An Overview of the Urban Indian Health System

1. Prepared for the Trans-National Institutes of Health American Indian and Alaska Native Health Communications and Information Work Group November 16, 2011 (historical) An Overview of theUrban Indian Health System D’Shane Barnett, National Council of Urban Indian Health

2. Removal (1825 – 1850) • American Indians are forced to move west of the Mississippi River • Open hostility and violence toward American Indians • Reservation (1850 – 1887) • Treaties with tribes to establish land-bases and rights • Regulations prohibit Indian culture and religion; and allow both military and religious control of reservations • Allotment and Assimilation (1887 – 1934) • American values of ownership and farming are forced on Indians • Increased emphasis on outlawing Indian culture and “civilizing” tribal citizens • Indian Reorganization (1934 – 1940’s) • Tribal governments are established in the image of American structure • Allotment is discontinued in an effort to salvage tribal land-bases • Termination (1940’s – 1961) • Assimilation through forced absorption • 109 tribes see their federal recognition terminated; 1.3 million acres of tribal land is lost • Self Determination (1961 – present) • Began under Kennedy (D-MA) administration, defined under Nixon (R-CA) • Tribal governments regain major roles, can contract with federal gov’t Federal Indian Policies *This slide is a summary of: Miller, Robert J., The History of Federal Indian Policies (March 17, 2010). Available at SSRN: http://ssrn.com/abstract=1573670

3. Part of the Indian termination policy (1940’s – 1961) • Began as a BIA program in 1948 and ended in 1979 • Mirrored the denial of funds for reservation-based services • Included certain government-designated urban centers: • Seattle, Los Angeles, San Francisco, Denver, Chicago, Salt Lake City, Dallas, St. Louis, Chicago, Cleveland, Cincinnati • Promises included: • Vocational training, employment assistance, housing assistance, economic assistance • More than 100,000 American Indians were relocated under the BIA program • More than 750,000 American Indians migrated to urban centers between 1950 - 1980 Indian Relocation

4. War Department established in 1789 – includes Indian relations • Throughout the early 19th century, Indians are treated by U.S. Army surgeons • In 1849, the Bureau of Indian Affairs (including health) is transferred from War Department to Department of the Interior • BIA discontinues medical services in 1877 due to inadequate funding. Healthcare services for American Indians are provided by Public Health Service (PHS). • BIA health division re-established in 1931 • BIA transfers health services back to PHS in 1955 (subsequently becoming DHHS in 1979) History of Indian Health

5. Comprehensive health service delivery system to approximately 1.9 million American Indians and Alaska Natives • Network of over 600 clinics, hospitals and health stations • System comprised of IHS (Direct Service), Tribal (638 Compact) and Urban (Title V) clinics • FY 2011 Enacted Budget of $4.07 billion

6. IHCIA Authorized: • Health Promotion Services • IHS Loan Repayment Program • Urban Indian Health Programs Public Law 94-437Indian Health Care Improvement Act of 1976

7. Urban Indian Health Programs Meeting the needs of more than 100,000 American Indians each year…

8. 35 UIHPs are located throughout 8 regions

9. Region I • Baltimore, MD • Boston, MA • New York City, NY • Region II • Chicago, IL • Detroit, MI • Milwaukie, WI • Minneapolis, MS • (Green Bay*) • Region III • Omaha, NE • Pierre, SD • Region IV • Billings, MT • Butte, MT • Great Falls, MT • Helena, MT • Missoula, MT • Region V • Portland, OR • Reno, NV • Seattle, WA • Spokane, WA • Region VI • Bakersfield, CA • Fresno, CA • Los Angeles, CA • Oakland, CA • Sacramento, CA • San Diego, CA • San Francisco, CA • San Jose, CA • Santa Barbara, CA • Region VII • Albuquerque, NM • Dallas, TX • Flagstaff, AZ • Phoenix, AZ • Salt Lake City, UT • Tucson, AZ • Wichita, KA • Tulsa, OK** • Oklahoma City, OK** • Region VIII • Denver, CO List of UIHPs

10. Poverty rates for Urban Indians1 • 50% of “Urban Indians” live below 200% of FPL (30% All Races) • 25% of “Urban Indians” live below 100% of FPL (14% All Races) • Infant mortality1 • All Races saw decline in infant mortality from 1995 – 2000; AI/AN did not • SIDS rates for “Urban Indians” from 1995 – 2000 was twice rate for All Races • General mortality1 • Leading causes of death (listed in order): Heart disease; Cancer; Unintentional Injury; Chronic Liver Disease & Cirrhosis; and Diabetes Mellitus • Depression2 • Studies show that 30% of AI/AN suffer from depression, likely higher for “Urban Indians” • No aggregate data for depression among “Urban Indians” and there is no plan to fund such research. Urban Indians -Major Health Concerns 1The Health Status of American Indians and Alaska Natives. Urban Indian Health Institute. March 2004. http://www.uihi.org/wp-content/uploads/2007/07/2004healthstatusreport.pdf 2Invisible Tribes: Urban Indians and Their Health in a Changing World. Urban Indian Health Institute. October 2008. http://www.uihi.org/wp-content/uploads/2009/09/UIHC_Report_FINAL.pdf

11. Networking and Communication • Resource Development • Training and Research Center (TARC) • Policy Advocacy NCUIH’s Role

12. www.ncuih.org Facebook.com/ncuih Twitter.com/NCUIH_Official Facebook.com/dshanebarnett Twitter.com/NCUIH_ED For More Information: