SEATTLE – A study done at the behest of the Seattle Indian Health board
revealed urban American Indians and Alaska Natives suffer from health
maladies at a higher rate than the general population.
The study is only the second of its kind and by far the most comprehensive
ever done on the subject. The study shows that American Indians and Alaska
Natives are more prone to such diseases as diabetes and cirrhosis of the
liver in addition to higher rates of alcohol-related deaths.
The only previous study was published in the Journal of the American
Medical Association (JAMA) in 1994 and was far more limited in scope.
Most studies related to American Indian health focus on reservations, which
are largely in rural areas. However, according to the 2000 census nearly
three-quarters of American Indians and Alaska Natives reside in urban
areas.
According to officials at the Urban Indian Health Institute, the branch of
the Seattle Indian Health Board that did the study, there is a
misperception that urban Indians are better off than their rural
counterparts and maintain that this study proves that urban Indian
health-related problems are comparable to rural areas.
Urban Indian Health Institute Program Manager Maile Taualii said that while
the results are similar in regard to reservation and urban Indians, the
causes are slightly different, though the root causes for both are
ultimately poverty. For example, Taualii said that while reservations lack
forms of economic opportunity, in urban areas Indians often lack the
training and skills to adequately compete in the job market.
Whereas on the reservations stores might lack inexpensive healthy foods,
urban Indians on a limited budget will often opt for low priced fast food
chains, a major cause of diabetes.
The statistics for urban Indian health problems, however, read like those
of their rural counterparts. The study shows that Indians suffer from
accidents at a rate 38 percent higher than the general public. Chronic
liver disease, including cirrhosis is 126 percent higher and diabetes is 54
percent higher, while alcohol-related deaths checked in at 178 percent
higher than the general population.
In fact, Taualii said that as high as these figures are they are only the
most conservative estimates. Among statisticians and reporters urban
Indians are one of the most difficult groups to track in the United States
because of their decentralized settlement patterns and many lack close
tribal affiliations.
In order to do this study the Urban Indian Health Institute had to devise a
clever plan that used 2000 Census figures and overlayed them with health
statistics from the federal Department of Health and Human Services. They
focused their efforts on 34 urban areas in which there are Indian Health
Service programs and used those statistics as well.
Despite the thoroughness of the study, Taualii asserts that the figures are
low because of racial misclassifications on death certificates in several
of the larger urban areas, such as Los Angeles and New York, which both
have significant American Indian populations.
“We believe these findings grossly underestimate the true extent of the
problem,” said Ralph Forquera, executive director for the Seattle Indian
Health Board in a press statement.
Taualii said smaller states with large reservation Indian populations such
as Montana where the majority live on reservations, more easily identify
American Indians on death certificates whereas larger and more diverse
cities tend to assign another ethnic category to American Indians.
“If we were to go on death certificates alone, American Indians would live
forever in Los Angeles and New York,” Taualii said.
These statistics are important for an organization such as the Urban Indian
Health Institute as one of their primary functions is to gather information
and set up a database of urban Indian health resources. The statistical
study is necessary, maintained Taualii in order to lobby congress to fund
programs that are seen as vital to urban Indian health needs.
Currently only 1 percent of the Rural Health Service, which overseas Indian
health programs, is going to urban Indians. Taualii claimed that studies
are vital to establishing adequate funding for the programs. However, in
the current political climate it might be a tough sell.
Though the most recent federal budget does not cut funding to Indian Health
Services, funding has been curtailed in other ways. Recent federal cuts to
state and local health services and changes to Medicare and Medicaid have
had a large impact on urban Indian health clinics.
According to an essay on Indian health needs by the former director of
Indian Health Services, Michael Trujillo, who served in both the Clinton
and current Bush administrations, nearly 40 percent of the cost of running
an urban Indian health clinic comes from Medicaid reimbursements.
These changes and cuts have affected the Seattle Indian Health Board as
they have had to lay off staff in wake of the federal cuts to the state and
local programs. Taualii confirmed that many of the services that were only
recently reimbursed by Medicaid are no longer covered.