The United States has a trust responsibility to provide services to American Indians and Alaska Native (AI/AN) persons. However, a long-standing history of underfunding of the Indian Health Service (IHS) has led to significant challenges in providing services. Twentieth century laws, including the Snyder Act, Transfer Act, Indian Self-Determination and Education Assistance Act, and Indian Health Care Improvement Act (IHCIA) have had an effect on the way health services are provided. IHCIA was reauthorized as part of the Patient Protection and Affordable Care Act (ACA). Several provisions in ACA allow for potential improvements in access to services for AI/AN populations and are described herein. Although policy developments have been promising, IHS underfunding must be resolved to ensure improved AI/AN health.
The American Indian (AI) population suffers from significant health disparities. Death rates from diabetes, cancer, infant mortality, and other causes are higher among AIs. Numerous psychosocial influences, including a history of genocide and boarding school experiences, have led to unresolved historical trauma and its associated poor health outcomes. Adverse childhood experiences are also a strong predictor of risk for numerous chronic and behavioral health conditions. Food programs for impoverished populations historically have led to high rates of formula feeding of infants and intake of high‐calorie, low nutritional value foods. Adverse adulthood experiences, including poverty, racism, and substance abuse, lead to depression, anxiety, and poor health outcomes. These social circumstances can have an impact on the quality of parenting skills for the next generation, leading to continued intergenerational health disparities. Additional research into the psychosocial influences and social determinants of health is needed to ensure improved policy and program development.
American Indians in South Dakota experience more ACEs, which may contribute to poor behavioral health. Preventing and mitigating the effects of ACEs may have a significant impact on health disparities in AI populations.
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