Archive for the ‘Indigenous Peoples’ Category

Self-Determination in American Indian/Alaska Native health care

August 23, 2016

lo-res-nixon-tribal-self-determination-ap700708064-e1292431589203

In 1975, the Indian Self Determination and Education Assistance Act (PL-93-638) was passed to allow for tribes to contract with federal agencies to govern their own services. Tribes, considered “dependent domestic nations”, have varied in how much they have taken advantage of self-determination opportunities in health care. For example, 99% of the Indian Health Service (IHS) funding in the Alaska Area is under tribal control, while very little of the Great Plains Area has been transferred to tribal control. Under treaty rights, the federal government is responsible for the “proper care and treatment” of members of recognized tribes in perpetuity. There exists some sentiment that self-determination is a way of letting the federal government out of its treaty responsibilities to Native people.  Others, like Donald Warne, MD, MPH, see so-called “638” tribally-managed health care as offering increased opportunities for third party revenue and grant funding, and increased local control versus IHS facilities, resulting in more services and better access.

AI/AN health care funds are not considered an entitlement like Medicare, Medicaid, or VA benefits, meaning that Congress must appropriate funding annually. In 2014, this was $3099  per user, which is less than that spent on federal prisoners. In comparison to the general US population, AI/AN people suffer higher age-adjusted death rates (from diabetes, chronic liver disease and cirrhosis, accidents, tuberculosis, pneumonia and influenza, suicide, homicide, and heart disease), as well as infant mortality twice the general population.  IHS is a severely underfunded and understaffed agency, which, at least in the Great Plains Area, is providing care which Senator John Barrasso (R-Wy) recently called “malpractice”.

I am calling upon the IHS to provide technical assistance, capacity development, and transfer planning for tribal control. I am also calling upon Congress to fund these efforts for the improvement of AI/AN health.

 

Got Worms? The High Cost of Neglecting Parasitic Infections in Ecuador

March 11, 2014

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If asked which parasitic disease were responsible for the greatest burden of morbidity, the majority of us would likely respond with HIV or perhaps malaria. In actuality, the biggest cause of Disability-Adjusted Life Years (DALYs) are due to what health expert Dr. Peter Hotez refers to as “the unholy trinity”: RoundwormWhipworm, and Hookworm. Collectively, these worms are known as “Soil-Transmitted Helminths” or STHs. Current data show that up to 35% of people in the Amazon region are chronically infected by STHs (up to 75% in some villages!), many of them children. STH infection can be especially pernicious in the young, due the detrimental effects of parasitic burden – chiefly anemia – which result in reduced cognitive and physical function and compromised academic performance. Moreover, these infections trend highly with impoverished and underprivileged populations.

Fortunately, there exist clear and cost-effective interventions for STH infections. Mass Drug Administration (MDA) with anti-helminthic medications remains the gold standard, is cheap to implement, and has a proven track record of effectiveness in numerous countries. In order to complete a successful intervention in Ecuador, it will be necessary to engage stakeholders at all levels of involvement. Organizations like the Bill and Melinda Gates Foundation and the Sabin Institute can provide required funding and strategic planning, with branches devoted entirely to neglected tropical diseases. PAHO can also help with active implementation of deworming efforts, but interventions will require cooperation from indigenous nations (CONFENIAE) and Ecuador’s Ministry of Health. By strategically combining the resources and aims of these key stakeholders, a successful deworming campaign could finally end the vicious cycle of helminth infection that disproportionately affects the impoverished young and perpetuates their socioeconomic handicap.

"The Unholy Trinity"

Details about the infection with STH.

By Paola Santacruz, Justin Price

Helmet use for motorcycle drivers and passengers in rural Thailand

March 9, 2014

The problem has been thoroughly researched and recognized by the government for years now… tens of thousands of head injuries or deaths of motorcycle drivers and passengers in Thailand, many of which were preventable by helmets.

Scooter

Although helmet use has been mandated for motorcycle drivers and passengers since 1994 and 2007, respectively, rates of helmet use are still strikingly low in rural areas, hovering around one third for adults and only 1% for children in the Chiang Mai North Region, according to the Thai Accident Research Center which specializes in investigating auto accidents. A survey of approximately 4,000 motorcyclists in Thailand revealed that 15% were not even aware of the helmet law for motorcycle passengers. The relative risk for fatality by accident is as high as 4.5 times greater than for those who wear helmets in the Surat Thani South Region.

To combat low use of helmets, organizations have collaborated with the Thai Ministry of Interior to educate communities regarding the importance of helmet use, such as AIP Foundation which launched the Thailand Helmet Vaccine Initiative. However, with less than half of Thai motorcyclists wearing helmets, the need for a stronger collaboration between government, public organizations, private sector, and communities is urgent.

Many people and organizations can benefit from getting the public to adopt helmets when traveling by motorbike. Efforts in raising public awareness of the importance of helmet use need to be further strengthened, especially in hard-to-reach areas, in conjunction with tougher enforcement by the Royal Thai Police.

Web Links and Resources:
Thai Accident Research Center: http://www.tarc.or.th/
Isara Foundation: http://www.isara.org/community/pages/thailand-helmet-campaign
Asia Injury Prevention Foundation: http://asiainjury.org/our-reach/thailand/
Safe Driver Education Company Limited: http://www.thaisafedriver.com/default.html
Federation Internationale de l’Automobile (FIA Foundation) organizations: http://www.fiafoundation.org
Space Crown Helmets: http://www.spacecrownhelmet.com/company.php

More articles covering the Thai helmet problem and efforts to solve it:

Charity motorcycle ride from Thailand to Cambodia to supply helmets:  http://www.phnompenhpost.com/lifestyle/bikers-ride-thailand-cambodia-good-cause

NY Times expose on Thai road safety:   http://www.nytimes.com/2014/03/01/world/asia/crash-that-kills-schoolgirls-highlights-thai-road-dangers.html?_r=0

Thai Vespa distributor hosts charity gala to unveil new model and give helmets:  http://asiainjury.org/news/vespiario-thailand-organizes-la-dolce-vita-charity-gala-dinner-in-to-unveil-the-new-vespa-946-and-benefit-helmets-for-kids-in-thailand/

The Importance of Contraception and Family Planning Services for Indigenous Guatemalan Women

August 22, 2012

In recent years, Guatemala’s Congress passed legislation to broaden access to family planning, sex education, and contraception.  These policies are likely to be especially beneficial for indigenous Guatemalan women, who suffer from disproportionately bad reproductive health and poverty compared to other Guatemalans.

(Photo Credit: Arturo Sanabria, Courtesy of Photoshare)

Indigenous Guatemalan women generally lack broad access to family planning services.  Their awareness and usage of contraception is much lower than their Latina counterparts, resulting in many indigenous women having a high number of pregnancies over their lifetime, often more pregnancies than they wish to have.  These women have worse health compared to other Guatemalans, and are often unable to adequately provide for all the children they bear On a long-term basis, the large size of these indigenous families and their relatively poor health contributes to their position as the most impoverished and marginalized members of society. 

The efforts of the Catholic Church and religious groups like Catholic Relief Services to reduce suffering among indigenous Guatemalans are commendable.  Unfortunately, their hard-line stance against contraception and family planning directly contributes to poor health outcomes among those they aim to help.  

(Photo Credit: BBC News)

Other influential aid groups must therefore act to ensure continued progress in the area of reproductive and sexual health.  These organizations must partner with local groups that promote women’s health and female leadership, and reproductive choice. Major stakeholders, such as USAID  and the US Global Health Initiative, must continue facilitating coordination among health officials, politicians, and local communities to establish the capacity, social will, and infrastructure needed to support the policies passed by the Guatemalan Congress. 

Above all, the discourse must incorporate the indigenous women’s perspective.  Aid groups, even religious ones, should work with the Guatemalan government to empower indigenous women, encouraging them to take control of their reproductive and sexual health, and helping them make informed, responsible decisions to improve their health and the health of their children.     

Youth Suicide in Indian Country

August 14, 2011

Suicide is the second leading cause of death among American Indian youth. In some communities, the suicide rate is as high as ten times the rate of the general U.S. population, requiring immediate attention. Like many public health issues, suicide is complex and influenced by multiple factors, including parental conflict, academic problems, substance abuse, and socioeconomic status. Although limited research exists on protective factors for American Indians, studies have found that positive school experience, supportive tribal leaders, and commitment to cultural spirituality were protective against suicidal thoughts. [1]. While these factors provide a good starting point for program development, suicide prevention programs must be flexible to account for differences between tribes, such as social structure, gender roles and conceptualization of death. [1]

The Indian Health Service (IHS) is committed to improving the health of American Indians and Alaska Natives and recently launched a Suicide Prevention Website to provide culturally appropriate information about suicide prevention. Other organizations are also joining the fight, including the Center for Native American Youth. States have recognized the need to address youth suicide in Indian country and include tribes in their state suicide plans. Finally, many tribes have developed tribal programs aimed at reducing youth suicide rates within their communities.

Despite these efforts, more is needed. We need additional funding for American Indian youth suicide prevention programs. Early research shows that suicide prevention programs can be effective.  Now, we simply need the funding to implement these programs. It is a matter of life and death for our children, our communities, and our future.

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[1]  Balis, T. and Postolache, T. (2008).  Ethnic Differences in Adolescent Suicide in the United States.  International Journal of Child Health and Human Development, 1(3), 281-296.

In 27 Indian states, Accredited Social Health Activists uplifts the health system. When will Goa wake up?

August 17, 2010

Accredited Social Health Activitist (ASHA) is a trained female community health activist, a concept introduced by the National Rural Health Mission, Government of India, in 2005, to improve the public health system at the rural level. ASHA is selected from the village itself and works as an interface between the community and the public health system.
All major Indian states have accepted the concept of ASHA and started recruitment and training of these activists. But the state of Goa hasn’t trained even a single Accredited Social Health Activist!

Changing lives in the rural sector How ASHAs are trained..

Recent health data from Goa is not impressive. The Health Ministry at the Centre is trying its best to convince the the State health ministry to take up this issue. The Goa health ministry, on the other hand, feels that Anganwadi Workers are equipped and qualified enough to do the job. The State Anganwadi Workers Association says they are overburdened with community work and would appreciate ASHAs sharing some work-load. Surprisingly, the Goa Medical Association feels that it is a wastage of resources and is against the concept. But, the Local panchayat can see that the loopholes in the current system and are pressing for ASHA recruitment and training.

Decreasing maternal and infant mortality rate, promoting vaccination, sanitation, personal hygiene, control of infectious diseases and achievement of millennium development goals requires ASHA. Media advocacy, convincing by central health minister, protests by the anganwadi workers should be promoted. In vernacular language, ASHA means a ray of hope and Goa badly needs it.

Native Americans Swallow Vitter Bill

August 17, 2009

Based on U.S. government and Native American treaties, this country has a legal and moral responsibility to provide health care to American Indians and Alaskan Natives (AI/AN). Indian Health Services (IHS) provides care to ~2 million tribal members in 35 states through hospitals, health centers, and clinics located on AI/AN reservations, but they also purchase health care through Contract Health Services.

FY 2000-2001 Regional Difference Report, Indian Health Services

FY 2000-2001 Regional Differences Report, Indian Health Services

Despite federal policy on treaties, the IHS is consistently under-funded. In 1976, the Indian Health Care Improvement Act (IHCIA) was approved in an attempt to address health disparity needs. Today, the IHS Federal Disparities Index (FDI) indicates current funding is at only 60 percent of IHS total need. The IHCIA expired in 2000 and despite broad support and intense AI/AN efforts, reauthorization of the bill failed.

Why did it fail? Sen. David Vitter introduced the Vitter Amendment, an anti-abortion rider supported by the National Right to Life Committee. Even though this amendment is redundant to the Hyde Amendment, Vitter is on a political crusade to slog down health care bills with Right to Life anchors. Ironically, the IHS doesn’t even offer abortion services.

During a radio interview, Stacy Bohlen, Executive Director of the National Indian Health Board, stated,

…a letter was sent to every member of the House threatening that a vote on the IHCIA was going to be scored as a National Right to Life vote whether the abortion language is in it or not.

Despite progress by the House Subcommittee on Health, the IHCIA bill remained hostage to abortion politics. Meanwhile, the IHCIA did make it to the Senate floor and the Vitter Amendment was reluctantly accepted in an effort to gain approval. It passed—no thanks to Vitter. He voted no.

For the 5th time since 2000, the IHCIA is once again before Congress. Please call your Congressional Representatives to show your support for the passage of this long-overdue AI/AN health care bill—and ask them to leave abortion politics out of it! Children like Ta’Shon Rain Little Light or Trevor should not be victims to Vitter political grandstanding, as their health care needs remained unmet due to shameful (under)funding policy.