Tribal leaders take aim at Indian health issues

POLSON - Tribal and federal officials and health care experts from around the country converged on this smoke-shrouded lakeside resort Monday to plan a renewed push to raise the level of health care for American Indians.

"The health disparities in Indian Country are overwhelming," Chippewa Cree tribal Chair Alvin Windy Boy Sr. told the planning committee, which he co-chairs. "It is our hope that this committee can develop a forum that's going to come up with some solutions or directions to solutions."

Windy Boy said the federal government spends about $1,530 per person for health care for Indians, compared with an average of about $3,500 for all Americans.

"It's no different than Third World conditions," he said. "How could a country claim to be so strong to other countries when their back yard is riddled with health disparities?"

The two-day meeting, which drew representatives from each of the 12 tribal regions - together representing all 586 federally recognized U.S. Indian tribes - as well as liaisons from several branches of the U.S. Department of Health and Human Services and several private health organizations, was held to plan an April summit that aims to bring U.S. senators and congressmen and high-ranking Bush administration officials to Billings. Summit planners hope it will lead to changes in the way the federal government provides health care to Indians, both in increased funding as well as institutional changes.

In several hours of meetings on Monday, the planning committee began to hash out the agenda for that April meeting. By Tuesday afternoon, they hope, the nine forum topics they began with - each one large enough for a separate summit - will be whittled down to three or four. Within each of those, they hope, will be specific suggestions for changes to laws and policies.

"The idea was to get all three groups into the room and have a discussion, a dialogue about health disparities and how to bring up the health of American Indians," said planning committee co-chair Don Kashevaroff, president of the Alaska Native Tribal Health Consortium, which provides health services to Alaska Natives.

"We want something Congress, HHS, and the tribes buy into together," Kashevaroff said. "One-tenth, one-one hundredth of a percent (of the HHS budget) would make a huge difference."

Windy Boy said he has been an advocate for tribal health care for 15 years and has been to many conferences, but that so far change has not happened.

He said that's because many conferences talk about the problem but not enough about the solutions. The April meeting will be more effective than past efforts, he said, if more of the people in power show up.

U.S. Sen. Conrad Burns, R-Mont., has worked closely with the committee and has agreed to send out letters inviting other congressmen and administration officials to the summit, Windy Boy said.

He added that he received a personal commitment from Health and Human Services Secretary Tommy Thompson to provide results.

Part of the problem is monetary, Windy Boy said.

"You can't take care of the 586 federally recognized tribes with a $3.1 billion budget," he said, referring to the budget of the Indian Health Service. Rather, he said, tribes are entitled to services from other HHS agencies that have more money as part of their treaties with the United States.

Windy Boy said members of the government should be educated about treaty obligations at the April meeting. U.S. treaties with the tribes include pledges to provide for housing, health care and education, he said.

"My people still believe in those treaties," said Tony Prairiebear, planner for the Northern Cheyenne Health Department. "We gave up large tracts of land for little or nothing. They need to know where our problems come from."

Not everyone is focusing on treaty obligations.

"I think it's more of a moral responsibility than a trust responsibility," Kashevaroff said. "You can't have Third World conditions in the best country in the world."

The planning process for the summitt began with a meeting in April. In its remaining four planning sessions, the committee will be identifying the specific services it wants to make a push for in order to make a pitch to the people with the purse strings in April - including, they hope, Thompson himself.

Both tribal and federal officials at the meeting said Thompson is committed to making gains in Indian health care with his remaining year in office.

"What he's saying is 'I want to open the department to tribes, and help me figure out a way to do this," said Eric Broderick, a senior adviser for tribal health policy at HHS.

Broderick said there are a variety of reasons why HHS resources don't get to tribes, including an outlook that assumes the Indian Health Service should handle Indian health issues on its own, as well as legislative and policy barriers. He said tribes need to identify specific barriers before they go to the April summit, and that Thompson will be prepared to listen.

Ed Fox, executive director of the Northwest Portland Area Indian Health Board, which provides health promotion and disease prevention for 43 tribes in Oregon, Washington and Idaho, said that at an Aug. 8 meeting in Alaska, Thompson had a "real frank dialogue" with him about his desire to change things in Indian Country.

"He was real clear that he wanted to do followup," Fox said, adding that Thompson said he wants a very specific identification of problems from tribes - exactly what the April summit is intended to provide.

Fox said Thompson is committed to working for a significant budget increase in the Indian Health Service budget next year.

A shortage of resources is not the only barrier to improving health care in Indian Country. The committee also discussed institutional changes it hopes to bring about.

Dean Seneca, assistant director of the Office of Tribal Affairs at the Agency for Toxic Substances and Disease Registry, an agency of the U.S. Centers for Disease Control and Prevention, said part of the problem is that historically the federal government funds states and lets states fund tribes. One way to get the federal government more engaged with tribal governments is to get more Indians working at the federal level, he said.

Seneca said he would like to see an office of tribal affairs at the Centers for Disease Control. ATSDR is the only agency at the center with its own tribal affairs office, he said. The office gives his agency a way to focus on Indian issues in a way similar to existing CDC offices that focus on women and minority issues, he said. Whereas ATSDR has a budget of about $75 million, CDC has a budget of about $990 million, Seneca said. An office of tribal affairs attached to the director's office of CDC would make more of that money available to Indian health problems, he said.

In the end, Windy Boy said, funding will be the most important component to bring parity to the system.