DOCSLIB.ORG

Self-Determination and American Indian Health Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Self-Determination and American Indian Health Care Self-Determination and American Indian Health Care: The Shift to Tribal Control Stephen Cornell, Miriam Jorgensen, Stephanie Carroll Rainie, Rachel Starks, and Maura Grogan, 5th Bi-Annual International Network of Indigenous Health Knowledge and Development Conference Image courtesy of the Honoring Nations September 2012 Presentation Roadmap ¤ Background ¤ Provision of health services for AIAN peoples ¤ Examples ¤ Research results ¤ What others have said ¤ Research questions ¤ What is tribal control? ¤ Some positive effects ¤ Some challenges ¤ Implications Term: American Indian or Alaska Native (AIAN) Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. Background Provision of Health Services for AIAN Peoples Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. Health Service Provision U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). • Treaty/trust responsibility • Reservation health care is a federal responsibility. The Indian Health Service (IHS) within the Department of Health and Human Services has long been the primary agency delivering health care to reservation populations. • Federal policy of tribal self-determination • Begun in the mid-1970s for a number of services previously managed by the federal government. • Since the 1980s, a growing number of Native nations have taken over management of various aspects of health-care delivery, applying existing sources of community strength and resiliency to tribal control of health care management. • Does tribal management lead to better health-care delivery than direct IHS management? Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. Health Service Provision U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). • IHS serves 2m people from 566 tribes through • IHS direct health care services administered 12 area offices and 163 IHS and tribally managed service units. • Tribally-operated health care services Tribal facilities are operated under the authority of the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended), Titles I and V (self-determination and self- governance contracts). • 82 Title V compacts (337 tribes; nearly 60% of tribes) • 231 Title I contracts • Urban Indian health care services and resource centers There are 33 urban programs, ranging from community health to comprehensive primary health care services. Approximately 600,000 American Indians and Alaska Natives reside in counties served by urban Indian health programs. U.S. Indian Health Service. “IHS Fact Sheets: IHS Year 2012 Profile – January 2012,” http://www.ihs.gov/PublicAffairs/IHSBrochure/Profile.asp Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. Examples of Differences in Service U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). Provision Tribe A Tribe B ¤ Title V compact combined ¤ Some Title I contracts with other funds ¤ Direct IHS primary care ¤ Tribally managed health- care services with many specialties available ¤ Direct IHS hospital care ¤ Another tribe provides ¤ Specialty care at distance hospital services ¤ Tribal health department ¤ Tribal health department ¤ Tribal programs ¤ Tribal programs Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. The Shift to Tribal Control Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. Study Population U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). These conclusions represent a series of interviews and case studies conducted from 2005-2010. • The interview populaon included 18 tribal leaders, tribal employees, and academics. • The case study populaon includes six anonymous federally recognized, reservaon-based American Indian naons that accepted the invitaon to par;cipate in the research. • Since this research is part of a larger project funded by the W. K. Kellogg Foundaon, two-thirds of the American Indian naons that par;cipated in this work were in the three states designated as focus areas for the Kellogg Foundaon: Michigan, Mississippi, and New Mexico. Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. What Have Others Said? Management in Other Arenas U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). • In the US, previous research indicates that American Indian nations taking advantage of federal opportunities for self-determination have experienced positive effects in such areas as economic development, land management, and policing (Berry 2009; Cornell and Kalt 2007; Edwards, Morris, and Red Thunder 2009; Harvard Project on American Indian Economic Development 2006; Krepps and Caves 1994; Wakeling, Jorgensen, Michaelson, and Begay 2001). • In Canada, Indigenous local control of health care services improved hospitalization rates (Lavoie et al. 2010), and exertion of First Nations practical-self rule reduced adolescent suicide rates (Chandler and Lalonde 2008; Chandler and Lalonde 1998). • In short, tribal control in a variety of arenas has produced practical benefits in the welfare of Native nations. Does this hold true for health care services provision? Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. References Berry, Alison. 2009. "Two Forests Under the Big Sky: Tribal v. Federal Management." Bozeman, Montana. Chandler, M.J. and C.E. Lalonde. 2008. "Cultural continuity as a protective factor against suicide in First Nations youth." Horizons U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). 9:13-24. Chandler, Michael J. and Christopher Lalonde. 1998. "Cultural Continuity as a Hedge against Suicide in Canada's First Nations." Transcultural Psychiatry 35:191-219. Cornell, Stephen E. and Joseph P. Kalt. 2007. "Two Approaches to Economic Development on American Indian Reservations One Works, the Other Doesn't." in Rebuilding Native Nations: Strategies for Governance and Development edited by M. Jorgensen. Tucson, AZ: University of Arizona Press. Edwards, Karen, Peter Morris, and Sharon Red Thunder. 2009. "Exercising Sovereignty and Expanding Economic Opportunity Through Tribal Land Management." The First Nations Development Institute and the National Congress of American Indians Policy Research Center, Washington, DC. Harvard Project on American Indian Economic Development. 2006. "Honoring Nations: Celebrating Excellence in Tribal Governance " Harvard University, John F. Kennedy School of Government, Cambridge, MA. Krepps, Matthew B. and Richard E. Caves. 1994. "Bureaucrats and Indians: Principal Agent Relations and Efficient Management of Tribal Forest Resources." Journal of Economic Behavior and Organization 24:133-151. Lavoie, Josee Gabrielle, Evelyn L. Forget, Tara Prakash, Matt Dahl, Patricia Martens, and John D. O'Neil. 2010. "Have investments in on-reserve health services and initiatives promoting community control improved First Nations' health in Manitoba?" Social Science & Medicine 71:717-724. Wakeling, Stewart, Miriam Jorgensen, Susan Michaelson, and Manley Begay. 2001. "Policing on American Indian Reservations." Washington DC: National Institute of Justice, U.S. Department of Justice. Copyright © 2010-2012 Arizona Board of Regents, on behalf of The University of Arizona. What Have Others Said? U.S. Census Bureau, Population Division, “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2009 (NC-EST2008-03),” http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html (accessed 20 December 2010). Health Care Services Management • Six comparison studies, published 1996-2002, analyzed data from 1980s-2001, excluded case studies • Four studies said tribal management leads to improved quality, expanded coverage, and easier access to health care services. • Six studies identified considerations for tribes to contemplate when moving toward tribal management or while managing health care services. • Five categories: funding, institutional, treaty and trust responsibilities, information needs, and access to health care services. Copyright © 2010-2012 Arizona Board
Load more

Recommended publications
  • Laurie O. Robinson Assistant Attorney General, Office of Justice Programs, U.S
    Laurie O. Robinson Assistant Attorney General, Office of Justice Programs, U.S. Department of Justice Ms. Robinson was sworn in as Assistant Attorney General on November 9, 2009. She previously served as Assistant Attorney General at the Office of Justice Programs (OJP) from 1993 to February 2000. During that time, she oversaw the largest increase in federal spending on criminal justice research in the nation's history, and under her leadership the annual appropriations for OJP grew substantially - from $800 million in 1993 to over $4 billion in 2000. At the same time, she also spearheaded initiatives in areas ranging from comprehensive community-based crime control to violence against women, law enforcement technology, drug abuse, and corrections. Ms. Robinson served as Acting Assistant Attorney General and Principal Deputy Assistant Attorney General of OJP from January 2009 until nominated by President Obama in September 2009. Since returning to the Department of Justice, she has overseen the implementation of the $2.7 billion in programs for which Congress assigned responsibility to OJP under the American Recovery and Reinvestment Act; launched a new agency-wide Evidence Integration Initiative to help ensure science-based approaches in OJP-funded programs; and held a series of listening sessions with state and local constituents to learn what OJP can do to better serve the field. From 2004 until January 2009, Ms. Robinson served as director of the Master of Science Program in the University of Pennsylvania's Department of Criminology. Between 2001 and January 2009, she also served as a Distinguished Senior Scholar in the University's Jerry Lee Center of Criminology and as Executive Director of its Forum on Crime and Justice.
    [Show full text]
  • Biography of Speakers
    Biography of Speakers Indian Health Care in the 21st Century: A Case Study in Disparities Monday, May 9, 2005 Georges C. Benjamin, M.D., F.A.C.P. Georges C. Benjamin, M.D., F.A.C.P., is well known in the world of public health as a leader, practitioner and administrator. Dr. Benjamin has been the executive director of the American Public Health Association (APHA), the nation's oldest and largest organization of public health professionals, since December 2002. He came to that post from his position as secretary of the Maryland Department of Health and Mental Hygiene, where he played a key role developing Maryland’s bioterrorism plan. Dr. Benjamin became secretary of the Maryland health department in April 1999, following four years as its deputy secretary for public health services. Dr. Benjamin, of Gaithersburg, Md., is a graduate of the Illinois Institute of Technology and the University of Illinois College of Medicine. He is board-certified in internal medicine and is a fellow of the American College of Physicians. An established administrator, author and orator, Dr. Benjamin started his medical career in 1981 in Tacoma, Wash., where he managed a 72,000- patient visit ambulatory care service as chief of the Acute Illness Clinic at the Madigan Army Medical Center. A few years later, he moved to Washington, D.C., where he served as chief of emergency medicine at the Walter Reed Army Medical Center. He later managed a $7 million budget and 175 employees as chairman of the department of community health and ambulatory care at the District of Columbia General Hospital.
    [Show full text]
  • Caring for Native Americans October 2020, Volume 22, Number 10: E831-905
    Caring for Native Americans October 2020, Volume 22, Number 10: E831-905 From the Editor in Chief Health of the First Americans 833 Audiey C. Kao, MD, PhD Case and Commentary How Should Allopathic Physicians Respond to Native American Patients Hesitant About Allopathic Medicine? 837 Madison L. Esposito and Michelle Kahn-John, PhD, RN What Should Physicians Consider About American Indian/Alaska Native Women’s Reproductive Freedom? 845 Felina Cordova-Marks, DrPH, MPH, Nikki Fennimore, MD, Amanda Bruegl, MD, and Jennifer Erdrich, MD, MPH Medical Education How Should Health Professions Schools Partner With AI/AN Communities? 851 Jennifer Erdrich, MD, MPH and Carlos R. Gonzales, MD Three Levels of Autonomy and One Long-Term Solution for Native American Health Care 856 Siobhan Wescott, MD, MPH and Beth Mittelstet, MD Health Law Effects of Substance Use Disorder Criminalization on American Indian Pregnant Individuals 862 Rachel Simon, MD, Jennifer Giroux, MD, MPH, and Julie Chor, MD, MPH State of the Art and Science Using OCAP and IQ as Frameworks to Address a History of Trauma in Indigenous Health Research 868 Angela Mashford-Pringle, PhD and Kira Pavagadhi, MPH AMA Journal of Ethics, October 2020 831 Medicine and Society Racialization as a Barrier to Achieving Health Equity for Native Americans 874 Vikas Gampa, MD, Kenneth Bernard, MD, MBA, and Michael J. Oldani, PhD, MS Holding Space for All of Us 882 Julie E. Lucero, PhD, MPH and Yvette Roubideaux, MD, MPH Policy, Wellness, and Native American Survivorship 888 Em Loerzel, MSW Art of Medicine Paintings From Spain’s COVID-19 Pandemic 893 Teófila Vicente Herrero, MD Indigenous Apocalypse and Transgenerational Trauma 898 Sam Ramos, MFA I Am Not Your Ballot 904 Arianna Victoria Ramirez Podcast Representation, Sovereignty, and Caring for Native American Patients: An Interview With Dr Mary Owen and Em Loerzel 832 www.journalofethics.org AMA Journal of Ethics® October 2020, Volume 22, Number 10: E833-836 FROM THE EDITOR IN CHIEF Health of the First Americans Audiey C.
    [Show full text]
  • Alaska Native Self-Government and Service Delivery: What Works?
    Joint Occasional Papers on Native Affairs No. 2003-01 Alaska Native Self-Government and Service Delivery: What Works? Stephen Cornell and Joseph P. Kalt ABOUT THE NATIVE NATIONS INSTITUTE The Native Nations Institute for Leadership, Management, and Policy (NNI) is part of the Udall Center for Studies in Public Policy, a research and outreach unit of The University of Arizona. Founded in 2001 by the university and the Morris K. Udall Foundation, NNI provides research, policy analysis, and executive education services to Native nations and other indigenous organizations in the United States, Canada, and elsewhere. Much of NNI’s work builds on and continues research originally carried out by The Harvard Project on American Indian Economic Development at Harvard University. The two organizations share some staff and work closely together in a variety of research and educational activities. NATIVE NATIONS INSTITUTE Udall Center for Studies in Public Policy The University of Arizona 803 East First Street, Tucson, Arizona 85719 Tel 520 884-4393 Fax 520 884-4702 http://udallcenter.arizona.edu ABOUT THE HARVARD PROJECT ON AMERICAN INDIAN ECONOMIC DEVELOPMENT Founded in 1987, The Harvard Project on American Indian Economic Development (Harvard Project) is housed within the Malcolm Wiener Center for Social Policy at the John F. Kennedy School of Government, Harvard University. Through applied research and service, the Harvard Project aims to understand and foster the conditions under which sustained, self-determined social and economic development is achieved among American Indian nations. The Harvard Project’s core activities include research, advisory services, executive education and the administration of a tribal governance awards program.
    [Show full text]
  • Interview Transcript
    Perspective of Change: The story of civil rights, diversity, inclusion and access to education at HMS and HSDM Interview with Yvette Roubideaux | October 29, 2018 JOAN ILACQUA: OK. So, we’re now recording. So, today is October 29th, 2018. My names Joan Ilacqua and on behalf of Center for the History of Medicine, I’m doing an oral history interview with Dr. Yvette Roubideaux. Dr. Roubideaux, do I have your permission to record us today? DR. YVETTE ROUBIDEAUX: Yes. JI: Excellent. So, my first question is probably the most broad. It’s a background question. So, if you could please just, you know, tell me about yourself. Where did you grow up? YR: I grew up in South Dakota. I was born in Pierre, South Dakota. And for the majority of my young life, I actually grew up in Rapid City, South Dakota. I am a member of the Rosebud Sioux Tribe. And also Standing Rock Sioux. JI: Great. And, you know, did medicine have a role in your early life, or the medical profession? YR: I first decided to become a doctor when I was thinking about careers in high school. And I recalled the incredible need that there was for doctors in the Indian 1 Health Service. I had heard a lot of relatives complaining about their care. And I realized at that time, I really had never seen an American Indian or Alaskan Native physician. And I realized, well maybe if we had more American Indian/Alaskan Native physicians, we could help improve the quality of healthcare.
    [Show full text]