Cruz Hulsey

DEMONSTRATE CIVIC AND COMMUNITY ENGAGEMENT

I spent a job shadow with an environmental engineer with Indian Health Service (IHS). IHS is a

federal agency that falls under the Department of Health and Human Services and is responsible for

providing access to healthcare and public health resources for Native American and Alaskan Native

communities. This time was especially meaningful since I am an enrolled citizen of the Choctaw Nation

and so is my Sister and Dad. My Mom is an enrolled citizen of the Tlingit and Haida Central Council of

Alaska. Even though my Sister and I are both tribes by blood, the federal law says we are only allowed to

enroll in one tribe for identification purposes.

Environmental engineers with IHS have a unique job of making sure folks on reservation have

clean drinking water and sanitary waste systems. Seriously clean water on reservation, even right here

in Oregon, is an issue. I big issue that impacts the health of generations. I want to finish this assignment

by including a part of paper I wrote on health and wellness in Indian Country, and I think it is important.

Native American and Alaskan Native People experience health and wellness differently than the

rest of the American population. When looking at the overall health experience for Native People, it is

hard to define one specific cause. In addition, the historical trauma resulting from termination policy,

involuntary relocation and boarding school forced assimilation has created a culture of suspicion

combined with discriminatory underfunding of the delivery of health services and the resulting loss of

hope in most Native communities. Jones, D. S. (2006) explains, “ Even more striking is that the

disparities have existed not for 50 years but for 500 years…raises questions about the actual causes of

the disparities. Health disparities have persisted, even as the underlying disease environment has

changed.” (p.2122)

General poverty is a problem that affects more than people’s bank account. Not being able to

pay the bills causes stress and desperation. Being poor and living in depressed areas limits access to
services like health care, education, transportation and clean housing and living, and the cycle

continues. Poor people become sick because they are stressed about money and don’t have good food,

clean water, safe housing or transportation to get to school or medical help. Given that more than half

(55%) of American Indians and Alaskan Natives have incomes below 200% of the federal poverty level

($28, 256 for a family of 3 in 2001), compared with 25% of Whites, the impact on the community is

widespread. (Katz, R. J., 2004, p. 13). When these resources are not available, people struggle with

physical, mental and emotional wellness.

Data from the Indian Health Service reports the higher death rates in Native American and

Alaska Native People compared to the rest of the population especially for Tuberculosis – 600% higher,

Vehicle crashes – 229% higher, Alcoholism – 510% higher, Diabetes – 189% higher, injuries – 152%

higher and Suicide – 62% higher. (Frizzell, L. B., & Spencer, K., 2016, p. 2). The data seem to indicate that

along with illness, most of the major health issues are related to preventable situations that are results

of living in hopelessness. Suicide, alcoholism, vehicle crashes and injury rates are symptoms of lack of

emotional wellbeing; they are ways to escape the depression. The higher tuberculosis and diabetes are

connected to poor diet, lack of education and access to basic medicine. Even though American Indian

and Alaskan Natives who are enrolled in federally recognized tribes are entitled to free health care, they

have to be able to get to the IHS or tribal clinics or hospitals offering it; typically near reservation or

tribal land. Many people have left the reservations to look for work in cities and urban areas. This

means they are giving up closer access to health care and moving to places where they would need to

have insurance to pay for healthcare. Of the 5.2 million remaining Native American and Alaskan Natives,

their uninsured rate is nearly 30%, compared to 15% for the country as a whole. (Vestal, C., 2013) and

even just getting to a facility can be a significant barrier. Others have argued that the health disparities

could be traced back to general poor conditions and that health and wellness couldn’t be addressed

until there were improvements to the general economic and living conditions. “Congressional
investigators were shocked by what they found: “So long as the Navajos remain on the barren wasteland

on which they live, without communities, roads, water, sanitation, or the opportunity to earn a living

wage, they must continue to live in squalor and disease. ” (Jones, D. S., 2006, p. 2129).

In recognizing the crisis and consequences of the health and wellness discrepancies experienced

by Native American and Alaskan Native communities, the first steps will create change; beginning with

serious efforts in cultural understanding from a historical trauma perspective as a low cost option with

immediate impact. Tackling the bigger issues of the full and consistent Congressional funding of IHS

programs and addressing problems with chronic poverty, will take continued research and a willingness

to partner in understanding meaningful solutions before there is a healthy way forward to overall

wellness.