Native American Health Care

From first European contact, the health status of Native American people changed dramatically as European infectious diseases, especially smallpox, ravaged Native communities. Beginning in the early 19th century and more or less continuously since then, the U.S. government has played a role in providing health care to American Indians. Under different names and different leadership, Native American health care has evolved from an organization devoted to missionizing Native American and Alaskan Native people in the “ways of civilization,” through the introduction of Western medicine and a reactionary [Page 950]organization trying to control infectious diseases, and finally, into a service devoted to providing comprehensive health care and promoting health equity among Native American and Alaskan Native people.

Today, the primary responsibility of providing comprehensive health care for eligible Native Americans and Alaskan Natives is assigned to the Indian Health Service (IHS), one of eight agencies in the U.S. Public Health Service. The mission of the Indian Health Service is to achieve the highest attainable level of health for Native American and Alaskan Native people. The broad goals of the IHS are to ensure equity in health care delivery and to assist Native people in defining their health needs, establishing local health care priorities, and providing management for health programs.

During the 20th century, and especially since 1955, the health status of American Indians and Alaskan Natives has improved dramatically. Despite the tremendous gains in the level of health—and IHS efforts that have contributed to this outcome—American Indians and Alaskan Natives have not achieved an equitable level of health parallel to the general population. In a nine-IHS-Service-Area comparison of rates with the 1987 U.S. rates, American Indians and Alaskan Natives experienced a 400% greater rate of tuberculosis, a 663% greater rate for alcoholism, and a 295% greater rate for accidents than the U.S. general population. In addition, American Indians and Alaskan Natives suffer a 268% greater rate for diabetes mellitus, a 134% greater rate for homicide, and a 95% greater rate for suicide. Such statistics reveal how large the gap is in health equity between the non-Native population and our nation's Indigenous Peoples. This entry reviews the history of federal involvement in Native American health care, describes the operation of the IHS, and looks at the broader issue of Native American health status.