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Warne: Indian Health a legal right

The media recently shined a spotlight on life expectancy rates in the United States. One obvious but unstated element in most news stories is that longevity correlates with health status, which directly correlates with economic status.

American Indians suffer alarming gaps in life expectancy. Death rates from preventable causes like diabetes, alcoholism and mental illness are dramatically higher among American Indians than the rest of the population. Nearly one-third of our people live in poverty, compared to approximately 12 percent of the rest of the country.

In Arizona, where I live, the average age at death is 72.2 years for the general population and 54.7 years for American Indians. Even people in Bangladesh and Ghana live longer.

Despite this gross inequality, American Indians are the only population born with a legal right to health care in this country.

The treaties between the tribal nations and the federal government - involving exchanges of vast amounts of Indian land and natural resources - resulted in federal guarantees for social services including housing, education and health care. The BIA and IHS were established to administer the federal government;s trust responsibility to provide health care and other vital services to American Indians.

In the 2005 federal budget, per capita expenditures for IHS were $2,130, a fraction of the federal funding for other health care programs like Medicare ($7,631), Veterans Administration ($5,234) and Medicaid ($5,010). Even the Bureau of Prisons allocation is higher, at $3,985.

So what would it take to fix the funding shortfalls in the IHS budget? The number of American Indians actively using IHS services is about 1.5 million, and clinical services for the IHS are funded at approximately $3 billion per year. Several studies have shown that the IHS is funded at approximately 60 percent of need. To bring the IHS up to the level of need, funding would require an additional $2 billion. The budget for the Department of Health and Human Services, in which IHS is an agency, is approximately $700 billion.

Relative to the rest of the federal budget, $2 billion is a small investment in Native health. It's remarkable that we can rapidly spend $150 billion to send taxpayers a $600 rebate to stimulate the economy, or that we spend about $2 billion per week on the war in Iraq. But we can't fulfill our trust responsibility to honor our treaties with the country's first inhabitants. That additional $2 billion can make life and death differences.

Tribal casinos have been wagered as an argument against additional funding. Most tribes do not have casinos, and most casinos are not making significant profits. Most tribes and reservations are located in rural areas and do not have a population base that could support gaming. People who live in urban settings like southern California have a skewed perspective on Indian gaming because the population base can support large and successful casinos. But even if that argument were solid, successful tribal economic development does not absolve federal trust responsibility to provide health care to American Indians.

Other opponents argue that successful casinos should fund the other tribes. Is this not advocating socialism? Until the rest of the nation is willing to socialize medicine and other services, tribes should not be held to a higher standard. Each tribe is a sovereign entity, and it is not the tribes' responsibility to provide health care to each other - it is the federal government's responsibility.

At the same time we have an underfunded health system, other policies, like damming of rivers and loss of land, have led to significant lifestyle changes. Less physical activity, less access to healthy food and less freedom all combine with discrimination to worsen health disparities.

The solutions to secure health equity among American Indians are in the policy-making arena. Social policies, such as the federal trust responsibility to provide health care to American Indians, have a much greater impact on health outcomes than genetics or other physical causes of disease.

Donald Warne, M.D., MPH, Oglala Lakota, is president and CEO of American Indian Health Management & Policy in Phoenix. He was featured in the PBS documentary series, ''Unnatural Causes.'' The episode ''Bad Sugar'' focuses on diabetes in Southwestern tribes. To watch video clips, visit www.pbs.org/unnaturalcauses/hour_03.htm.