In June, the Alliance for Early Success and the National Indian Health Board hosted a webinar offering an essential overview of the Indian health system, with a focus on how federal Indian law, tribal sovereignty, and the government’s trust responsibility shape access to care for Native mothers, infants, and young children.
Presenters Lacey Wind and Carrie Field of the NIHB helped participants understand the historical and legal foundations of American Indian health, the Indian Health System’s structure, and the key disparities affecting Native communities today.
Indian Health System & Tribal Sovereignty
- The federal government has a trust responsibility to provide healthcare to American Indian and Alaska Native (AI/AN) people, rooted in treaties and legal precedents.
- Tribal sovereignty grants Tribes authority over their health systems through self-governance compacts and contracts, enabling them to tailor healthcare to their needs.
- National Indian Health Board (NIHB), established by Tribes in 1972, advocates for the health rights of all 574 federally recognized Tribes and works to ensure Tribal voices are represented in federal health decisions.
Historical Context & Legal Foundations
- Treaties exchanged Tribal lands and resources for federal commitments like housing, education, and healthcare—many of which have been broken, undermining trust.
- AI/AN status is a political designation with unique legal protections, not merely a racial or ethnic category.
- Landmark laws like the Indian Self-Determination and Education Assistance Act (1975) and the Indian Healthcare Improvement Act expanded Tribal control over health programs.
- Tribal consultation is a formal process to ensure Tribes are involved in decisions impacting them.
Indian Health Service (IHS)
- IHS serves 2.8 million AI/AN people through over 660 facilities in 12 regions but faces chronic underfunding—federal resources meet only 1/7 of Tribally identified needs.
- High provider vacancy rates (35-50%) and funding shortfalls cause frequent service disruptions, especially in rural areas.
Health Inequities & Ongoing Challenges
- AI/AN populations face severe health disparities, including the largest drop in life expectancy (2019-2021), high maternal and infant mortality, and widespread mental health challenges.
- Factors compounding inequities include historical trauma, systemic racism, intergenerational poverty, governance barriers, and forced separation from Native cultures due to limited local resources.
Strengths & Indigenous Perspectives on Health Equity
- Despite these challenges, Indigenous resilience is a critical strength. The Indigenous Determinants of Health (see slide 47) model highlights cultural, social, and environmental assets Tribes can leverage to improve health outcomes.
- Achieving health equity requires respecting Tribal sovereignty, investing in Tribal public health infrastructure, and translating policy into real-world changes.
How to Be an Ally
- Build respectful relationships centered on reciprocity rather than paternalism.
- Support Tribal self-governance and meaningful consultation.
- Train organizational staff in Tribal sovereignty and cultural safety.
- Prioritize implementing policies that have tangible benefits for Native communities.
Terminology
- Use “American Indian and Alaska Native” (AI/AN) for legal contexts; “Indigenous” for broader/global references. Avoid casually using “Indian” as a non-Native person. When in doubt, ask individuals how they prefer to be addressed.
Resources & Next Steps
- Broken Promises: Continuing Federal Funding Shortfall for Native Americans
- Urban Indian Health Institute
- The Unapologetic ‘Auntie’ of Indigenous Data – Abigail Echohawk
- Area Indian Health Boards across the country and Alaska Native Tribal Health Consortium may be good resources for local health information, specific to the Tribes near you.
- National Tribal Health Conference coming up in Phoenix, AZ in September will also include maternal health resources
