Millions of American Indians and Alaska Natives living in or near cities throughout the United States are seemingly invisible to healthcare providers and federal and state policy makers, yet they face significant healthcare disparities, according to a new report entitled "Invisible Tribes: Urban Indians and Their Health in a Changing World." The report, released by the Urban Indian Health Commission (UIHC), a group convened by the Robert Wood Johnson Foundation and the Seattle Indian Health Board's Urban Indian Health Institute, examines healthcare issues that face urban American Indians and Alaska Natives. Nearly 67% of the nation's 4.1 million self-identified American Indians and Alaska Natives (approximately 2.8 million people) call US cities home. However, there is no uniform policy regarding urban Indian healthcare, and current federal executive policy actually aims to eliminate funding for urban Indian healthcare within the Indian Health Service. The report reviews the prevalence of three diseases-depression, diabetes, and cardiovascular disease-in the American Indian and Alaska Native population. Findings on each of these conditions are as follows:
* Up to 30% of all American Indian and Alaska Native adults suffer from depression, and there is strong reason to believe the proportion is even greater among individuals living in cities.
* Compared to the general US population, American Indians and Alaska Natives have a higher prevalence of and greater mortality rate from diabetes. They also have an earlier age of diabetes onset.
* Cardiovascular disease is the leading cause of death among American Indians and Alaska Natives. It kills more American Indians and Alaska Natives aged 45 and older than cancer, diabetes, and unintentional injuries combined.
According to the report, it is common for an urban Indian to suffer from more than 1 of the aforementioned diseases, which ultimately interact with, amplify, and perpetuate one another. Many of the underlying causes, markers, and barriers to treatment of these diseases are shared-at above-average rates-by other diseases and afflictions suffered by American Indians and Alaska Natives. A big challenge for urban Indians is accessing high-quality, appropriate healthcare. Most American Indians and Alaska Natives living in cities are ineligible for or are unable to use healthcare services offered through the Indian Health Service or tribes. Even when urban Indians do manage access to healthcare, they must overcome additional barriers to receiving appropriate care. Cultural misunderstandings, lack of respect, and communication obstacles often interfere with and inhibit the delivery of high-quality healthcare to urban American Indians and Alaska Natives.
The UIHC report recommends informed dialogue and targeted action. The public and private sectors must recognize and assist urban Indians in order to improve their access to appropriate healthcare services, work to enhance data collection and research pertaining to American Indians and Alaska Natives living in cities, support funding initiatives, and identify and institute best practices in urban Indian healthcare. Most importantly, Americans must understand that the quality of healthcare for all will not improve without addressing-and reducing-disparities. For access to the report, "Invisible Tribes: Urban Indians and Their Health in a Changing World," visit http://www.rwjf.org/programareas/resources/product.jsp?id=23193&pid=1142.
The Urban Indian Health Institute (UIHI) was established in July 2000 as a division within the Seattle Indian Health Board, a community health center that targets urban American Indians and Alaska Natives. The UIHI provides centralized nationwide management of healthcare surveillance, research, and policy considerations regarding the health status deficiencies that affect urban American Indians and Alaska Natives. The Robert Wood Johnson Foundation, founded more than 35 years ago, is the nation's largest philanthropy devoted exclusively to improving the health and healthcare of all Americans.