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Crisis in Indian country: Congress must provide more health care for American Indians

Today, there is a health care apartheid in the United States. If you are a person of color, you receive fewer services, inferior care and less successful ? medically speaking ? health care outcomes. And if you are an American Indian, especially one living in Indian country, the situation is even starker.

American Indians have a much heavier disease burden than the general population. This includes a higher death rate from alcoholism (740 percent), tuberculosis (500 percent) and diabetes (390 percent) than other Americans. Type 2 adult-onset diabetes is a particular problem, with 12.2 percent of American Indians those over 19 years old suffering from the disease. In just one extreme example, the Pima tribe in Arizona has the highest rate of diabetes in the world ? approximately 50 percent of the tribe between the ages of 30 and 64 have diabetes.

Despite these significant challenges, access to and funding for health care services is limited both on and off the reservation. In 2002, it was estimated that the Indian Health Service needed $15 billion to meet demand for services. It received only $2.9 billion. In 2000, only $1,430 per person was spent on health care for members of the Indian Health Service population compared to $3,766 per person for the general population. This is despite the fact that the Indian population is younger and has a higher incidence of illness and premature mortality than other U.S. populations.

You and I confront these statistics every day. My home state, Colorado, alone is home to over 41,000 American Indians, including 25,000 who live in or near my Congressional district in the Denver area.

In order to help stem this crisis, Congress, working with the IHS, reservations, tribal leaders, doctors, health care professionals and others must effectively address the issues that currently confound us.

As a member of the House Energy and Commerce Commission, which oversees most health care legislation, and as co-chair of the Congressional Diabetes Caucus, I have fought for increased funding for diabetes research and treatment and prevention activities.

This should begin with providing adequate funding of the IHS. When adjusted for inflation, the per capita spending for Indian health in real dollars is lower than it was in 1977.

We have won several victories in improving healthcare for American Indians. National Institutes of Health diabetes research funding has grown from approximately $300 million in 1996 to over $781 million this year. Diabetes prevention and treatment programs through IHS have increased from nearly $8 million over $110 million today in the same time period.

I also worked to ensure that pharmaceutical manufacturers study the effects of their medications on children of a variety of racial and ethnic backgrounds, including American Indians.

Adequate representation in clinical trials is important to the Indian community as the prevalence of Type 2 diabetes, also referred to as adult onset diabetes has dramatically increased in children. As myriad diseases including diabetes, heart disease, cancer and others disproportionately affect ethnic and racial minorities, it is crucial that these studies not only include a diverse range of America's children, but that the medications used to treat ailments that disproportionately affect them are studied as well.

I also worked to gain passage of the "Health Care Fairness Act." This bill, now law, seeks to improve minority health by establishing the National Center for Research on Minority Health and Health Disparities to conduct and support basic and clinical research, training, and dissemination of information regarding minority health.

There is, however, much more that can be done.

Congress must reauthorize the Indian Health Care Improvement Act. First passed in 1976, this act makes clear that the U. S. government's obligation under federal statutes and treaties includes providing health care services efficiently and effectively to Indians and Indian tribes.

In addition, I support efforts to elevate the position of Director of Indian Health Service to the Assistant Secretary for Indian Health. This would help tribes get better access to other Department of Health and Human Service programs as well as bring to the forefront disparities in health for Indians.

Facts are stubborn things. It is clear that the story they tell today about our health care system is an oppressive one. But that should not be cause for discouragement. Quite the contrary, it serves as an opportunity to strengthen a system that we know has and can work. We just need it to work for everyone. We need new facts and statistics so that a different story can be told tomorrow. I will continue to work towards this goal.

U.S. Representative Diana DeGette, D-Colo., is a member of the House Energy and Commerce Committee, which has jurisdiction over health care matters, and co-chair of the Congressional Diabetes Caucus.