The Indian Health Service

Plagues, Politics, and Policy is an overview of the major health challenges confronting American Indians and Alaska Natives over the past fifty years and is a case study of the federal government's attempt to provide medical services to a categorical group of people in the United States. While it is not a detailed analysis of what socialized healthcare should or should not look like, it does examine the major social and political issues affecting the delivery of health services to American Indians and Alaska Natives. This book addresses broad policy questions, such as whether or not American Indians and Alaska Natives have received better healthcare since the Indian medical service transferred from the Bureau of Indian Affairs to the Public Health Service in 1955. In the initial decades of Public Health Service control of IHS, the problems of infectious diseases were largely eliminated, but they have been replaced by new challenges which will require IHS and tribal leaders to work together to come up with solutions. Many American Indians and Alaska Natives also face public health challenges rooted in the social and political history of the federal Indian relationship. In this book, DeJong provides a path to improving the future of health care for American Indians and Alaska Natives.

Disease processes among American Indians and Alaska Natives often have distinct manifestations that need to be considered by clinicians and health policy makers involved with these populations. Equally important, all aspects of Indian life—including health—are governed by the special relationship between Indian tribes and the U.S. federal government. For American Indian Health, Everett R. Rhoades has gathered a distinguished group of scholars and practitioners to present a comprehensive assessment of the health of American Indian peoples today and the delivery of health services to them.

'If You Knew the Conditions' examines the inadequacies of the healthcare provided to American Indians by the Indian Medical Service. DeJong argues that, while Congress and the Indian Service had a responsibility to provide meaningful and relevant medical services to American Indians, parsimonious appropriations and indifference to American Indian conceptions of well-being limited the effectiveness of Indian medical services.

Indicators point to continuing lower health status among Native Americans as compared to the general population. Just a decade ago, the mortality rate of Native Americans was 37 percent greater than the rate for the general population, and Native Americans are still more likely to suffer from diabetes, tuberculosis, alcoholism, depression, and suicide. To address the basic health concerns of all Native Americans, this book examines the response of the Cherokee Nation of Oklahoma to critical medical issues. After 1976, the Cherokee Nation aggressively addressed inadequate levels of health services for tribal members and better coordinated efforts to deal with the health problems of their population. Improving American Indian Health Care shares the Western Cherokee experience so that other tribal governments may adopt or adapt the approaches particularly suitable to their own circumstances.

In Reproductive Justice, sociologist Barbara Gurr provides the first analysis of Native American women’s reproductive healthcare and offers a sustained consideration of the movement for reproductive justice in the United States. The book examines the reproductive healthcare experiences on Pine Ridge Reservation, home of the Oglala Lakota Nation in South Dakota—where Gurr herself lived for more than a year. Gurr paints an insightful portrait of the Indian Health Service (IHS)—the federal agency tasked with providing culturally appropriate, adequate healthcare to Native Americans—shedding much-needed light on Native American women’s efforts to obtain prenatal care, access to contraception, abortion services, and access to care after sexual assault. Reproductive Justice goes beyond this local story to look more broadly at how race, gender, sex, sexuality, class, and nation inform the ways in which the government understands reproductive healthcare and organizes the delivery of this care. It reveals why the basic experience of reproductive healthcare for most Americans is so different—and better—than for Native American women in general, and women in reservation communities particularly. Finally, Gurr outlines the strengths that these communities can bring to the creation of their own reproductive justice, and considers the role of IHS in fostering these strengths as it moves forward in partnership with Native nations. Reproductive Justice offers a respectful and informed analysis of the stories Native American women have to tell about their bodies, their lives, and their communities.