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Indianhistory,healthissues,andchallengesexperiencedbythispopulationandthe
UrbanIndianHealthOrganizationthatservethem.
“FewpeoplerealizethatthemajorityofAmericanIndiansand Alaska Natives in
theUnitedStatesarenowliving in Americancities,notonreservations.Yet,
FederalhealthcarepolicytowardAmericanIndiansand Alaska Natives
continuestofocuslargelyontheneedsofthoselivingonreservations in rural
areas—needsthat,despitedemonstrableprogresssincethecreationofthe
IndianHealthService(I.H.S.) in 1955,remainsubstantial(Kauffmanetal.,1997).
ThepurposeofthisIssueBriefistodescribethelargeandgrowingurbanIndian
population,theirhealthstatus,andthemajorfederalhealthprograms(i.e.,
I.H.S.andMedicare)andfederal‐stateprograms(i.e.,MedicaidandChildHealth
InsuranceProgram)thatareavailabletoimproveNativeAmericans’accessto
neededhealthservices. In settingforththecircumstancesofurbanIndians,this
IssueBriefdoesnotintendtosuggestthatthehealthcareneedsofIndian
peopleliving in ruralareasare in anywaylesscompelling.
AGrowingPopulationofUrbanIndians
In 1990,overhalfofthe2millionAmericanIndiansand Alaska Natives in the
UnitedStateslived in urbanareas... In contrast,anestimated430,000Indians
livedon279federalandstatereservationsthatyear,andanother40,000lived
in Alaska Nativevillages(Snipp,1996).
WhoareUrbanIndians?
UrbanIndiansaremembersof,ordescendantsofmembersof,oneofthemany
Indiantribes
orotherorganizedgroupsofaboriginalinhabitantsoftheAmericas
wholive in cities.TheIndianHealthCareImprovementActdefinestheterm
“UrbanIndian”tomeananyindividualwho“resides in anurbancenter”…and
“meetsoneormoreofthefourcriteria”forqualifyingasan“Indian”underthe
Act.
ThemigrationofIndiansfromthereservationstoAmericancitiesoccurred
throughoutthepastcenturyandisexpectedtocontinue.Theproportionof
Indiansliving in whattheCensusBureaudefinesas“urbanizedareas”grewfrom
45percent in 1970to56percent in 1990(U.S.CensusBureau,2001,personal
communication).Historically,thismigrationreflectedfederalgovernment
“relocation”policies in effectduringthe1950’s.Over160,000AmericanIndians
and Alaska Nativeswereforciblymovedfromtheirreservationsintocitiesto
promoteassimilationintothedominantU.S.society(Kauffmanetal.,2000;Hall,
...
Althoughthestatehasbeenanationalleader in developingasystemoflong‐termcare
thatallowsolderadultsandadultswithdisabilitiesdignityandchoices in howthey
wishtolive,tribalcommunitieshavelargelybeenleftout.Theneedoftribal
governmentstoassureappropriatecarefor
theircitizensmustberespected,andthey
musthaveequitableaccesstostateandfederalresources,aswellasinformationabout
existingprogramsforwhichAI/ANsareeligible.
Muchworkneedstobedone in long‐termcaretoensurethattheagingIndian
population in Washington,aswellas
AI/ANadultwithdisabilities,hasaccessto
essentialservicesandoptionswhentheyareneeded.DevelopingstrategiesforTribes
toprovidelong‐termcareservicesmustbeapriorityofbothstateandtribal
governments.
SupportingData
Thereislittledataavailableregardingthelong‐termcareneedsofTribaleldersand
youngerIndianadultswithdisabilities.Severalfactors,suchasIndianHealthService
nothistoricallyfundinglong‐termcareservices,thelowerlifeexpectancyofIndian
people,andthemisclassificationandmisreportingofIndiandata,allcontributetothis
gap.
Whatisknown,however,isthatAI/AN in Washingtonhavethehighestratesofchronic
diseases,includingbutnotlimitedtodiabetes,coronaryheartdiseaseandasthma,
thananyothergrouporpopulation.
10
Complicationsfromthesediseasescanleadto
elders,aswellasyoungeradults,nolongerabletotakecareofbasicactivitiesofdaily
livingwhichallowthemindependence(e.g.,walking,eating,dressing,usingthetoilet,
etc.). In, ImprovingHealthThroughPartnerships:The2007‐2009AmericanIndian
HealthCareDeliveryPlan,statisticaldataforAI/ANs in 10healthindicatorareaswas
comparedtootherpopulationgroups,andAI/ANsconsistentlyhadthefirstorsecond
worsthealthstatus in eachareawhich, in additiontothechronicdiseasesmentioned
above,includedstrokes,lungcancer,femalebreastcancer,andcolorectalcancer.
WithoutTribes
havingappropriatelong‐termcareservicedeliverysystems in place,
eldersandadultswithchronicdiseaseanddisabilitiesareathighriskforpremature
institutionalizationordeath.
... UrbanIndianHealthPrograms
TheAIHChasidentifiedUrbanIndianhealthasanareathatwarrantsadditional
attentionandheightenedawareness.ManyAI/ANpeoplelive in urbanareas in the
state,andtheseAI/ANindividualsfacesignificantandoftenuniquechallenges in
accessingcareandremaininghealthy.Manyoftheseindividualsaremembersof
WashingtonStateTribes,othersaremembersofTribesfromotherstates,someare
membersoffederallyrecognizedTribes,othersarenot. In ordertoeffectivelyaddress
healthdisparitiesofallAI/AN in Washington,theremustbeamoreconcertedeffortto
linkurbanIndianhealthprogramstohealthreformeffortstakingplace.Thiswillallow
forimprovedcoordination in providingacomprehensivehealthcaredeliverysystem
forIndianpeople in Washington. In SectionIIIA,oneoftheprioritiesidentifiedforthe
State‐Tribal‐UrbanIndianHealthCollaborativeistobeginthisworkbyraising
awarenessofurbanIndianhealthissues.
ThefollowingisfromanissuebriefdevelopedbyRalphForquera,executivedirector,
SeattleIndianHealthBoard
5
.Thisbriefprovidesacomprehensivesummaryofurban
...