UNIVERSITY OF OKLAHOMA GRADUATE COLLEGE A POLITICAL ECONOMY APPROACH TO HEALTH CARE AMONG AMERICAN INDIAN POPULATIONS IN CENTRAL OKLAHOMA A Dissertation SUBMITTED TO THE GRADUATE FACULTY in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Bobanne G. Roush Norman, Oklahoma 2005 UMI Number: 3174276 UMI Microform 3174276 Copyright 2005 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, MI 48106-1346 A POLITICAL ECONOMY APPROACH TO HEALTH CARE AMONG AMERICAN INDIAN POPULATIONS IN CENTRAL OKLAHOMA A Dissertation APPROVED FOR THE DEPARTMENT OF ANTHROPOLOGY BY _____________________________ Betty Harris _____________________________ Lesley Rankin-Hill Gus Palmer, Jr. __________________________ _ R. Warren Metcalf _____________________________ Jerry Bread © Copyright by Bobanne G. Roush 2005 All Rights Reserved Acknowledgments I wish to express my gratitude and thanks to all those who inspired my academic career. It has been a long, and sometimes, rocky road but well worth the journey. Throughout this time and effort many people have contributed to the successful completion of my education. I would like to recognize those individuals who stayed with me to the end. First, to my dissertation committee, I appreciate their patience, endurance, and encouragement. I especially thank Dr. Betty Harris for her willingness to chair my committee. Her helpful suggestions, guidance, and direction are greatly appreciated. I would like to thank Dr. Lesley Rankin-Hill for pro viding additional insights and sources for my research from time to time. A grateful thank you is extended to Dr. Warren Metcalf for his patience over the years and cheerful encouragement, even when I overlooked his book in my bibliography. Appreciation and thanks are also extended to Dr. Gus Palmer and Dr. Jerry Bread for their willingness to be added to my committee late in my Doctoral program. Their native knowledge was encouraging. It was reassuring to know I could call on them if I had questions about Native peoples. I am indebted to the Native peoples in and around the Perkins Indian community who were the focus of my research. They patiently spent their time answering my endless questions. For this I am especially grateful. I also want to express my thanks to various Iowa tribal administrators who allowed me access to their facilities, documents, and personnel for interviews. Without their permission this research would have been difficult. iv I appreciate my family s interest over the years, most notably, my three sisters, for their inquisitiveness and curiosity about my educational endeavors even though they did not fully understand my perseverance when the going got tough. It was a motivating factor and contributed to my endurance. I give an extra special thanks to my mother for her unwavering confidence that I would finally finish my Doctoral dissertation and graduate. It was a source of comfort and inspiration. To my father, I am ever so grateful for his financial support and advice to keep going. His lifelong success was a source of inspiration and unwavering determination. Heartfelt appreciation, many thanks, and great respect is extended to Dr. Robert L. Fields, friend and mentor, whose encouragement, direction, and admonitions were an inspiration. His persistent teasing and advice were welcomed, and his Native insights and empirical knowledge about Native cultures were invaluable. It got me through challenging times. And, finally, I extend many thanks to Glenda, his wife, who cheerfully put up with my frustrations and ranting. She was always ready to listen and feed me. My acknowledgments would be incomplete without a tongue-in-cheek thanks guys to Paul and Wayne who never could understand my desire to learn about Native cultures. To them I say, Surprise! When I left my home all those years ago I remembered what the divorce attorney wrote in his brief, She ran away to live with the Indians and silently I said, Just wait guys, you ll see! To all, Aho. v Table of Contents Acknowledgments iv List of Figures ix List of Maps ix List of Charts ix Abstract x Part I. Introduction. 1 Chapter 1. American Indian Health Wit hin A World-Economy 2 My Perspective on the Topic 6 Literature Review 8 Research Goals and Methods 12 Indians and Fieldwork 23 Tribe or Nation? 25 Maintaining Identity Despite Government Interference 29 So, What s In This Study? 32 Part II. The Political Economy of Tribal Government 33 Chapter 2. Tribal Sovereignty and Its Historical Roots 34 Tribal Sovereignty: What Is It? 35 Three Supreme Court Cases That Made a Difference 37 As The Road Turns, So Goes Federal Policy. Allotment and Assimilation Era, 1871-1928 39 Now It s Legal To Be Indian. Reorganization Era, 1928-1945 42 Let s Get Out of The Indian Business. Termination Era, 1945-1961 44 I m Goin To Dallas. Where You Goin ? Relocation Era, 1961-1975 46 Positive Effects of Tribal Self-Determination: 1975-1988 48 Tribal Sovereignty at its Best: Self-Governance Era, 1988-present 49 The Power To Tax 51 The Tie That Binds: Treaties 53 Original Nat ural Rights of Tribal Self-Governing Autho rity 57 Simply A State of Mind 58 Chapter 3. Tribal Governments Within Oklahoma: A Status Higher Than States 60 Consolidation and Fragmentation: An Oklahoma Consequence 61 Oklahoma Land Status vs. Indian Country 65 So, How Much Land Ya Got? 71 vi When Misunderstandings Lead to a Conflict of Interest 78 Chapter 4. Explanation and Theoretical Motivation: A Basis For Understanding Under The Sun 83 It s All About Making Sense of the World Around Us 87 Internal Colonialism: An Exercise in Duality 92 Political Economy, Capitalism, and Health 95 Medicalization of Illness: Clinical and Critical Medical Concepts 99 Summary: Connecting the Points 105 Part III. Kinship and Identity 107 Chapter 5. Kinship and Friendship and the Use of Network Analysis 108 Social Networks and Network Analysis 109 Structural Features of Network Analysis 112 Interactional Characteristics and Social Behavior 117 The Healing Connection: Unintended Consequences 119 Chapter 6. American Indian Identity: An Adventure Through Perceptions 123 Being American or Being Indian? 125 A Pluralistic Paradox 127 Pan-Indianism: A Dichotomy At Work 130 Couldn t find a wife from my tribe, we re all related 134 In The Beginning Identity was with Family 136 I am Bah-kho-je. Who Are You? 138 Identity Labels: Mixed Messages? 139 What if All Us Indians Were to be Shot at Dawn, Would You Show Up? 141 You Say You re Indn? Prove It 144 The Non-Indian Indian 147 It Seems Indians Will Just Not Go Away 149 Non-Qualifying Identifiable Indians 152 How Much White Blood You Got! 154 Analyzing the Blood Quantum Quandary 156 Will The Real Indian Please Stand Up? 160 Part IV. The Political Economy of Indian Health and Nutrition 162 Chapter 7. The Long Road To Indian Health Care 163 The Office of Indian Affairs and Federal Health Care for Indians 168 The Indian Health Service 175 Organization of the Indian Health Service 179 The Oklahoma City Service Area 182 Tribal Governments and Health Services 185 Health Programs and Services of the Iowa Tribe ok Oklahoma 187 vii Other Health Related Programs Offered by the Iowa Tribe 196 The Color of Medicine, Economics, and Health Care 197 Money, Medicine, and the Madness of it All: The Circle Shrinks 199 Where Will It End? Opening The Circle 204 Chapter Summary 205 Chapter 8. The Indian Side of Health and Wellbeing 207 Attitudes and Justifications How Far Can You Stretch a Dollar? 210 When the sun comes up tomorrow, ask me then 213 Affordable versus Natural: Quality or Quantity? Your Choice 216 Just gimme the damn cheese. I wanna go home! 218 Food Commodities and the Origin of Frybread 224 Canned Beef or Frozen Buffalo: Decisions, Decisions, Decisions 228 In Those Days and In Those Places 232 Review of the Chapter 238 Part V. Conclusions 239 Chapter 9. The End of the Road 240 Research Summary: Pulling it All Together 242 Results of the Research 253 Contributions From the Study 256 Nothing New Under the Sun After All 258 Bibliography 261 Appendix A Questionnaire for health care participants 283 Appendix B Questionnaire for health administrators 286 Appendix C Questionnaire for health clinic staff 288 viii List of Figures Figure 1. Iowa Tribe of Oklahoma Fire District 14 List of Maps Map 1. IHS Regional Map 180 2. Service Units of the OKC Service Area 180 3. Pawnee Service Unit 184 4. Shawnee Service Unit 184 5. Iowa Tribe Service Area 186 List of Charts Chart 1. Nutrient Composition 233 ix Abstract The health care system in America is in crisis. Costs of health services and nutritious foods are increasing dramatically every year for everyone. For American Indians it becomes a test of endurance and creativity to be able to access quality, affordable health care. A commonly held belief that Indians get free health care is misguided. Health care services are not free. They are expensive. They are a provision of many treaties that were negotiated between tribes/nations and the federal government. Thus, Native peoples are entitled to health care services but access is complex and comes at a price. Like a spider s web, healt h care and nutrition services are linked to identity, kinship, membership, and social networks which are dependent on the world economy. Tribal economic development is an avenue tribes are taking to be able to provide these services for its members. Economic development also decreases tribal dependence on the Federal dollar.