Native Health Initiative Program Plan and Evaluation Strategy

A Manual for Program Leaders: A. PROGRAM CONTEXT 1. American Indians and their health in the United States a. Overview: American Indians and Alaska Natives (AIAN) are heterogeneous groups of peoples whose ancestors were the original peoples of the Americas and who maintain tribal affiliation with one of the 569 federally recognized tribes or more than 300 state recognized tribes in the United States (Note 1). In all, this group represents more than 200 indigenous languages, with approximately 10% of AIAN households speaking a language other than English at home. Current estimates suggest that the AIAN population consists of 4.1 million people, approximately 1.5% of the U.S. population. While AIAN are often associated with reservations, land appropriated for tribes by the U.S. government, the majority live in cities and towns where indigenous peoples are the minority. Overall, AIAN are more likely to live in poverty (26% vs 13%), less likely to have a high school education (66% vs. 75% in 1990), and twice as likely to be unemployed than the average American citizen. b. Indian Health Service: Federally recognized tribes enjoy a government-to-government relationship with the United States. Through treaties, congressional laws (Synder Act of 1921, Indian Health Care Improvement Act of 1976), and court decisions the U.S. government agreed to provide health care for AIAN, a duty currently carried out through the Indian Health Service (IHS). A program under the Department of Health and Human Services (DHHS), the IHS cares for 1.8 million AIAN and describes itself as the "principal Federal health care provider and health advocate for Indian people. However, the IHS is poorly under-funded; a review that compared the IHS to mainstream health plans, accounting for other forms of coverage and payments fund AIAN health care, revealed that the IHS expenditure of $1,385 per user was 52% of the $2687 it would take to provide benefits similar to what the average plan offers. For those moving off their respective reservations, problems of access to care mirror those seen in other minority populations. Currently, the IHS allocates less than 1% of its budget to providing urban AIAN health care, despite the fact that more than 50% of the AIAN population live in these settings, suggesting that the government's promise of health care is an absent one for many AIAN.Master of Public Healt