Senator Campbell: Charting a new course in Indian Health Care


America is the richest and most powerful country the world has ever known. We are indeed fortunate to be citizens of this great nation but must also recognize that most Indians live in abject poverty and that much needs to be done.

In my years on the Senate Committee on Indian Affairs, Congress has enacted bills to reform Indian education, increase housing stock, strengthen tribal economies, settle an array of land and water settlements and protect Native sacred places.

Poor health has properly been called the "twin sister of poverty" and unfortunately Indian people know these siblings all too well. Year after year Congress debates the President's budget request for Indian health and argues about whether it is sufficient to meet current needs and whether it is properly targeted.

We can choose to do this again this year or we can take a different route: one that may in the long run be more beneficial to Indian people.

The time has come to tackle the fundamental and systemic problems and improve the health of American Indians. We have this opportunity with the reauthorization of the Indian Health Care Improvement Act of 1976.

We can do this by taking a comprehensive review of the facts on the ground and then deciding how to best spend limited Federal resources. Let's start with the facts.

1. Indian population growth. According to the 2000 Census, the Native population soared to more than 4 million from 2.2 million in 1990. Continuing a trend begun years ago, only 34 percent of the Native population now lives on-reservation, compared with 66 percent living in urban or suburban settings.

What do these trends mean for how the Indian health system is structured and funded? Well, right out of the box it tells me that more focus must be paid to the urban Indian health system, both structurally and financially. Figures clearly show that spending has not tracked these demographic changes and federal funding for urban health is a fraction of total health spending.

2. Health disparities continue. Like a lot of Americans, I am encouraged that incoming Senate Majority Leader Bill Frist has indicated that eliminating disparities in health care is one of his main priorities for the 108th Congress.

We should all be alarmed when the Indian death rate for diabetes mellitus is 249 percent higher than rest of the American population; when the pneumonia and influenza death rate is 71 percent higher; when the tuberculosis death rate is 533 percent higher and when the Indian death rate from alcoholism is 627 percent higher.

3. The current health care system results in Indian health problems being treated, not prevented. When I return to Lame Deer, Mont. - home of the Northern Cheyenne Tribe - I see the consequences of a "treatment only" health care system: growing obesity in young Cheyennes, a daily regimen of McDonald's and cigarettes, eight-hour round trips to Billings for dialysis therapy and amputations for those lucky enough to grow old.

To make the kind of sea-change required in Indian health care, we must shift the "band-aid strategy" of responding to symptoms rather than attacking the root causes of these health problems and plant the seeds for a healthier Native population in future years.

Nowhere is this more important than with our Indian youngsters. In the 107th Congress I held hearings on the many problems facing Indian youth and Indian elders across the country. The hearings pointed up the need to teach Indian youngsters that a good diet, physical activity and positive lifestyle can prevent the fate that meets far too many of their elders: diabetes, amputations, emphysema and shortened lives due to alcohol and tobacco use.

Just last December, Congress took a step in this direction by expanding the Special Diabetes Program for Indians to include $100 million to tribes and tribal organizations for diabetes treatment, research and prevention.

Because every dollar of diabetes funding is precious, I believe the major hospitals and research facilities that engage in Native diabetes research - in New Mexico, Colorado, Georgia, Alaska and Hawaii - can at a minimum share their results and encourage the use of "best practices" guides by IHS, tribal and urban health providers.

Evolving technology must be a part of the answer to better health care. Large swaths of Native America are rural, out-of-the-way places far from urban areas. Native Alaska offers probably the best example of a thin, but widely-dispersed, population that is highly susceptible to tele-medicine and state-of-the-art technologies. For example, the technology now exists to allow a physician sitting in Anchorage to download and analyze an X-ray, mammogram or blood work-up sent from a clinic in the bush country of Alaska. This can provide significant reductions in the cost of providing treatment to rural, Native communities and ought to be expanded.

We must maximize dollars dedicated to Indian health. In time of scarce Federal dollars and our nation preparing to fight a war abroad, the reality is that there will not be huge increases in discretionary funds for Fiscal Year 2004. The key will be on how to use the significant funding that already exists in the most productive way.

Since the enactment of the Indian Self Determination and Education Assistance Act in 1975, tribes and tribal organizations have provided quantitatively and qualitatively better health services than the IHS using the same core funding.

I am a strong supporter of contracting and compacting and am proud to have sponsored the Indian Tribal Self Governance Amendments, enacted in 2000, that made self governance in Indian health permanent. The trend toward greater tribal contracting and compacting continues: the IHS now contracts and compacts out to tribes and tribal organizations more than 50 percent of its $2.2 billion budget. It is my hope that more tribes will enter self governance in the years ahead.

As we enter the 108th Congress, I believe that a health care effort that focuses on these core elements will advance the cause of improving Native health for years to come.

Among other key committee assignments, Sen. Campbell, R-Colo., is the vice-chairman of the Senate Committee on Indian Affairs and is a member of the Senate Energy and Natural Resources Committee.