The Political Epidemiology of Infant Mortality: A Health Crisis among Montana American Indians

INTRODUCTION . . . politics is medicine on a large scale. -Rudolphe Virchow Although Virchow's often-quoted declaration was made over a hundred years ago, the statement summarizes the current health dilemma faced by Native Americans. Native American health, like so many other aspects of their lives, is intimately intertwined with a legal and political-economic structure which often determines individual and societal well-being. The health problems faced by many Native Americans today are a result of their political-economic status vis-a-vis the dominant society. For example, the current epidemics of substance abuse, diabetes, violence, and suicide, to name a few, are rooted in the political and economic relationships American Indians have with the federal government. The solutions to such health problems transcend the boundaries of medical technology and treatment, requiring political change, not just an administrative restructuring in current health policy or an infusion of the latest medical technology. This is not to deny that tremendous progress has been made in American Indian health. Most of the diseases that plagued pre-twentieth century Indian people have been controlled or nearly eradicated through massive public health efforts, but their treatment has remained largely reactionary or crisis oriented, addressing only the clinical manifestations of the disease rather than its causes. Certainly, medical technology and public health efforts have gone far in controlling infectious and environmental diseases, but these efforts have not made significant inroads into certain health problems that are firmly anchored in the political and economic spheres of contemporary American Indian life. One such health problem is infant mortality