An American Debt Unpaid: Stories of Native Health - Alliance for a ...

ment. 52 Furthermore, patients are eligible for contract services onlyif they live within their respective contract health services deliveryareas, 53 creating often insurmountable eligibility barriers.Despite these problems, IHS represents an existing infrastructure—muchof it tribally managed—with experience in Native communitiesand positive impacts on Native people’s health. 54Health care challenges away from reservationsThe majority of Indian people and Alaska Natives do not live onreservations, as they once did. Today, 67 percent reside in ornear cities. 58 This urbanization resulted from the 1950’s policy of“terminating” Indian nations and relocation of Indian people to oftenfaraway cities. 59 According to the Urban Indian Health Commission,“Today’s urban Indians are mostly the products of failed federalgovernment policies that facilitated the urbanization of Indians, andthe lack of sufficient aid to assure success with this transition hasplaced them a greater health risk.” 60American Indians and Alaska Natives are often shut out of themainstream health care system. Thirty-two (32.1) percent areuninsured, compared to 10.6 percent of whites, making them morelikely than any other racial group, except Latinos, to go without healthcoverage. 61 And Indian people living away from reservations havereported being turned away by health care providers and told toreceive services from the IHS. 62Yet, most urban Indians do not receive IHS services. 63 Those who aremembers of federally recognized tribes may be IHS-eligible but livetoo far from reservations to receive care there. 64 Others belong toone of the 109 tribes “terminated” by the federal government in the1950’s, rendering them ineligible for IHS care. 65As a result, Indian people living in urban areas often must turn tourban Indian health organizations (UIHOs) for their care. Proximityto UIHO clinics has been linked to decreased mortality from heartdisease, the country’s leading cause of death. 66 Yet these programstoo are chronically underfunded, historically receiving only onepercent of the Indian health budget. Consequently, UIHOs can serveonly a fraction of the urban Indian population, 67 and, often, theycannot provide the full range of health care services their patientsneed—some can provide only outreach and referrals. 68HAWAIIANS ANDTHE HEALTH CARE SYSTEMHawaiians are served by the Native Hawaiian Health Care Systems(NHHCS), 69 a statewide network of Native Hawaiian Health Centersthat offer health promotion and disease prevention services, primarycare, and assistance navigating the health care system. The NHHCSalso provide traditional healing practices. 70The NHHCS grew out of a 1987 federally funded health study thatidentified serious health disparities affecting Hawaiians. After thecompletion of this study, Hawaiians created Papa Ola Lokahi (POL),the Native Hawaiian Health Board, to address those challenges.NORTHWEST FEDERATION OF COMMUNITY ORGANIZATIONS 17