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

Joseph Nowoslawski Tribal Healthcare

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

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Page 1: Joseph Nowoslawski Tribal Healthcare

Bringing Sufficient Healthcare to Indian Country:

Beyond Healthcare: Tribal HC Systems as Economic Drivers

Joseph F. Nowoslawski M.D. Medical Director

www.americanhospital.us

2nd Annual Native American2nd Annual Native American Economic Development & Diversification ConferenceEconomic Development & Diversification Conference

Page 2: Joseph Nowoslawski Tribal Healthcare

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.

Page 3: Joseph Nowoslawski Tribal Healthcare

Indian Health Service Data

“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

Underfunding consistently results in inadequate facilities, frequent

staff turnover, delays in diagnosis and care, and rules that favor the system rather than the patient.

Page 4: Joseph Nowoslawski Tribal Healthcare

Trends in Indian Health, 2000–2001

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.

All of these disease states are associated with poverty and

lack of access to medical care

Page 5: Joseph Nowoslawski Tribal Healthcare

Case Study

Appalachian Regional Healthcare System (ARHS). The Appalachian region shares many of the parameters that define indian Country – a large clan-based 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

Page 6: Joseph Nowoslawski Tribal Healthcare

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

Page 7: Joseph Nowoslawski Tribal Healthcare

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

Tribal health program benefits go beyond health care

IHS photo, 1980

Tribal health systems can allow you to control your own physical, spiritual, and financial future

Page 8: Joseph Nowoslawski Tribal Healthcare

Tribal Health Care System

Tribal Health Care Systems are also Economic Drivers

Allied Health Educationfor Indian youth

Construction

Retirement Community

Co-Op for Healthy Food Staff Jobs

Hospital

Spiritual and Wellness

Center for Tourism

Medical Research Center

Medical Scholarships

Hotel Hospitality Training & Jobs

Community Center

Administration Center

clinics

Transportation

HomeCare Stores and Pharmacies

*Groundbreaking ;Anchorage Native Primary Care Center expansion

*

Page 9: Joseph Nowoslawski Tribal Healthcare

Contact:

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