Indian Health Services

The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, provides federal health services to American Indians and Alaskan Natives (AI/AN). The AI/AN comprise 560 federally recognized tribes; tribal nations range from fewer than 100 enrolled members to more than 100,000. The majority of AI/AN live in metropolitan areas, with more than half living in six states: Oklahoma, California, Arizona, New Mexico, Alaska, and Washington. The IHS currently provides health services to approximately 1.8 million of the 3.3 million AI/AN, with an annual appropriation of $3 billion.

The first regular appropriations of funds for the relief of distress and conservation of health among AI/AN was due to the Snyder Act of 1921. In 1954, the U.S. government transferred the responsibility for provision of health care from the Bureau of Indian Affairs to the Department of Health, Education, and Welfare under the Transfer Act of 1954. As a result, the IHS was established to undertake wide-ranging responsibility for Indian health, including medical, dental, public health, and environmental health services. Health and medical care for AI/AN is currently available through IHS in the 35 states that contain Indian reservations or Alaska Native corporations. The IHS delivery system is divided into 12 administrative jurisdictions, called area offices, based on geographical boundaries. These 12 area offices are further subdivided into 127 service units, each of which may include several smaller satellite facilities and field health stations.

In the mid-1970s, two pieces of legislation were passed which had a great impact on the Native American population. The Indian Self-Determination and Education Assistance Act of 1975 provided the legal framework for individual tribes to create and operate their medical delivery systems to meet their self-defined needs. Federally recognized tribes were allowed to contract with the federal government to assume management of their health care programs. In 1976, the Indian Health Care Improvement Act specified a number of areas in which Indian people may manage contracts: training programs, specific health services, health facilities, waste disposal programs, and urban Indian clinics. Title V of that act provided support for urban health centers. Currently, there are 34 urban Indian programs receiving federal funding. Although 55% of the AI/AN population lives in urban areas, less than 1% of the IHS budget is dedicated to urban Indian health programs.

The mission of IHS is to raise the physical, mental, social, and spiritual health to the highest level among AI/AN. The IHS goal is to ensure that comprehensive, [Page 482]culturally acceptable personal and public health services are accessible and available to all AI/AN people. Federally recognized tribes enjoy a government-to-government relationship with the United States. To carry out its mission, the IHS assists tribes in developing health programs through technical assistance and management training; assists tribes in coordinating health planning and obtaining and using federal, state, and local resources; and provides comprehensive health care, including prevention programs and hospitalization.

American Indians suffer high mortality and morbidity rates. IHS has identified alcohol and other drug abuse as the most pressing health problem in American Indian communities. According to the National Center for Health Statistics, the overall mortality rate was 35% higher for American Indians than for all other ethnic groups in the United States, combined, and deaths from alcoholism were 7 times greater than deaths among other groups. Alcoholism deaths occur more commonly among Native men than women, with the highest rates occurring in the age group 45 to 54 years. It is estimated that 80% of suicides and 93% of homicides are associated with alcohol; 65% resulting from motor vehicle crashes and 25% from other unintentional injuries. The IHS is currently funding more than 200 substance abuse programs serving Indian reservations and urban communities. However, there is a shortage of funding—the current IHS budget allows health care funding for AI/AN at approximately 40% of the rate for the rest of the American population.

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