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Urban Indian health care concerns voiced

WASHINGTON - With nearly half of the nation's American Indian population living off-reservation and in the urban areas of this country, the funding needs of urban health clinics are growing at an astounding rate.

Tribal governments continue to share in the duties and responsibilities of providing health care for urban American Indians in conjunction with the federal government and some state and private resources. While many urban American Indian health centers have fought against amazing odds to establish health services for their communities, they are far from meeting the growing needs of this major segment of the American Indian population.

"Although Denver is centrally located within 'Indian country' and many national Indian organizations are headquartered in Denver, it is isolated from tribal health and Indian Health Services," said Kay Culbertson, executive director of Denver Indian Health and Family Services.

"The closest Indian health facility in Colorado is located on the Southern Ute reservation, an eight-hour drive. The nearest Indian Health Service Hospitals are in Rapid City, S.D., and Albuquerque, N.M., so we do not have the ability to utilize other Indian health facilities to meet the gaps in services."

As many push for reauthorization of the Indian Health Care Improvement Act, some like Culbertson who work in these urban clinics are fighting to increase resources and support through the new bill. At the end of the year, the act, which authorizes federal health care for all American Indians, is due to expire. In anticipation of this date, Congress, the administration and the tribes have worked to redraft and update new legislation. Part of this legislation includes specific funding for the development of health programs for American Indians and Alaska Natives in urban areas.

Since the act was originally passed in 1976, amendments have expanded urban health care to include direct medical services, alcohol services, mental health services, HIV services, and health promotion and disease prevention services. IHS provides funding to 36 urban American Indian health centers and to 10 urban alcohol programs. These urban health programs range from comprehensive primary care centers to referral and information stations.

While many of these programs have grown over the years and made great strides in providing better health services to urban American Indians they have not grown to match the services provided at IHS or tribal facilities, larger facilities themselves which are not even meeting the health care needs of American Indians. Staff at these centers constantly run into problems of misconception and fighting an uphill battle of misinformation in their struggle to gain greater recognition of their needs.

"Often Indian people who come to an urban area have a misconception that urban Indian health programs are virtually the same as the Indian Health Service or tribal health programs on the reservation and may not elect to sign up for health care benefits," Culbertson said. "Indian people assume the IHS is everywhere. We are far from that."

Culbertson also says that hiring and retaining quality professionals has been difficult since her center has an operating budget of only $430,000 a year.

"The medical field is highly competitive in the Denver area and we are not always able to compete with other health facilities for staff," Culbertson said.

Consideration of the Indian Health Care Improvement Act reauthorization bill, along with its provisions on urban American Indian health, is expected to begin once Congress returns from its August recess. In FY 2001 Congress appropriated $29.8 million for Urban Indian Health. These centers also receive funding from a variety of other federal, state and private sources.