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"My lands are where my dead lie buried." Crazy Horse |
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2001 Executive Council Winter Session
February 21-23, 2001
Washington, DC
"Preserving Tradition Through Another Transition"
General Assembly Session Presentation
"Indian Health Care"
by
MICHAEL H. TRUJILLO, M.D., M.P.H., M.S.
ASSISTANT SURGEON GENERAL
DIRECTOR, INDIAN HEALTH SERVICE
(This speech served as the basis for remarks and may not exactly match the oral presentation.)
February 22, 2001
Good morning. It is a pleasure to be here again and to update you on what is happening within the Indian Health Service.
First of all, I would like to recognize all of you for everything that you have done in Indian country and your outstanding leadership. President Masten, thank you very much for inviting me. I have to be on my good behavior because my governor from Laguna Pueblo, Governor Harry Early, is also here today. Just as a personal anecdote, when I graduated from high school a number of years ago, I applied for a scholarship our pueblo had established for those who wished to go to college. At that time, Governor Early was the chairman of the Laguna Pueblo scholarship committee and managed the review of applications. I was fortunate to receive one of the scholarships. That scholarship program helped me, and many others, to go on to receive a level of education that was never available before. I often look back upon that as the start of my career. Because of that, I strive to make sure that our people are part of the education process.
I believe that the new Administration will provide a number of new opportunities for Indian programs, especially Indian health. We see the disparities of health status among our people and the rest of the nation every day. You and I know those differences and we face the problems every single day in our communities and families. There are great disparities in health status and health access, and also disparities in opportunities for education and economic prosperity for our people. I believe there will be increasing opportunities for collaboration and involvement of Indian tribes within our programs, the Department of Health and Human Services, other agencies within the Department, as well as working across Department lines to address these problems of disparity.
I also expect there will be a number of grant initiatives to establish and enhance programs in Indian country. One example, our Department is looking at the Medicare program and exploring proposals to address the increasing costs to cover catastrophic health expenses and also prescription drugs. Providing prescription drugs is one of the highest cost areas for tribal, urban, and Indian Health Service health programs. How do we begin to collaboratively look at covering the costs of drugs for our people?
Regarding access to care and health disparity, there are a number of proposals for establishing a health care safety net. For example, increasing the amount of pay for health professionals to levels competitive with the private community and reforming the National Health Service Corps placement process to ensure that health care providers and physicians are working in the neediest parts of the country and communities. There is also a Healthy Community Innovation Fund that will provide grants for pilot programs and demonstration projects to address major health risks in communities, and those funds and grant programs would also be available to Indian communities and Indian tribes. There are a number of proposals in the area of child welfare and family policy to promote stable and positive families, protect children, and provide competitive grants for initiatives to promote responsible fatherhood and also to prevent family violence.
Those are some of the health issues and problems that we see every single day. One aspect of health that we all must take to heart, is the responsibility for our own health and our families' health. Exercising, eating right, making sure that we don't smoke, and that we act responsibly and set an example. Those things can go a long way in helping our families, our communities, and ourselves remain healthy for as long as possible against the rising problems of diabetes and cardiovascular disease that we see across the country for Indian people.
Education levels influence health status. This Administration is also proposing education reforms that can address the disparity in achievement among disadvantaged students, and these proposals are essential for making a difference in Indian country. We can also look at how other resources might be brought into Indian education, especially at the lower elementary and high school levels, that can directly affect the health care status among our children throughout their lifetime. I believe that the quality of the educational system that we provide in our communities for our families and our children directly relate to better health status for everyone.
This Administration and the Congress place an increasing emphasis upon the Government Performance and Results Act as a way to look at outcomes of government programs. It is a way to assess how well we are doing. The GPRA results are also a part of our budget recommendations and justification. To strengthen our ability to assess the effectiveness of our programs and to determine where further programs or improvements are needed, we must invest in data systems. Investment in our data systems is critical to further gains and improvements in effective health delivery systems, enhancing resources through collections and justifiable requests, and supporting self-determination and sovereignty.
As always, there are a number of legislative issues that will affect Indian health care. Much of the focus of the legislation is on continuing to strengthen and foster partnerships whereby communities, Indian nations, and others collaborate on solutions and facilitate the programs. In the 107th Congress, two bills that directly affect the Indian Health Service have come into play. The Senate has introduced, and I believe you heard some discussion on this yesterday, the Indian Health Care Improvement Act. It is my understanding that Committees will probably have hearings on the Indian Health Care Improvement Act this coming March and the Indian Health Service and the Department will be asked to provide our views. There has been much, much work this past year-and-a-half by Indians and Indian leaders who drafted proposed language for the Indian Health Care Improvement Act that was submitted to the House and Senate. It is my understanding that the Senate will introduce the tribally written bill very soon and will also hold hearings.
Another bill that was reintroduced in both the House and the Senate, at the end of January, was the elevation of the position of Director of the Indian Health Service to an Assistant Secretary level within the Department of Health and Human Services. I would imagine that hearings would be held on that particular bill on both sides of Congress, the House and Senate.
In regards to the budget, the process certainly is on its way within the new Administration, the Department, and our Agency. I want to again stress that the involvement of tribal leadership and many individuals in the budget development process, including presenting the budget to the Office of Management and Budget and also the Department, has been critical in efforts to advocate for Indian nations, people, and programs throughout the Department as well as the Indian Health Service. That process, your involvement, and your understanding has made a difference in how the Department views Indian people, communities, and leadership as to their involvement in developing the Department's budget request and also looking at the budget requests of other agencies within the Department. Also, built within that process is a level of trust and integrity among those involved in the budget development process. I expect that the new Administration, the new Secretary, and the individuals within the programs will also continue to respect and interact with tribal leadership and tribal governments.
As I continue in my term appointment as the Director of the Indian Health Service, I will certainly ensure that we continue to look at the issues of self-governance, self-determination, and how we look at equitable resources and make sure that they are justifiable across the nation. I will continue to seek your input, your involvement, not only in how we work the allocations but how we set program priorities and how we look at the future to make sure that Indian health care programs continue to grow and be continually respected by other programs across the nation.
Secretary Tommy Thompson, the former Governor from Wisconsin, has now taken on the responsibilities of the Department of Health and Human Services. He has already been very supportive of Indian health care issues and has also committed to ensuring that there is access to health care for underserved populations, communities, and groups. He is also committed to organ donation programs. That is an area that I think is very important and one that we too have to deal with, in terms of organ donation and organ transplants, across Indian country. I have found his leadership and his commitment to be very positive. He has been very open, very cordial, and extremely personable. In fact, I will be leaving shortly to attend a meeting with the Secretary, which is held every Thursday with all agency heads, to discuss ongoing issues and planning. That meeting schedule has also been a very positive forum to bring forth issues of Indian country.
I believe that within the Department there will be new ideas and new concepts to strengthen collaboration among agencies and also with outside programs. Also, I think that there will be positive interest to look at budget items, such as escalating pharmaceutical costs, that we have had some major difficulties, and to look at new ways to build and renovate our facilities across Indian country. There will be new ways and new concepts of ensuring that the spirit and intent of self-governance and self-determination are part of the entire process within the Department and across other agencies. I look forward to exploring these opportunities and other possibilities with Secretary Thompson and his staff.
In addition to the Secretary, there are a number of new congressional staffers and Senate and House members. That provides an opportunity for all of us to educate those individuals to the needs and resources that exist across Indian country and to have them understand the relationship with the Federal Government to Indian programs, Indian nations, and Indian leadership in regards to self-determination and sovereignty. Those opportunities are there and I hope that we can all take advantage of them.
Partnership is an important aspect of meeting the health needs of Indian country. We will certainly continue with the number of workgroups that many leaders have been involved in, especially in diabetes, personal health services disparity, contract health services, contract support cost, and other programs. We also have established many collaborative relationships with universities and foundations that have expressed an interest in placing resources into Indian country, for example, the Kaiser Foundation, the Kellogg Foundation, the Robert Wood Foundation, and the Udall Foundation. In addition, a number of universities have established collaborative relationships with Indian communities, nations, and urban programs. In Indian Country, we still have problems with such public health problems such as safety, injury prevention, hearing loss, and Sudden Infant Death Syndrome. Incidentally, over the past several days of this conference the CJ Foundation and their executive council member, Ms. Mona Rosenman, have been speaking with Indian tribes and organizations to collaborate on ways to help reduce or eliminate SIDS as the leading cause of infant mortality in our communities.
We have major problems, as you all know, with diabetes, injury prevention, and problems of mental health, heart disease, and alcoholism and the affects of alcoholism. Our elderly population is also increasing. As we begin to look at a better health care system and better access for our people, how do we also respond to these problems and care for our people? I hope that we will be able to continue to work on these issues as we have in the past, together. Another major concern of mine is how we implement traditional medicine across our programs in Indian country, not only within the Indian Health Service, but within tribal and urban programs. How can we ensure that this important component of medicine and our culture remains within our direction and administration and is available to our people?
Recruitment and retention for our programs remains a high priority. If we do not have providers, how can we ensure access for those we are responsible for? We see a major shortage of dentists and pharmacists, and we will be seeing major nursing shortages because two-thirds of our nurses are over 40 years of age and eligible to retire: How do we together work on these issues? We continue to see salary disparities between our Indian health programs and outside health care systems that result in some of our providers leaving. How can we work together on this particular pay disparity?
Just as the Laguna Pueblo scholarship program made a difference in my life, we should always look to our young people as a way to prepare for the future and to ensure our future. Just recently the United National Indian Tribal Youth group, called UNITY, held one of their annual meetings in Arlington, Virginia. They developed a list of priority concerns. Coincidentally, it is in line with many of the priorities recognized by tribal leadership in past years. From the point of view of UNITY youth, their number one concern is alcohol and drug abuse. Next are teenage pregnancy, sexuality, and parenting. Their third concern is racism, fourth is the education drop-out rate, fifth is life skills and coping skills, sixth is spirituality, seventh is cultural preservation, eighth is technological improvement in the new millennium, and ninth is funding for college or vocational training. Number 10 is learning to cope with peer pressure, 11 is gangs and crime, 12 is diabetes and other chronic health diseases, 13 is the recognition and strengthening of tribal sovereignty, 14 is preservation of the environment, and 15 is fitness. Those are the issues that these young individuals, who will be taking our places in the future, are concerned about. I hope that you, I, and others across the nation, as well as the Administration and those in the Department, will look at these concerns of our children as guiding points and make certain that we are progressing to help resolve them.
Thank you for your time, all your contributions, and your commitments. As I have traveled across Indian country and have seen the many clinics and programs, there is not a single time that I have not been amazed by the improvements, the dedication, the involvement, and the creativity that I have seen in all Indian programs. It is amazing to me that despite many times facing a lack of resources, these individuals continue to do their best. I want to congratulate you on how you have been able to provide that leadership to your communities and to the health care professionals who serve those who come into your clinics. You deserve a lot of recognition in your leadership and for what you have accomplished in Indian country. Thank you very much. Thank you for all your support and understanding.
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