Better Indian health may hinge on power of tribes themselves
Head of NDSU program says Alaska network offers model for success
June 12, 2013
The average life expectancy of a Native American in South Dakota is 58.
Incidence of diabetes among tribal members is 208 percent that of non-Indians.
And the incidence of alcoholism among tribal members is 526 percent that of non-Indians.
These statistics came Tuesday courtesy of Dr. Donald Warne, director of the Master of Public Health Program at North Dakota State University. He was among the speakers at the first-ever Collaborative Research Center for American Indian Health Summit in Sioux Falls.
The conference, which drew about 350 participants Tuesday, concludes today at the Sanford Center. Its goal is to bring together tribal communities and health researchers from multiple disciplines to talk about health disparities experienced by Native Americans in South Dakota, North Dakota and Minnesota.
In his presentation, Warne was not despairing of Indian health care. Conditions that contribute to such poor health outcomes for Indians all are preventable, he said, and a theme running through the conference is that the best solutions come from tribes themselves.
“For thousands of years, the tribes took care of their own. They survived and thrived,” said Dr. Siobhan Wescott, a Sanford Research scientist.
The health summit is a consortium of Sanford, state universities in North Dakota and South Dakota, several other health care providers, the Cheyenne River Sioux Tribe, Oglala Sioux Tribe and the Great Plains Tribal Chairmen’s Health Board. Other regional tribes are expected to join in the next two years. The group was paid for by a grant from the Helmsley Charitible Trust.
If a community of clinical providers and researchers that is focused on Indian health issues emerges this week, the initial summit will have been a success, said Jen Prasek, Sanford Research project manager.
“The biggest success will be opening more conversations, more dialogue. A lot of the people in this room have never met before today,” she said.
The summit includes national speakers, panel discussions and training on topics such as community engagement in research, regulatory knowledge and research ethics.
In a summit session today, participants will take a detailed look at the Southcentral Foundation Nuka System of Care, the health care network owned and managed by Alaskan Natives. In his presentation Tuesday, Warne was clear that this is a preferred template for Indian health care everywhere — a situation where the tribes take more responsibility for their health care and essentially run the system.
The model is “the flagship” of how Native American health care should be run, Warne said.
But the model is not widely used in the Aberdeen Region of the Indian Health Service, which includes South Dakota, North Dakota, Nebraska and Iowa. And in the Aberdeen region, the state that uses it least is South Dakota, Warne said.
Of the state’s nine tribes, only the Flandreau Santee Sioux Tribe operate a health care facility.
After passage of the Indian Self-Determination and Education Assistance Act of 1975, tribes gained the ability to subcontract with federal agencies for the delivery of services guaranteed by treaties, including health care.
The federal government seriously underfunds IHS, Warne said. Its average expenditure per person is $2,600 annually, compared to $11,000 for Medicare recipients, he said.
But by contracting with IHS as a health care provider, tribes can leverage the federal appropriation to the greatest degree.
Where federal agencies such as IHS are prohibited from carrying forward money from one fiscal year to the next, a tribe contracting with IHS is under no such restriction. Federal agencies cannot lobby for additional money, nor can they seek grants. Tribes can do both. Tribes that subcontract as health care providers also can bill Medicare and Medicaid.
In addition, Warne said, if a tribe simply allows IHS to provide its health care, it receives only the value of the direct appropriation — Warne used the example of $2 million. But if a tribe subcontracts with IHS, it not only gets the direct appropriation but recovers indirect costs. So $2 million of health care provided directly by IHS could become a $2.6 million payment from IHS to the tribe.
Indians taking charge of their affairs are shaping other aspects of health care. Joseph Gone, a University of Michigan psychology professor, discussed in a summit presentation the interface of evidence-based medical mental health treatment and traditional tribal healing.
“Creative hybridity,” he called treatment approaches that borrow from both modes.
By overseeing genetic and other medical research involving Indians, “we want to make research mean something for us. We have not been getting anything back,” Cecelia Big Crow said
She was instrumental in establishing the Oglala Sioux Research Review Board. Founded on the principle of tribal sovereignty, it works in parallel with institutional review boards that traditionally have sought to make research in various disciplines adhere to ethics.