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Health disparities remain within Indian country

OLYMPIA, Wash. - American Indian and Alaska Native people have long experienced lower health status and inadequate health care when compared with other Americans.

Washington is working to reduce these disparities through statewide collaboration led by the Department of Health and the American Indian Health Commission. An August report highlights some accomplishments - and reaffirms the importance of working relationships between state and tribal governments:

o Washington was the first state to implement contracts with tribes to provide reimbursement through Medicaid Administrative Match. The match is federal funding that helps potential Medicaid beneficiaries to enroll in and access Medicaid services.

According to the health department, the success of the program is due in large part to training workshops provided to tribes through the sponsorship of the American Indian Health Commission, the Department of Health and the Northwest Portland Area Indian Health Board.

o In January, Rebecca Donovan Johnston was hired as the first director of the American Indian Health Commission. She brings a decade of experience as an advocate for tribal governments.

Also, Deborah Sosa was hired as manager of the state's Indian Health Program. She is a Mescalero Band Apache and mother of three. She serves as the state Medicaid program's liaison with Washington tribes and their health care systems.

o The American Indian Health Commission has been a frequent adviser to the Department of Health's Tobacco Control Program. As recommended by the commission, a tribe-supported funding formula was adopted by the Health Department that provides an adequate funding base for small and large tribes.

o Since 2000, the American Indian Health Commission has worked with the Washington state Office of the Insurance Commissioner to ensure that private health plans reimburse Indian health programs for services provided to American Indian and Alaska Native enrollees.

"It is critical that we work together to address the needs of the Native people of Washington state," state Health Secretary Mary Selecky said. "That means helping people get access to preventive and emergency care, building a diverse health work force, and coordinating response to public health threats or bioterrorism."

Marilyn Scott, chairwoman of the American Indian Health Commission and the Upper Skagit Tribe, commended the state's commitment to a government-to-government partnership of mutual trust and respect.

"In this time of shrinking federal dollars for the Indian Health Service and state budget shortfalls, it is very important that we have a joint commitment to improve health care for our people," Scott said.

The 2003 report paints a challenging picture of the health status of American Indians and Alaska Natives in Washington, using data to chart progress and identify areas of need. It also highlights successful strategies that tribes and the state have used to address health disparities, and offers recommendations and objectives for tribal and urban health programs and state policymakers.

There are 112,006 American Indians and Alaska Natives in Washington, less than 2 percent of the state's population. American Indians and Alaska Natives are more likely to have limited access to health services, high unemployment, and to live in poverty - almost three times the state average, according to the report.

American Indians and Alaska Natives are dying younger than the general population, mostly of treatable conditions, according to the report. Average life expectancy from 1999-2001 of American Indians and Alaska Natives in Washington was 74.4 years, 3.9 years less than the statewide non-Native population, the report state.

More American Indians and Alaska Natives die of stroke, chronic liver disease and diabetes than the total state population, the report state.

The American Indian and Alaska Native population has high rates of tuberculosis, meningitis, and sexually transmitted diseases (including HIV/AIDS). Tobacco use among American Indians and Alaska Natives is high - 37 percent compared with 22 percent among all adults in Washington, the report added.

Tribal leaders have cited diabetes, unintentional injuries, alcoholism and substance abuse as rising to crisis proportions in American Indian communities.

The report is available at www.aihc-wa.org.

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