Anda di halaman 1dari 8

1 Running head: HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION

Healthcare Disparities and Policies That Effect the Native American Population Kaitlyn Baldwin Ferris State University

2 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION Abstract The following paper will summarize the healthcare disparities related to substance use that are prevalent in the Native American population in America. Social determinants will be discussed that are specific to this population. Policies will be discussed that affect the Native Americans both positively and negatively. Underlying beliefs and values that contribute to the healthcare disparities will also be discussed.

3 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION Healthcare Disparities and Policies That Effect the Native American Population The Native Americans of America, American Indian Alaskan Native (AIAN), is a vulnerable population and suffer from health disparities. Vulnerability seems to mean lacking sufficient ability to advance health and wellness, along with a greater need to look to others for solutions (Harkness & DeMarco, 2012, p. 335). Health disparities can exist at a population level of one nation or across nations. The root of health disparities can be related to age, gender, genetics, and other characteristics like socioeconomic status. Health disparities are different in health status that result from (1) systematic disadvantages in access to basic health care needs or healthcare delivery services or (2) systematic deficiencies in the organization and delivery of healthcare services due to financing problems or lack of cultural or linguistic competence (Harkness & DeMarco, 2012, p.143). Native American Population According to U.S. Census Bureau in 2010, there were roughly 5.2 million American Indians and Alaska Natives living in the U.S., representing approximately 1.7% of the U.S. total population (CDC, 2012). As of May 2013 there are 566 tribes who are eligible for funding and are nationally recognized by the Bureau of Indian Affairs (BIA, 2013). In the 2010 U.S. Census, tribal groupings with 100,000 or more responses were: Cherokee (819,105), Navajo (332,129), Choctaw (195,764), Mexican American Indian (175,494), Chippewa (170,742), Sioux (170,110), Apache (111,810), and Blackfeet (105,304) (CDC, 2011).

4 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION Healthcare Disparities There are multiple heath disparities that the AIAN population experiences. The focus of this paper will be on the health disparities of premature deaths and diseases related to substance use the AIAN population experiences. In 2007, AI/AN populations (combined) had the highest rate of motor vehicle-related deaths, one of the highest rates of suicides, and the second highest death rate due to drugs (includes illicit, prescription, and over-the-counter) compared with other racial/ethnic populations (CDC, 2013). Healthy people 2020 have set a goal to reduce substance use in America. Reduce substance abuse to protect the health, safety, and quality of life for all, especially children (Healthy people 2020, 2013) The highest average number of binge drinking episodes during the preceding 30 days (4.9) was reported by binge drinkers whose household income was <$15,000, and the largest average number of drinks consumed by binge drinkers (8.4) was reported by American Indians/Alaskan Natives (CDC, 2011). Review of Social Determinants The AIAN population has many socioeconomic barriers that affect their ability to achieve a better health status which directly contributes to the reason why there is a significant amount of substance use and premature deaths. In 2009, the percentage of AI/AN adults living in poverty was among the largest compared with other racial/ethnic groups (and was similar to percentages among African Americans and Hispanics). Twelve percent more AI/AN adult lived below the federal poverty level, as compared with white adults (CDC, 2011).

5 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION Poverty is not the only social determinant that places the AIAN population at risk. Other factors include disability, low educational attainment, school dropout, underemployment, teen pregnancy, and single parent status (Ramisetty-Mikler & Ebama, 2011). The research shows that there is a link between poverty, poor academic performance and early initiation of substance use and other risky behavior. The connection of poverty, homelessness, substance use is shocking. The higher prevalence of lifetime heroin/meth use in this group is highly alarming and demands special attention due to drastic consequences of substance use. For example AI youth are 1.7 times less likely to have a high school diplomaand are 3 times more likely to be homeless than non-Indians. The poverty rate of urban Indians is 20.3% compared to 12.7% for the general urban population (Ramisetty-Mikler & Ebama, 2011). The likely hood of health problems related to substance use in the AIAN population shows that there is higher prevalence rates of accidental deaths (38% higher)alcohol related health disorders (liver disease/cirrhosis 126% higher, alcohol related deaths 178% higher) compared to urban counter parts( Ramisetty-Mikler & Ebama, 2011). Policies Contributing to Disparities Federally recognized tribes are provided health and educational assistance through a government agency called Indian Health Service (IHS), U.S. Department of Health and Human Services (HHS). The IHS operates a comprehensive health service delivery system for approximately 2 million American Indians and Alaska Natives. The majority of those who receive IHS services live mainly on reservations and in rural communities in 36 states, mostly in the western United States and Alaska. 36 percent of the IHS service area population resides in non-

6 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION Indian areas, and 600,000 are served in urban clinics. Typically, this urban clientele has less accessibility to hospitals; health clinics or contract health services implanted by the IHS and tribal health programs. Studies on the urban AIAN population have documented a frequency of poor health and limited health care options for this group (HHS, 2012). The law called the Indian self-determination and Education Assistance Act (ISDEAA) of 1975 was significant step in the right direction that allows for tribes to manage and control the healthcare for the AIAN population. There are however areas where the law is not meeting the needs of the AIAN population. Each tribe manages their own non-profit healthcare organization and receives grants and other types of funding through ISDEAA. This poses as a problem because there is not just one healthcare system that serves the AIAN population but multiple small systems that serve just the tribe it is dedicated for. This process of separated healthcare systems creates areas of underserved people in the AIAN population (Warne, 2011). The current healthcare policies that are in place for the AIAN populations are insufficient with just the ISDEAA and IHS. The change in the Affordable Healthcare Act seems like that can change. The new income sources are expected to help Indian health facilities expand and improve their services. Some, for example, do not now include dentistry or deliver babies. Few offer preventive services. According to a 2011 Centers for Medicare and Medicaid (CMS) report, the Indian Health Service budget$4.2 billion in 2010is only sufficient to provide about half the necessary health services required(Vastal, 2013). The AIAN population is not required to sign up for the governmental healthcare and they do not get penalized for that. This is a positive result of policy change for this population because they already are living in poverty. Longstanding treaties with the federal government guarantee

7 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION all Native Americans recieve free health care. As a result, the Affordable Care Act exempts them from paying a penalty if they choose not to purchase insurance. More than 2 million Native Americans receive free health care at federally supported Indian health facilities. Many others receive care from tribal facilities and urban Indian organizations (Vastal, 2013). Some underlying beliefs of the AIAN population create barriers to improving the issues of substance use and premature deaths related to accidental overdoses and disease. Cultural policies that are taught to the youth in the AIAN populations have a definite impact on overcoming this health disparity. Understanding of native cultures is crucial as certain behaviors might have been originated from familial and traditional practices. Several explanations can be projected for high prevalence and problems related to substance abuse among native populations including the spiritual meaning of intoxication, the recreational value of drinking and drug use, peer pressure, cultural conflicts, and experiences they face in the larger society. (RamisettyMikler & Ebama, 2011). In order to address the various issues that contribute to the health disparity of diseases and premature deaths related to substance use, the cultural policies and traditions should be considered. Encouraging the AIAN population to sign up for the new Affordable Healthcare Law should help them gain additional funding or access to healthcare that is not already provided by the ISDEAA and IHS programs. The socioeconomic contributing factors that affect the AIAN population, such as under education, underemployment, poverty and homelessness, need to be addressed in order to improve the health disparities associated with substance use because there is a correlation.

8 HEALTHCARE DISPARITIES OF THE NATIVE AMERICAN POPULATION References American Nurses Association (2010). Code of ethics with interpretive statements. Retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Nursing Standards Bureau of Indian Affairs (BIA). (2013). Retrieved from http://www.bia.gov/cs/groups/public/documents/text/idc1-023762.pdf Centers for Disease Control and prevention (CDC). (2013). American Indian and Alaska native populations, 2012. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html Centers for Disease Control and Prevention (CDC). (2011). Health disparities and inequalities report-United States, 2011. Retrieved from http://www.cdc.gov/minorityhealth/reports/CHDIR11/ExecutiveSummary.pdf Department of Health and Human Services (HHS). (2012) Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=52 Harkness, G. A. & DeMarco, R. F. (2012). Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins:Philadelphia. Healthy People 2020 (2013). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=40 Ramisetty-Mikler, S., Ebama M., (2011). Alcohol/drug exposure, hiv-related sexual risk amoung urban american indian and alaska native youth: evidence from a national survey. Journal of School Health. 81(11), 671-679. Vestal, C. (2013, October 15). Affordable care act a hard sell for native americans. USA TODAY. Retrieved from: http://www.usatoday.com/story/news/nation/2013/10/15/statelineobamacare-native-americans/2986747/ Warne, D. (Spring 2011). Policy issues in american indian health governace. Journal of Law, Medicine & Ethics. 42-45

Anda mungkin juga menyukai