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Urban Indians suffer health problems at higher rates

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  • Urban Indians suffer health problems at higher rates

    Urban Indians suffer health problems at higher rates

    Posted: April 21, 2004 - 2:57pm EST
    by: James May / Indian Country Today

    SEATTLE - A study done at the behest of the Seattle Indian Health board revealed urban American Indians and Alaska Natives suffer from health maladies at a higher rate than the general population.

    The study is only the second of its kind and by far the most comprehensive ever done on the subject. The study shows that American Indians and Alaska Natives are more prone to such diseases as diabetes and cirrhosis of the liver in addition to higher rates of alcohol-related deaths.

    The only previous study was published in the Journal of the American Medical Association (JAMA) in 1994 and was far more limited in scope.

    Most studies related to American Indian health focus on reservations, which are largely in rural areas. However, according to the 2000 census nearly three-quarters of American Indians and Alaska Natives reside in urban areas.

    According to officials at the Urban Indian Health Institute, the branch of the Seattle Indian Health Board that did the study, there is a misperception that urban Indians are better off than their rural counterparts and maintain that this study proves that urban Indian health-related problems are comparable to rural areas.

    Urban Indian Health Institute Program Manager Maile Taualii said that while the results are similar in regard to reservation and urban Indians, the causes are slightly different, though the root causes for both are ultimately poverty. For example, Taualii said that while reservations lack forms of economic opportunity, in urban areas Indians often lack the training and skills to adequately compete in the job market.

    Whereas on the reservations stores might lack inexpensive healthy foods, urban Indians on a limited budget will often opt for low priced fast food chains, a major cause of diabetes.

    The statistics for urban Indian health problems, however, read like those of their rural counterparts. The study shows that Indians suffer from accidents at a rate 38 percent higher than the general public. Chronic liver disease, including cirrhosis is 126 percent higher and diabetes is 54 percent higher, while alcohol-related deaths checked in at 178 percent higher than the general population.

    In fact, Taualii said that as high as these figures are they are only the most conservative estimates. Among statisticians and reporters urban Indians are one of the most difficult groups to track in the United States because of their decentralized settlement patterns and many lack close tribal affiliations.

    In order to do this study the Urban Indian Health Institute had to devise a clever plan that used 2000 Census figures and overlayed them with health statistics from the federal Department of Health and Human Services. They focused their efforts on 34 urban areas in which there are Indian Health Service programs and used those statistics as well.

    Despite the thoroughness of the study, Taualii asserts that the figures are low because of racial misclassifications on death certificates in several of the larger urban areas, such as Los Angeles and New York, which both have significant American Indian populations.

    "We believe these findings grossly underestimate the true extent of the problem," said Ralph Forquera, executive director for the Seattle Indian Health Board in a press statement.

    Taualii said smaller states with large reservation Indian populations such as Montana where the majority live on reservations, more easily identify American Indians on death certificates whereas larger and more diverse cities tend to assign another ethnic category to American Indians.

    "If we were to go on death certificates alone, American Indians would live forever in Los Angeles and New York," Taualii said.

    These statistics are important for an organization such as the Urban Indian Health Institute as one of their primary functions is to gather information and set up a database of urban Indian health resources. The statistical study is necessary, maintained Taualii in order to lobby congress to fund programs that are seen as vital to urban Indian health needs.

    Currently only 1 percent of the Rural Health Service, which overseas Indian health programs, is going to urban Indians. Taualii claimed that studies are vital to establishing adequate funding for the programs. However, in the current political climate it might be a tough sell.

    Though the most recent federal budget does not cut funding to Indian Health Services, funding has been curtailed in other ways. Recent federal cuts to state and local health services and changes to Medicare and Medicaid have had a large impact on urban Indian health clinics.

    According to an essay on Indian health needs by the former director of Indian Health Services, Michael Trujillo, who served in both the Clinton and current Bush administrations, nearly 40 percent of the cost of running an urban Indian health clinic comes from Medicaid reimbursements.

    These changes and cuts have affected the Seattle Indian Health Board as they have had to lay off staff in wake of the federal cuts to the state and local programs. Taualii confirmed that many of the services that were only recently reimbursed by Medicaid are no longer covered.
    This article can be found at

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