A recent report from the School of Public Health finds that American Indians and Alaska Natives (AI/AN) are enduring persistent disparities in health services, including high uninsured rates, significant barriers to obtaining health services, and continued declines in health status.

Associate Professor Linda Frizzell was the lead author of the report, which was submitted to the National Rural Health Association.

“American Indians and Alaska Natives have long experienced lower health status compared with other Americans,” says Frizzell. “They have lower life expectancy and disproportionate disease burden, perhaps because of limited educational opportunities, disproportionate poverty, discrimination in the delivery of health services, and cultural differences.”

Members of 567 federally recognized AI/ANs tribes and their descendants are legally entitled to health services from the U.S. government. Those services are primarily provided by the Department of Health and Human Services’ Indian Health Service (IHS). The system is funded through discretionary yearly appropriations to the IHS, which is typically funded to only 40 to 60 percent of needed funding. As a result, in 2013, the IHS per capita expenditures for patient health services were just $2,849, compared to $7,717 per person for health spending nationally.

“This underfunding can be directly attributed to the continued decline in health status of American Indians and Alaska Natives,” says Frizzell.

The report also finds that public health support is virtually non-existent for tribes, who often lack access to government-sponsored, accredited health departments, behavioral health facilities, or alcohol and substance abuse treatment facilities.

“Combine this with high rates of poverty, widespread historical trauma, and adverse childhood experiences, and the problems seem insurmountable,” says Frizzell.

For solutions, Frizzell recommends beginning with establishing improved methods for gathering and tracking AI/AN health statistics to help validate any instituted changes and evaluate the impacts of policies.

Most of all, Frizzell recommends that Congress prioritize direct public health funding to AI/AN tribes. This should be done by creating specific direct and recurring tribal block grants within established programs, such as Prevention Health and Health Services Block Grants; Community Mental Health Services Block Grants; Community Service Block Grants; and the Social Services Block Grants. Frizzell also says AI/AN health programs should be supported by federal block grants given to state health departments that support government infrastructure to avoid the instability of applying for grants to maintain current minimum services.

“Approving these stable sources of funding to tribes would provide them with a significant opportunity to develop the sustainable infrastructure required to address their own health priorities to improve health status,” says Frizzell.