The American Indian Health Crisis – A reflection on the AAIP 42nd Annual Meeting

By Timothy N. Kruse

On July 31 through August 04, 2013, Andrew Harrison and I attended the 42nd Annual Meeting of the Association of American Indian Physicians (AAIP) in Santa Clara, CA. The AAIP is an organization for American Indian and Alaska Native physicians across North America. The Mission of the AAIP is “to pursue excellence in Native American health care by promoting education in the medical disciplines, honoring traditional healing principles and restoring the balance of mind, body, and spirit”.

Association of American Indian Physicians

The title of the conference was “Promoting Wellness in Native American Communities Through Exercise, Disease Prevention and Traditional Healing”. There were many humbling presentations on health disparities. However, the conference also included numerous inspirational presentations on how to advance Native American health. The event had a small community feeling, which was very welcoming. With that atmosphere, I felt comfortable introducing myself to some of the significant attendees, including Dr. Judith S. Kaur (Division of Medical Oncology and Medical Director of Native American Programs at Mayo Clinic), Dr. Yvette Roubideaux (Director of the Indian Health Service), Dr. Jeremy A. Lazarus (immediate past-president of the AMA), Billy Mills (1964 10k Olympic Champion), Dr. Marc A. Nivet (Chief Diversity Officer of the AAMC), Margaret Knight (Executive Director of the AAIP), and Dr. Nicole Stern (President of the AAIP).

Spirit of EAGLES group photo. Back row (left to right): Andrew Harrison, Robert Brown, Justin Kaye, Mylan Panteah, Castrenze Fricano, and Courtney Rocke; Front row (left to right): Erica Doxzen, Micoleen Yazzie, Dr. Judith Kaur, Dr. Yvette Roubideaux, Timothy Kruse, and Trudie Jackson.

The statistics concerning Native American health are overwhelming. For historical perspective, in 1787, the US government and Native American communities agreed to trade land for free healthcare. Some of the most shocking facts I discovered at this conference include (1):

1. The Indian Health Service (IHS) has a yearly budget of about $4.3 billion. It is estimated the IHS would need a budget of at least $27 billion to run effectively.
2. Per capita, expenses for an IHS patient are about $2,896 per year. This figure is $12,042 per year for Medicare patients.
3. The average age of an IHS clinic is 35 years. Public and industry buildings typically get replaced after 10 to 12 years.
4. Vacant IHS positions include: dentists (32%), nurses (19%), physicians (18%), and pharmacists (11%).
5. In almost every parameter, Natives Americans have the worst health statistics when compared to other demographics: 526% higher rates of alcoholism, 60% higher rates of stroke, 40% higher rates of infant mortality, 30% higher rates of high blood pressure, 20% higher rates of heart disease, 208% higher rates of diabetes (800% higher in some communities), 350% higher rates of end-stage renal disease, 60% higher rates of suicide, some of the lowest transplant rates in the country, and the lowest life expectancy of any group in the US.
6. On this last point, the life expectancy of a Native American man on the Rosebud Reservation is only 45 years. This is the second worse life expectancy demographic in the Western Hemisphere.

Many of these health disparities stem from complex social determinants of health, such as cultural, spiritual, historical, and logistical factors. In general, there is mistrust between Native American communities and the local healthcare system. Also, many Native Americans live in rural areas. Some of the historical traumas they have faced include relocation, forced boarding schools (which were designed for assimilation), and multiple massacres. With this in mind, it is important to not forget America’s biggest secret: the American Holocaust. Written by historian David Stannard, American Holocaust extensively covers the genocide of the indigenous people of North America, post-arrival of Christopher Columbus (2). Some of the lowest estimates are that 80% of indigenous people across North America died due to disease alone. This figure does not include the numerous wars that wiped out entire communities.

It is apparent that third world health conditions exist within the US for Native Americans. Furthermore, it will be a long and difficult journey to overcome all of these obstacles. However, the 42nd Annual Meeting included many inspirational talks on currently activities, accomplishments, and goals. I saw multiple groups developing culturally competent and sensitive methods to eliminate these health disparities. There were also groups developing a more diverse workforce, which would more accurately reflex the nation’s demographics. Importantly, President Obama is also a proponent for this cause. In his most recent national budget proposals, he attempted to increase funding to the IHS. For reference, the IHS is part of the Department of Health and Human Services (HHS), which includes CMS, the NIH, the FDA, the CDC, and the AHRQ.

IHS funding status in the context of the budgets of HHS and other US Federal Executive Departments. Approximate values are based on data from the 2012 and 2013 Federal Fiscal Years. Acknowledgement: Andrew Harrison for this figure.

So the conversation has started. More and more people are joining every day. By writing this post, I am making a change. By reading it, you are making a change. Thus, things are getting better.

AAIP Cultural Night, which featured traditional Apache Social Singing, Dancing, and Sonoma County Pomo Dancers. Acknowledgement: Trudie Jackson (undergraduate student at ASU) for this photo.

Timothy N. Kruse is a student in the Postbaccalaureate Research Education Program (PREP) at Mayo Clinic and under the mentorship of Dr. Mike J. Joyner. He is a member of the Kwethluk Tribe in the Yup’ik community within the Calista Corporation of Alaska.

Tim Kruse hiking on Wonderland Trail around Mt. Rainier in the state of Washington.

Acknowledgement: I thank Andrew M. Harrison for helping me and encouraging me to write this blog post. We (TNK and AMH) thank Dr. Judith S. Kaur and the entire Mayo Clinic Spirit of EAGLES staff (Marcy L. Averill, Colleen F. Berg, and Lisa A. Baethke) for providing the travel scholarship that made this opportunity possible for us. We encourage any interested readers to investigate the upcoming Spirit of EAGLES Conference in Albuquerque, NM, on October 26-28, 2013.

References

1. Promoting Wellness in Native American Communities Through Exercise, Disease Prevention and Traditional Healing. (2013). 42nd Annual Meeting of the Association of American Indian Physicians (AAIP). Santa Clara, CA.
2. Stannard, D. E. (1993). American holocaust: The conquest of the New World. Oxford University Press, USA.