The Indian Health Services (IHS) was created in the 1950s with the aim of ensuring that comprehensive and culturally acceptable personal and public health services are available and accessible to Native American people. Since the installment of IHS, Native American health trends have been tracked. A study performed by Epsy and colleagues showed that from 1990 to 2009, there was a significant decrease in all-cause mortality seen in Caucasian populations, which was not seen in the Native American population. A study performed in the 1960s showed that the first prenatal visit was usually late in the second trimester, and this trend has continued to the present day. In terms of neonatal health, a study performed in Washington and Montana revealed that Native mothers were 1.34 times more likely to give birth prematurely when compared with Caucasian populations. The prevalence of diabetes is 14.1 % in the Native population (7.9% among Caucasians), and Native women with diabetes are 1.92 times more likely to have a premature birth. According to a report by the IHS, during 1996–1998, the infant mortality rate was 24% higher than the U.S. rate for all races in 1997.
From where do these disparities stem? To receive services from IHS, one must be a member of a federally recognized tribe and live in or around the immediate service area. In Phoenix, we’re lucky to have a IHS facility in town; however, there are only four urban areas that have IHS facilities. According to the 2010 census of the 5.2 million individuals who identify as either partially or solely Native American, 71% of them do not live on tribal lands or in geographic areas where IHS provides care. This means that those 71% are not eligible and therefore cannot access IHS services.
Consequently, there are greater gaps in care for urban Native Americans. A study that looked at initiation of prenatal care between urban and rural Native American women showed that urban women were less likely to initiate prenatal care in the first trimester (56.6% vs. 64%) and were more likely to have late or no prenatal care (15.9% vs. 10.0%). A study in Washington state described a twofold increase in infant mortality rates from 1981-1990 among natives living in an urban area.
The Indian Health Care Improvement act (Title V) authorized the creation of the Urban Indian Health program in 1976. Funding authorization for the program ended in 2000 but was reinstated without an expiration date in 2010, when it was included in the Affordable Healthcare Act. What can we do to help address these disparities? The first is to encourage legislators to support adequate funding for Title V. Next, we can recognized that the appeal of the ACA could put Title V funding in danger. Lastly, we must realize that the healthcare of urban Native women may be fragmented. As a future physician, I hope to address these healthcare needs.