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The Federal Government and Native American Health

by Sarah Stern
July 7, 2020

This interview with Sarah Stern, a Health Educator at John Hopkins American Indian Health (JHCAIH), was conducted and condensed by franknews

frank | Native American populations have been disproportionately impacted by COVID. I am curious about what the current reality of tribal healthcare infrastructure looks like and the history that has played a role in shaping it? 

Sarah Stern | The reality is that tribal healthcare infrastructure has been and remains underfunded and understaffed. 

The Indian Health Services (IHS) has been vastly underfunded since it’s creation in 1955. The Snyder Act of 1921 was the first federal agreement to even allow Native people to receive medical care. We see facets of American history that are not even 100 years old. I stress this as a reminder that while Native people have always existed in the United States, there are far more years of physical and cultural genocide against Native people within American history than years of serving, protecting, and advocating for Native lives. 

IHS remains the last in line to receive federal funding to aid the health and wellbeing of Native people. The National Indian Health Board (NIHB) released tribal budget recommendations showing that the IHS spends on average only $3,332 per capita on each patient, compared to a national average of $9,207. In comparison to the Veterans Administration (VA), which is also underfunded, the VA remains about 14 times as funded than the IHS. Highlighting these gaps creates dialogue for both Native people and allies to engage in political pressure to increase funding for healthcare and save lives. 

From my understanding there was a "Self-determination Era," which came about in the 1960s, giving tribal governments greater control over local government operations, including healthcare and health clinics. Can you go into the history of that era?

The “Self-Determination Era” allowed Native people to use federal funds as they wanted, but the caveat was (and remains today) that Native people had to report how they wanted to use funds and keep records of the cash flows using systems developed by non-Native people. This created a newer opportunity to add in ‘western’, or non-Native educational programs. School-based teachings of Native cultural values or language were not allowed until 1975, which is less than 100 years ago. Public services, workforce creation, and health care facilities were more developed as Native people were granted the federal ability to allocate funds into these things, alongside education. 

It is important to recognize Native people have always utilized the act of self-determination to keep community members, especially children and elders, safe from harm’s way, even before the “Self-Determination Era”. We have worked persistently to protect our land, people, and allies since time immemorial. As Native people proved in many ways to survive physical and cultural genocide, the United States eventually allowed Native people to use federal funding as they saw fit, which was not the case before the 1960s. Basically, the onslaught of Native people cost the United States so much time, money, and non-Native causalities that they eventually folded and decided to stop murdering on stolen land. 

Native people also began to have more rights for self-governance, which allowed for leadership among the facets the people wanted funding applied to. 

As we see in successful public health initiatives today, when communities have voices at the table representing what the needs and realities are, more positive opportunities take place. 

Without Native leadership, the “Self-Determination Era” would not have been as successful nor propelled us to where Native communities are presently. 

How can the federal government effectively help in this crisis while also ensuring levels of continued self-determination?”

The federal government can listen to Native leadership directly. Native community leaders have the means to communicate what their people need during this time. This is the most direct way for the federal government to help.

Another way that the federal government can help is to increase public health funding to health programs and educational opportunities. JHCAIH is committed to providing national leadership in training Indigenous scholars in health care and public health science. JHCAIH has awarded over 1,500 scholarships to people representing 45 tribal communities around the nation. Linked below is more information on the public health training programs and online application for scholarships. 

JHCAIH Training Programs

Online Application for Scholarships

Is there a specific piece of that history and its effects that you are thinking about most right now? 

Treaty rights, and the broken treaties this country participates in. 

Broken treaties impact all aspects of Native American communities. Broken treaties account for the fact that some Native people are not federally or state recognized, which in turn impacts the ability to apply for education, housing, health, and infrastructure assistance. Broken treaties have taken away Native lands and water rights. 

Broken treaties have created health disparities we see across Indian Country. 

Broken treaties have fueled stereotypes against Native people and treaties continue to be broken to this day. For example, in February, the current administration demolished Tohono O'odham Nation’s sacred burial lands without consulting the tribe. Members of the Mashpee Wampanoag community are currently battling the federal administration for seizure of land granted by a federal trust. Land has life. Land connects to Native creation stories, it holds memories, it gives protection, and when land is seized, people hurt. I encourage you to find out what Native land you live on, who the Native people are in your area historically and presently, and how you can show allyship to Native people during this time. Allyship can help combat broken treaties. 

How do the economic crisis and health care crisis particularly feed off of each other? 

Both crises increase panic. Health care requires money. Lack of economic opportunities diminishes ability to pay for health care costs and decreases the ability to fund health care initiatives. 

Collapse of economic ventures impacts everyone, regardless of whether the business is run by Native people or not. This will vary by community, but Native leadership works diligently to ensure that community members have the means to purchase essentials, like food and water, and as they are able, they create plans for how business can run with social distancing procedures at the foreground. Protecting the health and lives of people is the best practice to begin re-opening businesses during the pandemic.