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Health
Report calls on U.S. to honor health care commitment


A draft report from the U.S. Commission on Civil Rights (CCR) calls health problems and lack of adequate health care the "enemy" of Indian Country.

"Broken Promises: Evaluating the Native American Health Care System" is a follow-up to last year's "Quiet Crisis" report that generated considerable discussion for noting that the federal government spends less on health care for American Indians and Alaska Natives than on prisoners. According to the analysis, Indian Health Service patients receive $1,914 on average compared to $3,803 on average for inmates.

Numbers like that led the CCR to conduct a further investigation of the health care system for Native Americans. Last year, panel members visited a facility near the Navajo Nation and held two days of public hearings in New Mexico.

Along with interviews with tribal leaders and health care experts, panel staff quietly released the follow-up report in July. Its major finding -- that Native Americans experience health care problems at rates far higher than the rest of the country -- will not be a surprise to many.

But the 145-page draft seeks to spur the executive branch and Congress into action. "Unlike our earlier report on the quiet crisis created by unmet funding needs in Indian Country, this report looks beyond financing to examine other factors contributing to the disparities in health status and health care experienced by Native Americans," the staff wrote.

The recommendations urge IHS to eliminate social and cultural barriers that may impede adequate care for Native Americans. These include cultural training, partnerships with tribes and improved investigation and handling of bias and discrimination complaints.

IHS is also urged to address "structural" barriers that may affect delivery of health care. One major suggestion is to change the contract health services (CHS) system to allow all Native Americans, regardless of location, to receive services.

As for Congress, the report calls for full funding of the IHS based on the FEHBP Disparity Index (FDI), a benchmark based on Federal Employee Health Benefits program. Currently, IHS funding falls at about half of this standard.

"No federally funded program providing health care to Native Americans should be permitted to fall below an FDI of 60 percent," the report states. "In the long term, Congress should raise funding levels to establish an average FDI of 100 percent.

The report supports the reauthorization of the Indian Health Care Improvement Act. The bill, first passed in 1976, has languished in Congress for several years but Bush administration officials say they are committed to its passage this year.

The draft also endorses the Tribal Contract Support Costs Technical Amendments of 2004 to ensure that self-determination and self-governance contracts are funded 100 percent. Currently, tribes receive only as much money as the government is willing to pay, resulting in shortfalls in the hundreds of millions.

"[I]f you authorize us, if you fund us, if you empower us, we can make the solutions a reality," Ron Allen, the chairman of the Jamestown S'Klallam Tribe of Washington, is quoted as saying.

The report cites a laundry list of health problems facing American Indians and Alaska Natives. Based on federal statistics, Native Americans are 770 percent more likely to die from alcoholism, 650 percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280 percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or influenza than the rest of the nation.

IHS is praised for helping to reduce disparities despite a lack of adequate funding. As one example, the life expectancy for Native Americans is now 71 years of age, up from 65 year in 1976.

In conclusion, "this report should be considered a clarion call to those who inexplicably fail to acknowledge the present state of Native American health care and to those who lack the commitment necessary to address the overwhelming need for clear and decisive action," the staff wrote.

"Such a call is certainly appropriate for our political leadership and the message is clear—it is finally time to honor our nation's commitment to protecting the health of Native Americans."

Get the Report:
Broken Promises: Evaluating the Native American Health Care System (July 2004)

Related Report:
A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country (July 2003)

Relevant Links:
National Indian Health Board - http://www.nihb.org
Indian Health Service - http://www.ihs.gov

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