Indian health services (IHS) is a division of the United States department of health and human services, responsible for the provision of medical and public health services to the federally recognized Indian and Alaska natives (Mullner, 2009). Alaska natives are persons with Tsimpsian, Athabascan, Haida, Tlingit, Aleut or Eskimo descent. On the other hand, American Indians refer to the approximately 556 American Indian tribes that are federally recognized by the United States. Two thirds American Indian and Alaskan natives (AI/AN) live in reservations and approximately half are in the urban areas (Mullner, 2009).
Currently, the Indian health services is responsible for the provision of health care to more than 1.5 million AI/AN across its twelve offices. The IHS services are both provided directly and via health care programs that contracted and operated tribally. In addition, services are purchased from some private providers (Mullner, 2009).
IHS has faced variety conflicts and issues with the local population which it serves (Smedley, Stith & Nelson, 2003). The initial issue concerned the disregard of the natives’ traditions and attitude. According to Kitzes & Domer (2011), those in charge of the health policy making were mainly politicians from Washington with little input from the natives’ tribal officials or the natives’ health care providers. However, recently the idea of community leadership has been incorporated and more natives have taken the leadership positions.
Despite the various challenges that have faced IHS, it has done a lot to improve the AI/AN’s health status. Since its inception, maternal death rates has decreased by 92 percent, infant mortality has decreased by 85 percent, deaths from diarrhea and tuberculosis have also dropped by 93 and 96 percent respectively, with the life expectancy increasing by approximately 20 percent (Kitzes & Domer, 2011).
Although the health status of the AI/AN have been improved by IHS, the AI/AN population still experiences considerably high mortality rates in many areas. Smedley et al (2003) indicates that, although the death rates from unintentional injury and tuberculosis have decreased; they remain alarmingly high going from 600 percent and 264 percent to 425 percent and 184 percent respectively. The AI/AN are more affected by the type II diabetes mellitus than the general US population. Unintentional injury related deaths which includes deaths from motor vehicle accidents is another leading cause of deaths among the AI/AN population. According to . Smedley et al (2003), the main factor associated with the unintentional injury deaths is the prolonged response and transport time especially in the rural areas leading to higher levels of mortality traumas.
Inadequate heath statistics and specific research on the AI/AN population is another significant issue related to the IHS (Smedley et al, 2003). This mostly affects the AI/AN population residing in the urban areas. This section of the AI/AN population is often overlooked by the IHS.
Moreover, traditional healers are still common among the AI/AN population. Each of the more than 500 tribes that forms AI/AN community have certain sacred rituals and ceremonies, most of which are known and recognized only by the tribe members (Kitzes & Domer, 2011). The natives’ cultures strongly links medicine and religion. It is highly believed that prescribed lifestyles must be followed to maintain optimal health. However, the IHS has paid little attention to the role of traditional medicine among the native cultures (Kitzes & Domer, 2011).
In conclusion, although IHS has put much effort to improve the health status of the AI/AN population, they still need to understand the structure of providing health care to the natives and the unique characteristics of the population. The historical traditions of the community and the AI/AN’s individual beliefs and attitudes are some of the significant components. Therefore, just like any community, it is vital for the IHS to view the heath and the health care provision to the AI/AN community from cultural perspective.