Health disparities and IHS

Indian Health Services (IHS), an agency within the Department of Health and Human Services, was created in 1955 to broader effort to reform health care on the reservations. In its initial survey IHS found that total mortality was 20% higher, infant mortality was 3 times higher, life expectancy was 10 years lower, and infectious diseases and accidents were more prevalent; however, heart disease and cancer were less common. In 1970s life expectancy was two thirds the national average, and the incidence of infant mortality (1.5 times), diabetes (2 times), suicide (3 times), accidents (4 times), tuberculosis (14 times), gastrointestinal infections (27 times), dysentery (40 times), and rheumatic fever (60 times) also were above the national average. Although still above the national level, by 1990 incidence of  tuberculosis was reduced by 96%, infant mortality by 92%, pulmonary infections by 92%, and gastrointestinal infections by 93%. However, disparities persisted. American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (500% higher), alcoholism (514% higher), diabetes (177% higher), unintentional injuries (140% higher), homicide (92% higher) and suicide (82% higher). Life expectancy at birth is five years less than that of the U.S. All Races population (72.5 vs. 77.5  years).

Congress passed several bills aimed at improving conditions on reservations. In 1975 Congress enacted Indian Self-Determination and Indian Assistance Act followed by 1976 Indian Health Care Improvement Act. These acts gave tribes more control over their health services. For the fiscal year 2012, the budget of IHS is $4.6B (for comparison, Veteran Administration total budget was $127B).

Despite a significant progress, disparities remain. Many causes were proposed and debated throughout several centuries, from invocations of providence in environmental factors such as diet, living conditions, and climate to more deterministic causes such as behavioral, genetic, and socioeconomic. Some blamed personal choices, others argued that roots of disparities lie in disrupted social conditions following colonization and continues to this day due to exploitative policies of the federal government (e.g. uranium mines, water rights). That disparities cut across a number of diseases challenges the belief the disparities are the product of inherent susceptibilities of American Indians. Instead, and rather much more likely, the health disparities arose from the disparities in wealth and power that have endured since colonization.

Going West

For the next four or five weeks I am working at Gallup Indian Medical Center (GIMC) in Gallup NM, on the border of the Navajo Reservation. Located about half way between Albuquerque, New Mexico, and Flagstaff, Arizona, Gallup was settled in 1881 as a coal mining town and became a stop for the railroad and the Interstate Highway of Route 66 in the past and the present I-40. Route 66 still goes through Gallup, and much of local sites bear history of that era. In the 1930s, 40s, and 50s Gallup has seen a lot of motion picture crews with a long list of movie stars and even two presidents, President Reagan and President Eisenhower. GIMC is a 100-bed Indian Health Services hospital that serves American Native patients, primarily Navajo. While here I will do inpatient medicine, HIV, ID, and general medicine clinics, and do home visits to Navajo patients. And of course hope to do a lot of traveling and site seeing.