Overview of Tribal Healthcare systems as economic drivers. Case studies with solutions.

1. 2nd Annual Native American
Economic Development & Diversification Conference
Bringing Sufficient Healthcare to Indian Country:
Beyond Healthcare: Tribal HC Systems as
Economic Drivers
Joseph F. Nowoslawski M.D.
Medical Director
www.americanhospital.us

2. Timeline:
 Indian affairs were administered by the War
Department until 1849.
 1849: Office of Indian Affairs was transferred from the
War Department to the then newly formed Department
of the Interior.
 Health care became a major challenge for the Office
of Indian Affairs and remained so throughout its tenure.
 1890-1925 program of assimilation of Native
Americans into white culture dominated reservation
health care during this period.
 1928: Meriam Commission issues a report
documenting substandard health conditions due to
government inefficiency and lack of adequate funding.
 1954: transfer of Native American health services
from the Bureau of Indian Affairs (BIA) to the Public
Health Service (PHS).
 The Indian Health Service (IHS) began on July 1, 1955.
 Management of Indian health programs has recently
shifted from the IHS to tribes.
PHS photo, late 1960s
Today, over half of the current IHS budget
is managed by tribal health programs.

3. “The health issues facing American Indians in the
[U.S.] make them the most at-risk minority in the
country, and yet, the Indian Health Service receives
only 55% of the funds it needs.”
-Peter Bresko, columnist,
Fargo Forum, Sep 22 2008
Indian Health Service per capita health care
expenditures are much lower than those of
other health care systems in the United
States.
…”the failure of the federal government to
adequately fund the Indian Health Service for the
provision of care to the 1.8 million patients it is
supposed to serve means that the promises of
treaties signed in the 1800s have never been
fulfilled.”
Yvette Roubideaux, M.D., M.P.H.
Beyond Red Lake — The
Persistent Crisis in American
Indian Health Care
Nov. 3, 2005
Indian Health Service Data
Underfunding consistently results
in inadequate facilities, frequent
staff turnover, delays in diagnosis
and care, and rules that favor the
system rather than the patient.

4.  American Indians/Alaska Natives have Diabetes
rates two to three times that among non-Hispanic
whites .
 Alcohol-related death rates are 7.4 times as high
among American Indians and Alaska Natives as in the
overall U.S. population.
 American Indians/Alaska Natives also have a high
prevalence and risk factors for mental health and
suicide, obesity, substance abuse,
and liver disease.
 American Indians and Alaska Natives have an
infant death rate almost double the rate for
Caucasians.
 American Indian/Alaska Native men were twice as
likely to be diagnosed with stomach and liver cancers
as in the overall U.S. population.
 American Indian Women were 20% more likely to
die from cervical cancer compared to the overall U.S.
population.
 In general, American Indian/Alaska Native adults
are 60% more likely to have a stroke than their
White adult counterparts.
Trends in Indian Health, 2000–2001
All of these disease states are
associated with poverty and
lack of access to medical care

5. Case Study
Appalachian Regional Healthcare System (ARHS).
The Appalachian region shares many of the
parameters that define indian Country – a large clanbased population with strong ties to the land,
poverty and similar health problems such as
diabetes, obesity, substance abuse, and strokes.
ARH is a not-for-profit health system serving
350,000 residents across Eastern Kentucky and
Southern West Virginia.
Partnered with School of Nursing at Appalachian
State University to “grow” its own local nursing staff
and build an Allied Health Education facility
 With over more than 4,000 employees, ARH is the
largest provider of care and single largest employer
in southeastern Kentucky and the third largest
private employer in southern West Virginia.
ARHS Blowing Rock Hospital

6. Case Study
Southcentral Foundation (SCF)
 Alaska Native-owned healthcare
organization serving Alaska Native and
American Indian people living in Anchorage,
the Mat-Su Valley, and 60 rural villages.
 Committed to recruiting and training Native
staff.
 established a Traditional Healing Program
and culturally-sensitive counseling along with
Western medicine.
 serves 46,800+ Alaska Native and American
Indian people
 employs more than 1,200 people in 65
programs
SCF Traditional Healing staff

7. Tribal health program benefits go
beyond health care
 Sovereignty
 Culturally appropriate counseling and
treatment
 Values-based / family-based
 Restoration of Trust = better
compliance
 meets the needs of a growing elder
population
 Medical-professional job generation for
youth
 Allows for tribal-specific research
IHS photo, 1980
Tribal health systems can allow you
to control your own physical,
spiritual, and financial future

8. Tribal Health Care Systems are
also Economic Drivers
HomeCare Stores and Pharmacies
Hotel
Hospitality Training & Jobs
Transportation
Spiritual and
Wellness
Center for
Tourism
Co-Op for Healthy
Food
Medical Research Center
Administration Center
Hospital
Allied Health Education
for Indian youth
Staff Jobs
Community Center
clinics
Retirement Community
Medical
Scholarships
Construction
*
Tribal Health Care System
*Groundbreaking ;Anchorage Native
Primary Care Center expansion

9. Contact:
Joseph F. Nowoslawski M.D.
Medical Director
American Hospital Service Group, Inc.
415 Eagleview Boulevard, Suite 108
Exton, PA 19341-2239
Phone: 1-800-872-8626, Ext. 280
Fax: 610-524-0948
Website: www.americanhospital.us

10. Contact:
Joseph F. Nowoslawski M.D.
Medical Director
American Hospital Service Group, Inc.
415 Eagleview Boulevard, Suite 108
Exton, PA 19341-2239
Phone: 1-800-872-8626, Ext. 280
Fax: 610-524-0948
Website: www.americanhospital.us