Acquiring health care a dangerous struggle for American Indians

by JAMIE A. WELCH

American Indians are 249 percent more likely to die from diabetes compared to the general U.S. population. They are also 533 percent more likely to die from tuberculosis and 627 percent more likely to die from alcoholism. Without enough medical treatment and health care coverage, American Indians are subjected to a life expectancy of 71.1 years. This is four years less than that of the general U.S. population.

According to a report by the Utah Department of Health in 2001, 17.3 percent of American Indians and Alaska Natives have been unable to get the health care they need. This figure can only be fought by tackling some of the most difficult problems within the health care world as it pertains to American Indians.

A major factor is geography. Melissa Zito of the Utah Department of Health serves as the Indian health liaison/health policy consultant. She compared the state of American Indian health to a ripple effect in a pond. “The closer you are to the center, the higher quality you will receive,” she said. Many American Indians live far away from major cities and hospital clinics. The farther they are from a clinic, the lesser their chance of attaining quality health care.

One resource, the Indian Walk-In Center of Salt Lake City, assists registered American Indians with gaining access to medical resources such as immunizations, acute or chronic health care, eye care services, nutrition counseling, dental services, and primary health care. Often, however, the help the center offers is limited and can be difficult to attain.

To qualify for coverage at the Walk-In Center, Zito says individuals must be registered members of an American Indian tribe. The center’s Web site lists the steps individuals must take to register for health services. An individual must bring a photo ID, documentation of income, proof of residency, Social Security numbers for self and family members, documentation of Indian blood, and a basic knowledge of which type of health insurance is needed. Because nearly 50 percent of Utah’s American Indians live on reservations, it can be difficult to obtain such documentation without traveling to a larger city and filling out forms for each article, which can be a time-consuming task.

LeAnna VanKeuren, health program manager of the Indian Walk-In Center, recognizes the challenges facing American Indians. She said another major struggle the health care world encounters is the “lack of data to accurately describe the health status of American Indians who live on reservations.” In other words, without detailed information, it is difficult to estimate exactly what kind of help most American Indians need and how many need it.

So, if an American Indian needed emergency care and didn’t know the kind of coverage he or she had or the medical history of the patient, time could run out for the patient, assuming the distance traveled to get urgent treatment was not a factor involved.

Anthony Shirley, coordinator of recruitment and financial aid at the University of Utah College of Nursing, says health care access for American Indians is in a worse state than it was 10 years ago.

In an e-mail interview, Shirley said “most American Indians are not insured so they [are referred] out of the Indian Walk-In Center in Salt Lake City. These doctors and nurses and health professionals are unknowledgeable of our culture so we often do not get referrals within the Salt Lake Valley.” Also, many people are forced to return to the reservation to find an Indian health service clinic or hospital.

Another problem, Zito admitted, is that “it’s difficult to get folks enrolled in the health care they need so desperately.” Older generations of American Indians are not accustomed to receiving regular health check-ups and therefore see little reason to travel far away to get them. This is especially dangerous because American Indians are at a high risk for developing diabetes. Without habitual care, suffering can be prolonged.

“Diabetes is at all-time high for American Indians,” Shirley wrote in his e-mail. He said the problem “is a combination of education/awareness and demographics. Many American Indians are not educated on proper diet and with many American Indians living on the reservation, the only resources they have are cheap foods that contribute to diabetes.”

Zito recognizes this as well, saying, “Diabetes is a problem in the social, cultural and physiological parts of American Indian society.” It is a problem that is especially difficult to combat without modern treatment such as insulin and medications.

Currently, the Utah Department of Health uses the Utah Indian Health Advisory Board (UIHAB) to connect tribal, state and federal governments in an effort to better address American Indian health policies and concerns. UIHAB is also used to establish trust among governmental groups and American Indian organizations. And, according to Article III of the board’s bylaws: “UIHAB will advise and make recommendations for improved physical, mental, emotional, and spiritual health of American Indian people in Utah.”

Zito quoted a historic phrase used by Cherokee leaders to say, “as long as the grass grows and the rivers flow the government will provide for the Native people.”