By Jerome Tharaud/Havre Daily Newsemail@example.com
POLSON - After two days of meetings, a group of about 30 tribal and federal officials and health experts have chosen the three issues they will bring before a group of congressmen, senators and high-ranking Bush administration officials as they press for better health care in Indian Country.
"It went real well," said Chippewa Cree tribal chair Alvin Windy Boy Sr., co-chair of the planning committee, after the session ended Tuesday afternoon. "We're kind of corralling the issues of disparity to three areas," he said, adding that when planning sessions began about four months ago, the committee had about 48 areas. That list had been narrowed to nine before this week's meeting.
The session, which was attended by representatives from each of the 12 regions that comprise all of the 586 federally recognized tribes as well as officials from national Indian health care organizations and the U.S. Department of Health and Human Services, was the latest stage in planning a national tribal health care summit scheduled for Billings in April.
Sen. Conrad Burns, D-Mont., is sponsoring the summit, and tribal leaders hope he will be able to draw a high-profile audience - possibly even HHS Secretary Tommy Thompson - to Montana to address health conditions that tribal leaders have likened to those of a Third World country.
The summit will focus on: developing direct lines of communication between tribal governments and the federal government to receive health resources; comprehensive care that includes both treatment and prevention; and better resources for health care in Indian Country. Within each of those three areas are several specific points. Issues that will be set aside until a later date or incorporated in some way into those three points include environmental health and access to pharmaceuticals.
"We were trying to pick the ones that were most important to the folks in the room," said Don Kashevaroff, president of the Alaska Native Tribal Health Consortium and co-chair of the planning committee. "These are the critical issues."
Three subcommittees will develop issue papers and propose solutions regarding the three topics. The papers will be distributed to participants before the summit. In Billings, the anticipated 300 or more participants will break into small groups to discuss the proposals. Committee members hope they can draw people with the power to make some commitments on the spot - congressmen, senators and directors of HHS agencies, rather than liaisons and staff members.
Kashevaroff said the summit will be a big step for tribal health care.
"There's never been a time when we've had all three (groups) sit down and work together as partners," Kashevaroff said, referring to tribes, members of Congress and federal administrators.
Kashevaroff said he believes there are many roadblocks in the federal bureaucracy that prevent Indians from getting better health care, and that by improving government-to-government relations, those mechanisms can be streamlined.
He also said he hopes the summit will result in more resources for preventative medicine.
"The government has never appropriated very much money for prevention because there are immediate needs," he said. "At the same time we need to look down the road 10 years. If we don't do something we're going to have a bigger problem" in the future, he said.
Julia Davis-Wheeler, chair of the National Indian Health Board in Washington, D.C., and a Nez Perce tribal council member, said she hopes many tribes working together can accomplish some change.
"Each of us as (tribal) governments go in and try to get our point across to the congressional people and to the agencies," Davis-Wheeler said. "This way, with all of us doing it we may be able to get the message through that the funding for the American Indian and Alaska Native tribes is very inadequate for what services are needed at home."
The National Indian Health Board serves as an advisory group for the Indian Health Service as well as other agencies in HHS, Davis-Wheeler said.
Windy Boy said he hopes the summit will have tangible benefits for the Chippewa Cree.
"My main concern naturally is Rocky Boy," Windy Boy said. He said he wants the tribe to be able to contract with other HHS agencies - not just the Indian Health Service - for its health care operations. He also said that when a tribe takes over its own health services from the Indian Health Service as Rocky Boy has, the tribes should get contracts that include administrative costs, not just services, as university medical facilities do.
He said he wants to see a variety of health services become more available at Rocky Boy, from the more than 200 kids at Rocky Boy who need orthodontics to cancer treatment that is not just limited to crisis care.
Windy Boy said he also wants to bring to HHS an awareness of health issues at Rocky Boy like wastewater treatment, septic waste and trash disposal that are particularly pressing on mountain reservations, and would like to see changes in existing legislation to allow Rocky Boy deal more directly with the federal government.
Here are a few examples of the changes the committee wants:
Tribes want decision-makers to recognize that according to treaties between the tribes and the federal government, tribal issues are the domain of HHS as a whole, not just the Indian Health Service. IHS has a relatively small budget - $3.1 billion compared with about $500 billion in the entire department - so such a recognition would mean more resources for tribal health.
Tribes also want an advisory committee within each HHS agency - similar to offices that deal with women's and minority issues in HHS - that can be an advocate for Indian issues.
Tribes want to have consultation with state and federal governments on a regular basis, and they want consultation governed by specific policy and procedures.
As sovereign governments, tribes believe they should not have to compete with states and cities for grant money, but should instead have some funds set aside for them.
Comprehensive care, treatment and prevention:
The tribes would like to have epidemiology programs for every tribe to collect data to track the rate of different diseases. Funding is generally data-driven now, said D.J. Lott, executive director of the Indian Family Health Clinic in Great Falls and a member of the subcommittee to deal with comprehensive care, so if tribes can provide data, they will be more likely to receive funding.
Tribes want HHS to identify the HHS programs and grants they are eligible for.
A new injury prevention initiative from the U.S. Centers for Disease Control and Prevention will fund about 30 tribes to reduce the number of preventable deaths in Indian Country. The committee wants CDC to fund more than 30 tribes, and also to make sure that smaller tribes are eligible, Lott said.
Tribes want access to more HHS programs. Out of more than 300 HHS programs, tribes only have access to 125 because of legislative and regulatory barriers, said Chris Walker, executive director of health services for the Cherokee Nation and a member of the resources subcommittee.
The committee would like reports on the budgets of different HHS programs, including how much goes to Indians and what percent of the total program budget that amount is. They say Indians make up 2.4 percent of the population of the United States, so they should get 2.4 percent of the funds available.
Committee members said tribal health systems should be able to offer benefit packages similar to that offered by the federal government so they can recruit and retain doctors and other health professionals.
"This issue of resources is so critical because the government will say with Afghanistan, Iraq and the war on terrorism, we just can't afford to meet the needs of tribes that we screwed over years ago in treaties," Walker said. "And here they're sending billions of dollars to Iraq."