Impact of the U.S. Government on Indigenous Health

The United States government has had a long and extensive history of undercutting and neglecting Indigenous peoples. It is then no surprise to learn that policy has impacted Indigenous health. The issues read about in history classes are not just that though. Indigenous populations still suffer from poor healthcare access because of neglectful policies.

Much of the disparities in Indigenous health outcomes come simply because of negligent and insufficient care. Much of this starts with the Indian Health Service (IHS), the federal department that oversees indigenous healthcare needs. Sam Halabi, Senior Associate Vice President for Health Policy and Ethics at Colorado State University, describes a core issue at the IHS explaining that, “The total federally-appropriated IHS budget is insufficient to provide adequate health care services to the population that it serves, much less reduce existing health disparities” (Halabi 239). The need for funding is demonstrated in the lack of services at the IHS. Halabi’s analysis includes that only thirty-six states have some sort of healthcare program for Native American, only nine states coordinate to have regular feedback from tribes about the healthcare needs of their communities, and only eight states offer consultations for indigenous groups within their jurisdiction (Halabi 234-235). Indigenous groups thus face few opportunities to seek appropriate care, and even the services that are available are impacted by poor funding. Laura Brown, a physician who worked in a IHS hospital in Arizona narrates her experience, “When service units are forced to hire temporary locum tenens physicians in lieu of decreasing services, the quality of care can change dramatically,” (“Tribes Lose Again” 1). Decreased funds mean that IHS facilities are stretched even thinner, reducing the quality of the care indigenous populations have access to. The poor national, state, and local government policies serve to

deprioritize the healthcare needs of Indigenous populations and does little to address the disparities in care.

There have been attempts for positive Indigenous healthcare policies. In 2005, New Mexico implemented a new collaborative model of healthcare for Native Americans living in the state, which sought to respond to cultural needs. An analysis of the shift stated that, “State officials in New Mexico instituted specific positions and structures to facilitate the inclusion of Native American perspectives into State-level decision-making processes related to the reform.” (Willging et al 883). By impeding indigenous decision-makers into the fabric of their system, New Mexico sought to better serve the healthcare needs of Indigenous groups. However, the analysis found that, “Across the board, participants did not believe that any of the community input mechanisms created by the State were particularly effective in conveying Native American concerns to the Purchasing Collaborative,” (Willging et al 889). Instead of being populated by Indigenous representatives, most of the new committees consisted of individuals removed from the realities of Native American life. In some cases, healthcare providers even sat on committees (Willging et al 889). There was also little tangible improvement in care as ninety-six percent of Indigenous families saw no difference in their care (Willging et al 890). The failure of New Mexico’s system echoes the fundamental issue with federal Indigenous health policies: those in power do not care enough to get it right.

References

Halabi, S. (2019). The Role of Provinces, States, and Territories in Shaping

Federal Policy for Indigenous Peoples’ Health. American Review of

Canadian Studies, 49(2), 231–246. https://doi-

org.proxy.cc.uic.edu/10.1080/02722011.2019.1613797

“Tribes Lose Again, This Time on Health Care.” The Wall Street Journal,

Dow Jones & Co., 2017, https://doi.org/info:doi/.

Willging, Cathleen E., et al. “The Impact of State Behavioral Health

Reform on Native American Individuals, Families, and

Communities.” Qualitative Health Research, vol. 22, no. 7, July 2012,

pp. 880–896. EBSCOhost, doi:10.1177/1049732312440329.