Ngày tải lên :
16/03/2014, 05:20
...
Indianhistory,healthissues,andchallengesexperiencedbythispopulationand the
UrbanIndianHealthOrganizationthatservethem.
“Fewpeoplerealizethat the majorityofAmericanIndiansandAlaskaNatives in
the UnitedStatesarenowliving in Americancities,notonreservations.Yet,
FederalhealthcarepolicytowardAmericanIndiansandAlaskaNatives
continuestofocuslargelyon the needsofthoselivingonreservations in rural
areas—needsthat,despitedemonstrableprogresssince the creationof the
IndianHealthService(I.H.S.) in 1955,remainsubstantial(Kauffmanetal.,1997).
The purposeofthisIssueBriefistodescribe the largeandgrowingurbanIndian
population,theirhealthstatus,and the majorfederalhealthprograms(i.e.,
I.H.S.andMedicare)andfederal‐stateprograms(i.e.,MedicaidandChildHealth
InsuranceProgram)thatareavailabletoimproveNativeAmericans’accessto
neededhealthservices. In settingforth the circumstancesofurbanIndians,this
IssueBriefdoesnotintendtosuggestthat the healthcareneedsofIndian
peopleliving in ruralareasare in anywaylesscompelling.
AGrowingPopulationofUrbanIndians
In 1990,overhalfof the 2millionAmericanIndiansandAlaskaNatives in the
UnitedStateslived in urbanareas... In contrast,anestimated430,000Indians
livedon279federalandstatereservationsthatyear,andanother40,000lived
in AlaskaNativevillages(Snipp,1996).
WhoareUrbanIndians?
UrbanIndiansaremembersof,ordescendantsofmembersof,oneof the many
Indiantribes
orotherorganizedgroupsofaboriginalinhabitantsof the Americas
wholive in cities. The IndianHealthCareImprovementActdefines the term
“UrbanIndian”tomeananyindividualwho“resides in anurbancenter”…and
“meetsoneormoreof the fourcriteria”forqualifyingasan“Indian”under the
Act.
The migrationofIndiansfrom the reservationstoAmericancitiesoccurred
throughout the pastcenturyandisexpectedtocontinue. The proportionof
Indiansliving in what the CensusBureaudefinesas“urbanizedareas”grewfrom
45percent in 1970to56percent in 1990(U.S.CensusBureau,2001,personal
communication).Historically,thismigrationreflectedfederalgovernment
“relocation”policies in effectduring the 1950’s.Over160,000AmericanIndians
andAlaskaNativeswereforciblymovedfromtheirreservationsintocitiesto
promoteassimilationinto the dominantU.S.society(Kauffmanetal.,2000;Hall,
...
Although the statehasbeenanationalleader in developingasystemoflong‐termcare
thatallowsolderadultsandadultswithdisabilitiesdignityandchoices in howthey
wishtolive,tribalcommunitieshavelargelybeenleftout. The needoftribal
governmentstoassureappropriatecarefor
theircitizensmustberespected,andthey
musthaveequitableaccesstostateandfederalresources,aswellasinformationabout
existingprogramsforwhichAI/ANsareeligible.
Muchworkneedstobedone in long‐termcaretoensurethat the agingIndian
population in Washington,aswellas
AI/ANadultwithdisabilities,hasaccessto
essentialservicesandoptionswhentheyareneeded.DevelopingstrategiesforTribes
toprovidelong‐termcareservicesmustbeapriorityofbothstateandtribal
governments.
SupportingData
Thereislittledataavailableregarding the long‐termcareneedsofTribaleldersand
youngerIndianadultswithdisabilities.Severalfactors,suchasIndianHealthService
nothistoricallyfundinglong‐termcareservices, the lowerlifeexpectancyofIndian
people,and the misclassificationandmisreportingofIndiandata,allcontributetothis
gap.
Whatisknown,however,isthatAI/AN in Washingtonhave the highestratesofchronic
diseases,includingbutnotlimitedtodiabetes,coronaryheartdiseaseandasthma,
thananyothergrouporpopulation.
10
Complicationsfromthesediseasescanleadto
elders,aswellasyoungeradults,nolongerabletotakecareofbasicactivitiesofdaily
livingwhichallowthemindependence(e.g.,walking,eating,dressing,using the toilet,
etc.). In, ImprovingHealthThroughPartnerships: The 2007‐2009AmericanIndian
HealthCareDeliveryPlan,statisticaldataforAI/ANs in 10healthindicatorareaswas
comparedtootherpopulationgroups,andAI/ANsconsistentlyhad the firstorsecond
worsthealthstatus in eachareawhich, in additionto the chronicdiseasesmentioned
above,includedstrokes,lungcancer,femalebreastcancer,andcolorectalcancer.
WithoutTribes
havingappropriatelong‐termcareservicedeliverysystems in place,
eldersandadultswithchronicdiseaseanddisabilitiesareathighriskforpremature
institutionalizationordeath.
...
First,aState‐Tribal‐UrbanIndianHealthCollaborativehasbeenre‐institutedata
state/triballeaderpolicylevelforaddressingappropriatesystemschangeandpolicy
decisionsthatneedtobemadetochangehealthoutcomesforIndianpeople.This
group—comprisedoftribalgovernments,healthstaff,andstateleadersacross
multiplesystemsanddepartments—willbestrategicallyaligningstatewideIndian
healthdisparitiesworkwithGovernorGregoire’s5‐PointHealthCareInitiative.Thiswill
allow the grouptoleverageexistingresources,maximize the limitedfundscurrently
available,andcreate the infrastructurenecessarytofurtherreduceIndianhealth
disparities in the future.
Second,severalagencies,organizations,andinstitutionshaveexpressedarenewed
interest in comingtogethertodevelopamorecompletesetofAmericanIndianhealth
statusdata.Accuratedataisnecessarytosupportcommunityhealthassessmentsand
policydevelopmenttoimproveservicedeliveryandhealthstatusofIndianpeople.
WithoutpaintingamorethoroughpictureofIndianhealth in Washingtontoday, the
abilitytoplanorimproveservices,monitorquality,andanalyzecostsisseverely
impaired.Tribalgovernmentsmustbeintricatelyinvolved in sucheffortstoassure the
useof the dataisculturally‐appropriate,acceptable,andmeaningful in improving the
healthoftheirpeople.Byreinstitutingeffortsthatbegan in 1997between the
AmericanIndianHealthCommissionandWashingtonStateDepartmentofHealth
throughanAmericanIndianDataCommittee,anupdatedframeworkcanbedeveloped
foraddressingpriorityhealthissuesforAI/AN.
Third,sweepingnationalhealthreformand the currentadministrationofferaunique
opportunityforchange in howhealthcareisprovidedtoAI/ANs.AsIndianhealth
leadershipsuchas the U.S.IndianHealthServices, the NationalIndianHealthBoard,
andmoreregionally, the NorthwestPortlandAreaIndianHealthBoard,strongly
advocatesfor the inclusionofIndianhealthreform in nationalreformstrategies, the
stateisalsorethinkinghowitprovidesquality,affordable,andcost‐effectivehealth
caretoitscitizens. The state,Tribes,and the commissionwillactivelypartner in these
effortstoaddress the needforAI/ANincreasedaccesstoexistingservices,increased
Tribalproviderreimbursementopportunitiesso
culturally‐appropriateservicescanbe
provided in Tribalcommunities,anddevelopmechanismsforevaluatingprogressfor
improvedIndianhealthstatus.
SectionIII,2007‐2009Accomplishments,highlightssomeof the majorachievements
madeforIndianhealth in the statesince the lastplanwaspublished in 2007.Additional
partnershipshavebeendeveloped,keypolicyissueshavebeenaddressed,andthere
...