Jordan Ellis
Healthcare on Native American reservations is provided by the federal Indian Health Service (IHS). These health facilities are often in remote locations, far from homes and communities. The IHS is divided into twelve areas of the United States, each working with a unique group of tribes. Native Americans have been disproportionately impacted by COVID-19, with higher rates of diagnosis, hospitalisation and death. Despite growing populations, Congress has failed to provide sufficient funding for adequate healthcare services. Some hospitals have created programs to accommodate Native American beliefs and practices, offering traditional foods and support for alternative healing traditions.
| Characteristics | Values |
|---|---|
| Healthcare provider | Indian Health Service |
| Healthcare coverage | Federal Health Program for American Indians and Alaska Natives |
| Healthcare challenges | Remote locations, limited services, language barriers, cultural differences, inadequate funding |
| Initiatives | Navajo interpreters, traditional foods, dietary education, telehealth, specialised treatments, behavioural health services |
| Hospitals/Health Systems accommodating Native Americans | Flagstaff (AZ) Medical Center, Northern Arizona Healthcare System, Texas Native Health |
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What You'll Learn
- Healthcare services are often far from Native American communities
- Hospitals are making changes to accommodate Native American beliefs and practices
- Native Americans are disproportionately impacted by COVID-19
- Congress has failed to provide adequate funding for healthcare services
- Native Americans have faced historical healthcare issues
Healthcare services are often far from Native American communities
The federal Indian Health Service (IHS) provides healthcare on reservations, but these services are often located far from homes and communities. The IHS is divided into twelve areas across the United States, each working with a unique group of Tribes. However, the levels and quality of health services have not kept up with the growing tribal populations, and Congress has failed to provide sufficient funding for adequate healthcare. This has resulted in a lack of adequate healthcare services for Native Americans, with some remote Tribal communities having no other option than the IHS.
The impact of limited healthcare access is felt particularly keenly in the post-acute care phase. For instance, setting up a patient with oxygen may require a two-hour trip to their home. Additionally, creating discharge plans can be challenging due to the limited services and assisted living facilities available on reservations. Hospitals have made efforts to accommodate the beliefs and practices of Native American patients, but the distance and lack of resources remain significant barriers to providing effective healthcare.
Furthermore, cultural and language barriers can hinder the delivery of healthcare services to Native American communities. For example, Native American patients may primarily speak languages like Navajo and struggle with English, impacting their understanding of educational materials and instructions. This highlights the importance of building relationships with providers on reservations and working closely with medical homes and primary care providers within these communities.
To address these challenges, organizations like Texas Native Health aim to promote overall well-being within the Native American community in Texas. They offer a range of services, including medical, dental, lab, and behavioral health, alongside educational initiatives to empower community members to make informed decisions about their health and future. Such efforts are crucial in ensuring that Native American communities have access to the healthcare they need and deserve.
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Hospitals are making changes to accommodate Native American beliefs and practices
The healthcare system in the United States is witnessing changes to better cater to the beliefs and practices of Native Americans. Hospitals are increasingly recognising the importance of educating themselves about Native American beliefs and practices to provide effective treatment plans and discharge instructions. This includes hiring interpreters and traditional healers, offering traditional foods, and coordinating spiritual and physical treatments.
Interpreter Services
Interpreters play a crucial role in bridging the language gap between healthcare providers and Native American patients. Hospitals are employing full-time interpreters, such as the three full-time Navajo interpreters at a hospital covered by Relias Media, to ensure effective communication and understanding of treatment plans.
Traditional Healers and Practices
Some hospitals are incorporating traditional healing practices into their treatment approaches. For example, the Navajo Nation and the Hopi reservation hold very traditional Indian medicine beliefs. Hospitals serving these communities may allow patients to perform tribal healing ceremonies, such as sprinkling corn or cornmeal around the bed before surgery or treatment, or burying the umbilical cord after childbirth. Additionally, hospitals may hire traditional healers or medicine men/women to coordinate spiritual and physical treatments, respecting the patients' beliefs and promoting confidence in the care provided.
Dietary Considerations
Diet is an important aspect of cultural sensitivity in healthcare. Hospitals are working with dieticians, like the Indian Health Service dietician, to help Native American patients adhere to their dietary restrictions. This may involve educating patients about preparing healthy meals with familiar ingredients rather than imposing strict dietary guidelines.
Discharge and Follow-up Care
Hospitals are also modifying their discharge processes to better suit the needs of Native American patients. Instead of providing extensive discharge education packets in English, hospitals are now providing more concise and immediate need-to-know information. This shift occurred after hospitals discovered that many Native American patients were not opening the packets and instead relied on their primary care providers for follow-up instructions.
Furthermore, hospitals are building relationships with providers on reservations to improve transitions of care and ensure better access to post-acute services, especially for patients living in remote areas. This includes providing medical equipment, such as oxygen tanks, and offering telehealth programs tailored to the needs of Native Americans.
While there are efforts to accommodate Native American beliefs and practices, challenges remain, particularly in remote areas with limited services. Hospitals continue to adapt their practices to better serve the unique needs of their Native American patients, fostering an inclusive and respectful healthcare environment.
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Native Americans are disproportionately impacted by COVID-19
Native Americans have been disproportionately impacted by the COVID-19 pandemic, with early data indicating dramatically disproportionate rates of infection and death among this demographic. In Arizona, Native Americans make up 5% of the population but account for 20% of coronavirus-related deaths. Similarly, in New Mexico, Native Americans account for over 36% of all positive cases, despite making up a much smaller percentage of the state's population.
There are several factors that contribute to this disparity. Firstly, many people living in tribal communities have limited access to basic utilities like electricity and running water, which are essential for hygiene practices that help prevent the spread of the virus. For example, the Navajo Nation, which saw a rapid increase in COVID-19 cases, struggled with a lack of running water that complicated coronavirus suppression efforts.
Secondly, there is inadequate funding for healthcare services in these communities. This means that Native Americans may face barriers in accessing timely and adequate healthcare, which can lead to worse health outcomes during the pandemic.
The pandemic has brought to light long-standing racial inequalities and shortfalls in healthcare for minority populations. The disproportionate impact of COVID-19 on Native American communities highlights the urgent need for increased investment and resources to address these disparities.
Furthermore, the high rates of infection and death among Native Americans may be partly due to extensive testing in these communities, as health departments attempt to control virus clusters. Nevertheless, the underlying issues of racial inequality and insufficient healthcare funding must be addressed to mitigate the impact of the pandemic on this vulnerable population.
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Congress has failed to provide adequate funding for healthcare services
Native Americans face significant inequity in healthcare compared to the rest of the United States population. Despite the federal government's responsibility to provide healthcare services to Native Americans, Congress has consistently failed to provide adequate funding, resulting in limited access to comprehensive health services for tribal members. This underfunding has led to a lack of hospitals and medical facilities on reservations, with only one assisted living facility reported on one reservation.
The Indian Health Service (IHS), the federal health program responsible for providing healthcare to Native Americans, has been chronically underfunded. As a result, hospital administrators are forced to limit the services offered, impacting the health outcomes of Native Americans. According to the National Indian Health Board chief executive, Stacy Bohlen, Native Americans have the highest rates of diabetes and are five times more likely than non-Hispanic whites to have tuberculosis. Moreover, Native youth have the highest suicide rates in the country.
The inadequate funding has also led to challenges in providing post-acute services for patients living in remote areas of reservations. For example, patients may require a two-hour trip to receive oxygen supplies. While some clinics in these remote sites provide wheelchairs and walkers, the lack of resources is evident. The National Indian Education Association has also highlighted how underfunding has impacted schools, resulting in broken heaters and a lack of teachers.
The impact of inadequate funding extends beyond healthcare. A report by the U.S. Commission on Civil Rights found that funding levels for Native American tribes are insufficient, impacting their ability to address issues such as suicide, high dropout rates, violence against women, and climate change. The report recommended that Congress assemble a spending package that meets tribal needs, including basic necessities like electricity and running water.
The failure to provide adequate funding has resulted in a crisis of health equity for Native Americans, with health outcomes that lag behind other groups. To address this crisis, it is essential to invest in evidence-based, outcome-based, and community-based approaches to improve the health of Native Americans and ensure they have equal access to comprehensive healthcare services.
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Native Americans have faced historical healthcare issues
Native Americans face significant inequities in healthcare and health status compared to other populations in the United States. They have a lower life expectancy and higher death rates from preventable illnesses such as chronic liver disease, diabetes, and chronic lower respiratory diseases. Additionally, American Indian women are 20 times more likely to give birth in a hospital without obstetric services due to the limited number of IHS-run healthcare facilities with labor and delivery programs.
The historical trauma and oppression faced by Native Americans, including forced relocation, loss of land, forced assimilation, and suppression of cultural practices, have had lasting impacts on their health and access to healthcare. This has led to a lack of trust in the healthcare system and difficulty in seeking medical care. Native Americans also face challenges with insurance, as many are uninsured or underinsured, further limiting their access to healthcare services outside of the IHS system.
To address these issues, there have been reauthorizations of the IHCIA to enhance health services for American Indians and ensure funding. The IHS Scholarship Program aims to address the shortage of medical personnel in tribal communities by providing educational opportunities for American Indian and Alaska Native students pursuing healthcare careers. These efforts are crucial in improving healthcare services and ensuring equitable access to healthcare for Native Americans.
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Frequently asked questions
Healthcare on Indian reservations is provided by the federal Indian Health Service. This service is divided into twelve physical areas of the United States: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson. Each area works with a unique group of tribes.
Native Americans often face challenges in accessing healthcare services due to remote locations and limited options. Additionally, there is a lack of adequate funding from Congress, which has resulted in a struggle to meet the needs of growing tribal populations.
The Indian Health Service aims to accommodate the beliefs and practices of Native American patients. For example, hospitals may offer traditional foods and provide extensive education on Native American beliefs and practices for their staff. Interpreters and chaplains may also be available to support patients.
There are ongoing efforts to improve healthcare for Native Americans, such as the work of Secretary Deb Haaland, an enrolled member of a federally recognized Indian Tribe, who has promised to address issues within Indian Nations. Additionally, organizations like Texas Native Health strive to promote overall well-being within the Native American community through various initiatives and services.
