost national awareness of the importance of tribal colleges. Within HHS, the Office of Minority Health coordinates this activity.
  • National Forum on Health Disparity Issues for American Indians and Alaska Natives. In September 2002, HHS' Office of Minority Health and other HHS agencies sponsored the National Forum on Health Disparity Issues for American Indians and Alaska Natives, creating an opportunity for Tribal leaders, urban Indian health organizations, health officials, federal and state policymakers and public/private organizations to address the health status of American Indians and Alaska Natives.
  • Indian Health Service. Within HHS, the Indian Health Service is responsible for providing health services to more than 560 federally recognized tribes with the goal of ensuring that comprehensive, culturally acceptable, personal and public health services are available and accessible to American Indians and Alaska Natives. The fiscal year 2003 budget for IHS is $2.9 billion.
  • Administration for Native Americans. The Administration for Native Americans (ANA), housed within HHS' Administration for Children and Families, promotes the goal of social and economic self-sufficiency of American Indians, Alaska Natives, Native Hawaiians, and other Native American Pacific Islanders, including Native Samoans. In July 2003, the ANA and the Agency for Toxic Substances and Disease Registry signed an agreement to address village-level concerns regarding the environment in Alaska, specifically the potential impact of contamination on local economic subsistence lifestyle.
  • Centers for Medicare & Medicaid Services. CMS continues to work with the IHS and tribes primarily in the areas of outreach, enrollment and education. In December 2002, CMS sponsored an educational conference on long-term care (LTC) in Indian Country, in order to provide information to tribes accessing Medicare and Medicaid support LTC services. In addition, CMS established a joint steering committee with the IHS to address Medicare, Medicaid and SCHIP concerns common to both agencies.
  • Intradepartmental Council on Native American Affairs. In November 2002, Secretary Thompson convened the inaugural session of the Secretary's Intradepartmental Council on Native American Affairs to further support the department's policies, programs and goals affecting Native American populations. Providing access to quality health care is a primary goal of the Council.
  • Tribal Consultation. HHS' Office of Intergovernmental Affairs has lead responsibility for all HHS consultation, including liaisons with tribal governments, American Indian and Alaska Native communities, and serves as the central point of contact for tribal governments and their representatives.

PROMOTING SELF-DETERMINATION AND SELF-GOVERNANCE

Self-determination and self-governance have important meaning to tribes and affect how their health services are delivered, particularly surrounding health disparities. The Indian Self-Determination and Education Assistance Act gives tribes the opportunity to redesign their health programs to better meet their specific needs. The Act allows the Indian Health Service to transfer its resources to tribes so they can administer their own health programs if they decide to do so. Tribally managed programs now make up more than 50 percent of IHS' budget.

In May 2002, HHS announced final regulations giving American Indian and Alaska Native tribes a guaranteed right to negotiate agreements, or compacts, for the operation, control and redesign of most IHS programs and activities. A rulemaking committee, involving 23 tribal representatives and seven federal representatives, negotiated details of the rule as required under law. Tribal self-governance for IHS programs began in 1994 as a demonstration involving 14 tribes. Today, there are 56 compacts, covered by 75 funding agreements, which transfer more than $860 million in operating funds for tribal health programs serving more than 279 tribes.

REDUCING AND PREVENTING HEALTH DISPARITIES

There exists significant disparities in the health status of American Indian and Alaska Native people compared to the general U.S. population. Prevention and treatment of chronic health problems require long-term, clinical and community-based intervention strategies to prevent the burden of death and disease.

Preventive Health Framework

  • Closing the Health Gap. Secretary Thompson launched Closing the Health Gap in November 2001. Closing the Health Gap is a health education and information campaign for minority communities, established to mobilize resources in order to combat some of the most pressing health disparity concerns, including obesity, cardiovascular disease and diabetes. Closing the Health Gap reflects key elements of HHS' Steps to a HealthierUS campaign, designed to encourage all Americans to incorporate physical activity and healthy lifestyle choices into their daily routine. In 2003, Take Your Loved One to the Doctor Day expanded beyond the African American community to include Hispanic American/Latino, Asian American and Pacific Islander, American Indian and Alaska Native communities. More than 400 national, state and local organizations spanning 50 states, Washington, D.C., and Puerto Rico have partnered with HHS to promote Doctor Day and host activities in their communities.
  • Indian Health Service Strategic Plan. On April 4, 2003, IHS issued its 10-year Strategic Plan to improve the health of American Indian and Alaska Native people through collaboration and innovation. The Plan is structured around four strategic goals: building healthy communities; achieving access to essential health services; providing compassionate, quality care; and embracing innovation in the Indian health network.
  • Indian Health Service Preventive Task Force. In November 2002, IHS created a Preventive Task Force specifically to focus on eliminating health disparities in Indian Country. The Task Force, along with IHS' Health Promotion/Disease Prevention Policy Advisory Committee, combines representation from HHS and national Indian organizations, and serves as a liaison to the department's Steps to a HealthierUS campaign.
  • Tribal Epidemiology Centers. The innovative Indian Health Service Tribal Epidemiology Center program was authorized by Congress to provide significant support to multiple tribes in each of the IHS Areas. Operating from within tribal organizations such as regional health boards, the Epidemiology Centers are uniquely positioned to be effective in disease surveillance and control programs, and also in assessing the effectiveness of public health programs.

Care, Treatment and Prevention

  • Indian Health Service National Diabetes Program. The IHS National Diabetes Program (NDP) promotes collaborative strategies between IHS, tribal and urban Indian diabetes programs for the prevention of diabetes and its complications in the 12 IHS Service Areas through coordination of a network of 19 Model Diabetes Programs and 13 Area Diabetes Consultants.
  • Diabetes Grants. On Dec. 10, 2002, Secretary Thompson announced $100 million in grants to support programs to prevent and treat diabetes among American Indians and Alaska Natives, particularly among children and teenagers. Funded through the IHS Special Diabetes Program, the grants go to 318 tribal, urban Indian, Indian organizations and IHS health programs to support diabetes prevention and treatment programs, including efforts to reduce cardiovascular disease associated with diabetes. The President's fiscal year 2004 budget request provides $150 million for the Special Diabetes Program, up 50 percent from fiscal year 2003. Funds were made available by 2002 amendments to the Public Health Service Act.
  • Native American Cardiology Program. The Native American Cardiology Program was developed in 1993 as a collaboration between the Navajo, Phoenix and Tucson areas of the IHS, based at the University of Arizona. The program was developed to provide direct cardiovascular care to Native Americans on-site at reservation clinics within the Navajo, Phoenix and Tucson areas as well as to provide a tertiary care for complex cardiovascular disease. The program now supports more than 30 hospitals and clinics in Arizona, Nevada, Utah, and parts of New Mexico and California.
  • Substance Abuse and Mental Health Services. HHS' Substance Abuse and Mental Health Services Administration brings culturally competent, respectful and known-effective substance abuse prevention, addiction treatment and mental health services to America Indians and Alaska Natives in their home communities through its discretionary grant programs, including, the Circles of Care program, the Rural Community Substance Abuse Treatment Planning Grants program, and the Community-Initiated Prevention program.
  • Nutrition and Caregiving. The fiscal year 2004 budget request proposes $885 million for HHS' Administration on Aging elderly nutrition and caregiver support programs, including funding for tribes to provide meals and other supportive services for their elderly members and to help their members provide care for their elderly relatives. In addition, the 2000 amendments of the Older Americans Act established the Native American Caregiver Support Program, recognizing the needs of Native elders.
  • Urban Indian Health. The Urban Indian Health Program supports contracts and grants to 34 urban health programs funded under Title V of the Indian Health Care Improvement Act of 1976. Since passage of this legislation, amendments to Title V have strengthened Urban Indian Health programs by expanding direct medical, alcohol, mental health, HIV, health promotion and disease prevention services.
  • REACH. The Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health Program funds and evaluates locally planned demonstration projects designed to eliminate health disparities for racial and ethnic minorities, including American Indians and Alaska Natives.
  • MOU for American Indian Veterans. In February 2003, IHS signed a Memorandum of Understanding with the Department of Veteran Affairs announcing that rural American Indians and Alaska Natives who served in the military would receive enhanced medical care as a result of the MOU. The agreement will affect more than 165,000 American Indian and Alaska Native veterans.
  • Injury Prevention Program. IHS has developed a comprehensive, public health oriented program to address community-based injuries. The program emphasizes community-based epidemiological assessment of injuries, development of community capacity to address injury problems, and funding to assist tribes in addressing their injury issues. Starting in 2000, the IHS provided $1.8 million annually in competitively awarded cooperative agreements to 36 tribal programs for the development of injury programs and prevention strategies.

Sanitation and Construction

Approximately 92 percent of American Indian and Alaska Native homes in need have been provided sanitation facilities since the inception of the IHS Sanitation and Facilities Construction Program, but roughly 8 percent of homes still lack a safe indoor water supply, compared to 1 percent of all U.S. homes. The program is an integral part of the IHS disease prevention initiative. In January 2003, Secretary Thompson announced that the President's 2004 budget request includes $114 million for IHS sanitation construction projects -- a $21 million increase over the fiscal year 2003 appropriation, the largest sanitation increase in more than a decade.

In April 2003, the Navajo Nation held a groundbreaking ceremony for a new IHS Four Corners Regional Health Center to be located in Red Mesa, Ariz. The new center will have a 24-hour emergency room and a six-bed short stay nursing unit. Additionally, in July 2002, IHS dedicated a 240,000 square-foot replacement health care facility in Fort Defiance, Ariz., on the Navajo Nation Reservation, the largest reservation in the United States. The facility serves nearly 30,000 Navajos and members of other Indian tribes.

Consumer Education

  • CMS Satellite Network. In January 2003, HHS' Centers for Medicare & Medicaid Services launched a new, state-of-the-art satellite network to provide Medicare and Medicaid information to 57 IHS and tribal health facilities in 24 states, including Alaska. The initial broadcast featured key federal policy makers and introduced the Medicare training and customer service available through the Medicare Learning Network and its partner, Trailblazer Health Enterprises.
  • Healthfinder Web site. In November 2002, HHS www.healthfinder.gov/justforyou/, an easy-to-use consumer resource that provides a central point for current health information of special interest to American Indians and Alaska Natives.

RESEARCH

HHS is a focal point for promoting important and vital research on racial and ethnic minorities in order to eliminate health disparities. The American Indian and Alaska Native community needs targeted biomedical and clinical research that will serve to foster critical discoveries in the fight against health disparities.

The Native American Research Centers for Health
In September 2002, Secretary Thompson announced $4.5 million in funds to support 11 medical research grants aimed at improving the health of American Indians and Alaska Natives. The Native American Research Centers for Health (NARCH) grants are the result of an ongoing collaboration between IHS and National Institutes of Health (NIH). The NARCH initiative is aimed at developing a cadre of Indian scientists and health professionals engaged in biomedical, clinical, and behavioral research; enhancing partnerships of tribes with academic research centers; and encouraging competitive research on health conditions of importance to American Indian and Alaska Native people. The program is administered by IHS, with funding from NIH's National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, National Institute of Drug Abuse, National Institute of Dental and Craniofacial Research, and the NIH Office of Behavioral and Social Sciences Research.

National American Indian and Alaska Native Pediatric Height and Weight Study The American Indian and Alaska Native Pediatric Height and Weight Study will assess the current height and weight status of Indian children less than 18 years of age. The study is being conducted by the Inter Tribal Council of Arizona, Inc., Epidemiology Center in collaboration with the IHS. Goals of the study are to establish a national baseline prevalence of childhood overweight and underweight by defined geographic regions; increase awareness of the high prevalence of childhood overweight; measure and compare the prevalence of the overweight and underweight with the general U.S. population and other ethnic populations; target resources for healthy growth and development; and justify a variety of intervention strategies.

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Last Revised: November 28, 2003

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