Myths and reality

Lorraine Jessepe, Today correspondent
5/23/09

WASHINGTON – “Most Indians live on reservations and don’t pay taxes.” “Indians don’t have to work because the government provides all their needs.” “Native Americans are all wealthy from gaming casino revenues.”

These are a few of the myths and misconceptions that can affect funding for urban Indian health care, according to the National Council of Urban Indian Health.

The nonprofit organization was founded in San Diego in 1998 to support and develop quality accessible health care programs for American Indian and Alaska Natives living in urban communities through advocacy, education, training and leadership development.

Geoffrey Roth, NCUIH executive director, said misinformation is the main obstacle to ensuring the vitality of Urban Indian Health Programs.

The Reality

More than 64 percent of American Indians live in cities, according to the 2000 U.S. Census. Today’s urban Indians are the descendants of Indians who voluntarily moved to the cities or who were forced to move by government
relocation policies.

Title V Urban Indian Health Programs are the key providers of care to the large population of uninsured urban Indians.
AI/AN suffer from chronic conditions such as diabetes, cirrhosis and alcoholism at rates much higher than the general population. According to the Urban Indian Health Institute, Native populations suffer from diabetes at a 54 percent higher rate, cirrhosis at a 126 percent higher rate, and have the third highest HIV/AIDS infection rate.

Another pervasive myth is that American Indians are rich from gaming profits. The NCUIH Web site points out that only 39 percent of tribes operate casinos and that Indians are still among the poorest in the country, with 25 percent living in poverty, according to the U.S. Census Bureau. “Gaming has really hurt us,” Roth said.


Federal Trust Responsibility

Roth said another problem is a lack of awareness and failure to understand the federal trust responsibility. Access to health care is one of the central tenets of the “Secession of Land in Exchange for Services” federal trust relationship and urban Indians are a congressionally mandated part of the trust responsibility.

Roth said the entire ITU (IHS, Tribal and Urban) system is severely underfunded. “The government is not keeping up their end of the bargain.”

Although only a little more than one percent of the IHS budget goes to Urban Indian Health Programs, Roth said the programs have successfully leveraged every dollar provided through IHS with two dollars from private, local or state resources.

NCUIH also touts Urban Indian Health Programs for identifying health issues particular to AI/AN communities and for their practice of incorporating traditional and western practices in the treatment process.

Roth, who is of Standing Rock Sioux descent, said Urban Indian Health Programs can provide urban Indians with a sense of connection to their cultural community. “Sometimes when you’re in a city, that can get lost.”

Los Angeles has one of the highest concentrations of American Indians in the U.S. Dave Rambeau, current board president of NCIUH and executive director of United American Indian Involvement in Los Angeles, said UAII offers traditional practitioners as part of the treatment process. “That’s one of the strongest elements of our program.”

UAII has been a Title V Urban Indian Health Program since 1996, but has been in existence since 1974. “We started out on Skid Row,” Rambeau said.

The program has grown into a comprehensive multidisciplinary service center with culturally-specific programs including a youth treatment center and the Robert Sundance Family Wellness Center. Rambeau said one of the programs receiving the most positive response is the Healthy Roads Diabetes Prevention Program. “We try to give them the tools to work with for their future lives.”

Rambeau, a member of the Pauite Tribe of California, said UAII serves about 35,000 clients annually, and 85 percent of the staff is Native.

One of the issues particular to urban Indian communities is the population’s movement from city to reservation and from city to city.

“The communities are very transient,” said Roth, who cited a need for better integration of services between IHS, tribal and urban Indian health care providers to improve the quality of care.

Rambeau said he sees a shift towards urban Indians and tribes working together to meet their common goals. “Now we’re becoming stronger as a nation of people.”

The turning point came, he said, when the Bush Administration zeroed out funding for both urban and tribal programs. “There was a need for us to get our political ducks in a row. That was the turning point, I believe.”

Lorraine Jessepe can be reached at lorrainejessepe@msn.com.

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