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Health Care, Not Assimilation

While the health care reform debate continues throughout the country

While the health care reform debate continues throughout the country, America’s indigenous peoples suffer from some of the worse conditions imaginable. Comprising only 1.6 percent of the general population, American Indians and Native Alaskans have not, do not, and more than likely will not receive adequate, if any, health care by the time the Democrats and Republicans are finished.

According to the Office of Minority Health, the Indian Health Service (IHS) provides services to only 1.9 million individuals out of 4.9 million who qualify. This paltry health care delivery comes at a critical time, when American Indians and Alaskan Natives are blighted by appalling conditions and afflictions, such as:

* Infant death rates 40 percent higher than the rates among whites. [1]

* Death rates from alcoholism and tuberculosis approximately 650 percent higher than overall US rates. [2]

* A male population twice as likely as white men to have liver and IBD cancers. [3]

* A male population 1.8 times more likely than white men to contract stomach cancer and twice as likely to die from it. [4]

* A female population 2.4 times more likely than white females to contract, and die from, liver and IBD cancers. [5]

* A female population 40 percent more prone than white females to kidney/renal/pelvic cancers. [6]

* A population of which 31 percent will die before the age of 45; “… the overall adjusted death rate for American Indians is 35 percent greater than the US rate … (The age-adjusted death rate for those living in the Aberdeen area – a region that harbors most of the Lakota-Sioux reservations in South Dakota, has risen beyond 1,000 percent). [7]

* Higher rates of diabetes and obesity than the general population. [8]

* An on-reservation unemployment rate of 49 percent – approximately five times the national rate. [9]

* The legal infrastructure of the United States of America has proven incapable or unwilling to provide any restitution for history’s most victimized and terrorized peoples.

What I ask, and what we should all be asking, is: Why is it so difficult to provide fair and equal health care to an entire group of people who comprise less than two percent of the general American population? And: Will the eventual health care reform bill ensure fair and equal care be provided for American Indians and Alaskan Natives? And also, if so: Will the provisions for the presumptive benefit of Native Americans included in the health care proposal be drafted with some regard to their needs and wishes, unencumbered by any equivocal provisos and/or tendentious legislative furnishings?

Health Care as a Euphemism for Assimilation

Health care for Native Americans is essentially the extension of assimilation programs, sanctioned and directed by the Indian Health Service (IHS) under the auspices of the Department of Health and Human Services (DHHS).

In 1921, the Snyder Act provided legislative authority for a federal health program designed to provide services to Native Americans. The IHS claims that the act authorized funds “for the relief of distress and conservation of health … [and] … for the employment of … physicians … for Indian Tribes throughout the United States.”

However, even prior to the ratification of the Snyder Act, the US had been involved in “health care” measures designed for the remaining native population. Holly T. Kuschell-Haworth wrote for DePaul Journal of Health Care Law in the summer of 1999:

The Origins of Federal Native American Health Care Attention to Native American health care began in the nineteenth century when contagious diseases, such as smallpox, threatened the once substantial populations of Native American people. The federal government’s earliest goals were to prevent disease and to speed Native American assimilation into the general population by promoting Native American dependence on Western medicine and by decreasing the influence of traditional Indian healers. In 1849, responsibility for Native American health was transferred from the War Department to the Bureau of Indian Affairs (BIA). The BIA oversaw the use of Congressional appropriations for the establishment of health programs for Native Americans. Responsibility for Native American health has since endured many organizational transfers, and now resides with the Indian Health Service (IHS), an operating division of the Department of Health and Humans Services (DHHS). [10]

Then came the Indian Health Care Improvement Act. Passed in 1976, this piece of legislation detailed the US’s responsibilities: “Congress hereby declares that it is the policy of this Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to meet the national goal of providing the highest possible health status to Indians and to provide existing Indian health services with all resources necessary to effect that policy.” (Author’s note: My italics have been added to emphasize the obscene irony of these words with respect to the real, physical effects of the referenced provisions).

In 1976, the US admitted to running a covert program of involuntary sterilization affecting about 40 percent of all American Indian women of childbearing age. [11] Article II of the United Nations 1948 Convention on Punishment and Prevention of the Crime of Genocide explicitly proscribes involuntary sterilization as a means of “preventing births among” a targeted population. Nonetheless, the IHS – an adjunct of the Bureau of Indian Affairs (BIA) at the time – authorized and administered the illicit sterilizations. The putative termination of the program resulted in the transfer of the IHS to the Public Health Service. There were no indictments or punishments for those involved. And the malfeasance does not stop there.

The IHS fails as it continues to expand assimilationist health care.

Founded in 1955 and accredited by the Joint Commission on Accreditation of Healthcare Organizations, the IHS is a federally administered health care program designed to provide services for North America’s federally recognized indigenous peoples.

IHS dependents are restricted to services provided by the clinics and hospitals that contract with the IHS only. The majority of IHS facilities are located within “contract health service delivery areas” comprising reservations, the counties containing the reservations, and the adjacent counties. The IHS itself estimates that 43 percent of Native Americans live outside “contract health service delivery areas.” [12] And according to Bonnie Duran, writing for the American Journal of Public Health in 2005: “… more than 60 percent of members of US tribes reside outside their home reservations at least part of the year, but only 1 percent of the IHS budget is earmarked for urban Indian health care.” [13]

In the 1950’s, claims American Indian scholar, author and activist Ward Churchill, “the federal government unilaterally dissolved more than a hundred indigenous nations and their reservation areas” through a series of statutes. Concomitant rulings were enforced to ‘encourage’ the relocation of sizable ‘numbers of Indians from the remaining reservations to selected urban centers,'” Churchill maintains. [14] These legislative instruments were suspended in the 1970’s, but by the 1990’s the federal relocation program had succeeded in pushing more than half of all US indigenous peoples out of reservations and into city ghettos, with the ostensible objective of “assimilation.” [15]

The fact that the bulk of IHS facilities are located not in city ghettos but on and around reservations, concurrent with the reality that nearly half the native population resides nowhere near service areas due to former federally mandated relocation programs, not only substantiates the concern that adequate health care is not being provided to America’s indigenous peoples, but also that these conditions are federally ignored.

With respect to its finances, IHS is categorized for budgetary purposes as a discretionary program. In other words, there is no federal guarantee that there will ever be adequate funding for the IHS. Meanwhile, Medicare and Medicaid are federal mandates and those who are eligible are guaranteed full access to their programs. Bonnie Duran reveals: “For reservation-based populations, the level of per-capita funding is less than half of what is provided to those on Medicaid and in prison.” [16]

In 2005, the General Accountability Office (GAO) discovered a number of IHS facilities with zero funding to contract for “non-urgent” care. The same GAO study discovered that eleven out of thirteen facilities surveyed had zero to limited ability to treat chronic pain and seven out of thirteen facilities had zero to limited ability to perform cancer screenings. [17] Let me remind the reader that these findings pertain to a specific group of people who are, at the very least, twice as likely as the white population to contract, and die from, preventable cancers.

As if that weren’t bad enough, the IHS receives only 50-75 percent of the funding needed to operate. [18] The IHS is, in fact, virtually bankrupt.

Meanwhile, the 1.8-million-acre San Carlos Apache Reservation, home to a community of 13,000, is one of the poorest reservations in the United States. Writing for Congressional Quarterly in April of 2006, Peter Katel quoted Tribal Chairwoman Kathleen W. Kitcheyan lamenting: “We suffer from a poverty level of 69 percent, which must be unimaginable to many people in this country, who would equate a situation such as this to one found only in Third World countries.”[19]

The Syndicated Creation of Disease and Destitution

Most of these desperate conditions could have been prevented. More than one-half of the nation’s uranium deposits, one-fourth of its low-sulfur bituminous coal reserves, one-fifth of its oil and natural gas, as well as substantial deposits of copper and other ores are located within the confines of reservations. [20] These resources are valuable and can also be lethal once mined and/or processed on site. Nonetheless, it is peculiar to find the most impoverished demographic in the US residing directly above a large quantity of such valuable resources. In his essay, “The Political Economy of Radioactive Colonialism,” Ward Churchill claimed that the natural resource base of the Navajo Nation alone is far greater than that of Luxembourg, Lichtenstein and Monaco, combined. [21]

Through a series of acts (e.g., Indian Reorganization Act, 1934), the US defined itself as the primary governing body of Indian reservations, establishing a system of tribal council governments for each reservation, the main responsibilities of which, under the rubric of “economic planning,” include: mineral-lease negotiations, contracting with external corporations, long-term agricultural leasing, water-right negotiations, land transfers and more. [22] In effect, the US has established a legal means of regulating resources on reservation lands. The US is able to contract with external corporations and seize, expropriate or manage, etc., land on reservations that possess lucrative resources. Tribal councils are federal appointees that manage the oversight of this activity, in essence, giving away sovereign land to federal and private holdings for resource exploitation.

Decades of uranium mining on American Indian territory ruined many lives. Uranium tailings – fifty to sixty feet high – litter defunct mining sites situated on reservation lands, releasing radioactive debris into topsoil and groundwater. There is no such thing as a “safe dose” of radiation. The debris that taints much of Indian country is replete with alpha-emitting substances which continue to cause cancers and other degenerative diseases. Keep in mind that most IHS facilities cannot afford to offer cancer screenings.

Dr. Gordon Edwards, writing for Perception magazine in 1992, explained that uranium tailings contain about 85 percent of the original radioactivity found in the ore. They emit at least 10,000 times the amount of radon gas (able to travel a thousand miles in just a few days) as does undisturbed ore. [23]

The Nuclear Regulatory Commission (NRC) estimates that radon emissions from uranium tailings in the Southwestern US will result in over 3,000 cancer deaths per century over the entire North American continent. Other researchers posit that this assertion is underestimated by at least a factor of ten. [24]

By the 1950’s, cases of lung cancer, pulmonary fibrosis, pneumoconiosis, silicosis, tuberculosis, birth defects, kidney damage and more plagued the populations residing near uranium-mining sites. By 1978, the GAO had recorded 140 million tons of “on site tailings piles at twenty-two abandoned and sixteen operational mills.” There are more than 1,100 abandoned uranium mines in the Navajo Nation alone. Continued production results in the creation of six to ten tons of tailings annually, along with small cell carcinoma for the Navajo miners. [25]

Yucca Mountain, situated on Shoshone Nation land, is a proposed nuclear waste repository site. Left with thousands of tons of nuclear waste per annum, US nuclear power facilities are desperately seeking a place to store their ever-increasing stockpiles of deadly waste. America’s best idea thus far is to stuff it all inside a mountain, on land that does not belong to the US.

Backed by the Ruby Valley Treaty and the Nevada Enabling Act, Yucca Mountain and its surrounding region are not US territory, therefore not for federal use. Not surprisingly, this injunction has been flouted by military nuclear weapons testing on Shoshone land. To make matters worse, roughly 64 percent of the nation’s gold mining occurs upon Shoshone Nation land, although gold ore is commonly found throughout the US. [26]

Gold mining threatens the health of miners as well as the health and livelihood of the residents of surrounding communities; it is also deleterious to its own and surrounding lands. Tons of rock must be dug from the earth to extract an ounce of gold. The processing of the metal involves the application of sodium cyanide, sulfuric acid, mercury and other lethally toxic substances, as well as being water-intensive, drawing from an ever-diminishing water table.

There are literally thousands of other examples I could provide to illustrate how the US and its corporate collaborators have contributed to the creation of poor health conditions and abject poverty among an already marginalized population. And matters are made desperately worse by the inadequacies of the IHS.

Seeking Solutions

Rectifying a problem as grisly and entrenched as the exploitation of America’s indigenous populations will be difficult. Some lawmakers are pushing for reauthorization of the Indian Health Care Improvement Act as one means to that end.

On October 14, Rep. Martin Heinrich (D-New Mexico) sent a letter to House Speaker Nancy Pelosi, Majority Leader Steny Hoyer and Education and Labor Committee Chairman George Miller urging “the inclusion of reauthorization of the IHCI Act as part of comprehensive health insurance reform,” reports. They quote Heinrich, “Our country desperately needs health insurance reform – but our pursuit of reform cannot leave Native Americans behind,” he said. “I represent tens of thousands of Native Americans in central New Mexico, and my constituents have made it clear that they cannot wait any longer for health care reform in Indian country.”

According to New Jersey Rep. Frank Pallone: “Less is spent on providing health care to American Indians per-capita than any other sub-population. In fact, we spend more to provide health care to federal inmates than we do for American Indians.” As reported at, Pallone is appealing for an amendment to the current health care bill that would add changes to services for American Indians to “any health care reform that happens in Congress.”

Many wonder, though, how far reauthorizing the Indian Health Care Improvement Act with a few additional provisions would go to really ameliorate the problem.

Ideally, health care services for Native Americans must be developed in accord with Native Americans’ requirements and wishes. Services should incorporate the traditional unique traditions and practices of each tribe alongside the option of accessing conventional methods of treatment.

More capital should be injected into both the health system itself and allocations for environmental clean-up costs. Clean-up projects must be conducted immediately and include adequate sanitation gear. Such projects could provide a massive amount of much-needed new tribal employment as well.

A concerted effort by US policymakers must culminate in programs that not only rectify centuries of genocidal maltreatment, but also recognize indigenous sovereignties with respect. This would include the withdrawal of all unwanted military and corporate activity from Indian country. In the end, the health of the land and the health of the community residing there are one.

[1] For a documented record of these numbers, see The Office of Minority Health,

Also, see IHCIA Fact Sheet, procured by the National Congress of American Indians and National Indian Health Board,…/FriendsofIndianHealthFY_09_testimony.pdf.

[2] “American Indian Population and Labor Force Report 2003,” p. ii, Bureau of Indian Affairs, cited in John McCain, chairman, Senate Indian Affairs Committee, Byron L. Dorgan, vice chairman, letter to Senate Budget Committee, March 2, 2006,

Also, see Senate Bill 1029 (related to SB 1010), p. 2 Fiscal Impact Report, prepared by the Legislative Finance Committee 28 February 2005, for the appropriation of $45,000 from general fund to the Department of Indian Affairs for the purpose of producing a documentary film on American Indian health care,

[3] The Office of Minority Health, op. cit.

[4] Ibid.

[5] Ibid.

[6] Ibid.

[7] Goldsmith, M.F. (1996). “First Americans Face Their Latest Challenge: Indian Health Care Meets State Medicaid Reform,” JAMA, 275, 1786; also see Voss, Richard W., Victor Douville, Alex Little Soldier, and Gayla Twiss, Tribal and shamanic-based social work practice: a Lakota perspective, Social Work, Vol. 44, 1999.

[8] The Office of Minority Health, op. cit.

[9] See 2005 American Indian Population and Labor Force Report as prepared by the US Department of the Interior Bureau of Indian Affairs, p. 5,

[10] Kuschell-Haworth, Holly T., “Jumping Through Hoops: Traditional Healers and the Indian Health Care Improvement Act,” DePaul Journal of Health Care Law, 1999.

[11] Dillingham, Brint, “Indian Women and IHS Sterilization Practices,” American Indian Journal, vol. 3, no. 1 (1977), pp. 27-28. For more info on this, see Churchill, Ward, “In the Matter of Julius Streicher: Applying Nuremberg Precedents in the United States,” “From a Native Son: Selected Essays on Indigenism, 1985-1995” (Boston: South End Press, 1996).

[12] James, Cara, Karyn Schwartz and Julia Berndt, “A Profile of American Indians and Alaska Natives and Their Health Coverage, Race, Ethnicity and Health Care,” Kaiser Family Foundation, September 2009, p. 6.

[13] Duran, Bonnie M., American Journal of Public Health, May 2005, Vol. 95 Issue 5, pp. 758-758.

[14] Churchill, Ward, “Since Predator Came: A Survey of Native North America Since 1492,” from “From a Native Son: Selected Essays on Indigenism, 1985-1995” (Boston: South End Press, 1996), p. 26; also see House Concurrent Resolution 108 of August 1953 and the Relocation Act (PL 959) of 1956.

[15] US Bureau of the Census, 1990 Census of the Population, Preliminary Report (Washington, DC: US Government Printing Office, 1991).

[16] Duran, Bonnie, op. cit.; also see James, Cara, et al., op. cit.

[17] Government Accountability Office, Indian Health Service: Health Care Services are not Always Available to Native Americans, Washington, DC. GAO-05-789, 2005; also see James, Cara, et al., op. cit.

[18] Goldsmith, M.F., op. cit.; also see Voss, Richard W., et al., op. cit.

[19] Katel, Peter, (2006, April 28), “American Indians,” CQ Researcher, 16, 361-384.

[20] Churchill, Ward, “Native North America: The Political Economy of Radioactive Colonialism,” from “A Native Son: Selected Essays on Indigenism, 1985-1995” (Boston: South End Press, 1996), p. 147; also see Garrity, Michael, “The US Colonial Empire is as Close as the Nearest Reservation,” Trilateralism: The Trilateral Commission and Elite Planning for World Management, ed. Holly Sklar (Boston: South End Press, 1980), pp. 238-68.

[21] Churchill, Ward, “Native North America,” from “From a Native Son,” p. 150; also see US Commission on Civil Rights, The Navajo Nation: An American Colony (Washington, DC: US Government Printing Office, 1976).

[22] See Deloria, Vine, Jr., and Clifford E. Lytle, American Indians, “American Justice” (Austin: University of Texas Press, 1984).

[23] Edwards, Dr. Gordon, President of Canadian Coalition for Nuclear Responsibility, “Uranium: The Deadliest Metal,” Perception Magazine, v. 10 n. 2, 1992.

[24] Ibid.

[25] Quartaroli, MaryLynn, “‘Leetso,’ the Yellow Monster: Uranium Mining on the Colorado,”[[.

[26] See and see (Western Shoshone Defense Project).

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