MTPR

Discrimination, Lack Of Access Are Barriers To Native American Healthcare

Dec 12, 2017

Today, NPR’s Morning Edition aired a story about discrimination Native Americans face when trying to get healthcare in America. It included an interview with Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes.

We’re going to follow up now by looking at some of the persistent myths about American Indians that get in the way of them getting healthcare.

In Montana, the life expectancy for Native American men is 56 years, that’s 19 years lower than for non-Indians. For Native women in Montana, life expectancy is 20 years shorter than non-Indian women.

"My mom died at 57 because she was denied health care," says Anna Whiting Sorrell, a member of the Confederate Salish and Kootenai Tribes. "She was diagnosed with cancer and died six weeks later. Even though she had gone to the hospital and a primary care doctor many times saying she was sick."

One persistent myth is that Native Americans get free healthcare from the federal government.

"There is a trust responsibility for the federal government to provide healthcare to Indians," Sorrell says. "It's part of my treaty. The Hellgate treaty of 1855 says that because we gave up Western Montana we get healthcare. We paid for it. But we don't just get healthcare for free. That's not what's happened at all."

The federal government established the Indian Health Service in 1955, but Congress has never allocated enough funding for it to meet Native Americans’ needs.

"All it has done has added layers of complication for us to get bad healthcare," Sorrell says.

The IHS is not health insurance, it’s a system of clinics and hospitals scattered across the country, which often offer only limited services. IHS is supposed to pay for private sector healthcare when its facilities can’t meet a patient’s needs, but a federal inspector general’s report last year  found that the IHS denies roughly half of those referrals.

"So I can get something that's delivered at an IHS federal or tribal facility," Sorrell says. "But if it's not delivered there I have to figure out how does it get paid for in the private sector? So because I have it I  now have to figure out more ways to work through the federal bureaucracy to get it."

Credit Mike Albans

Sorrell was able to get IHS to pay for some of her care at a non-tribal hospital, but getting access to the healthcare system is only one challenge for many Native Americans.

They also face significant prejudice, says Margaret Moss. Moss is a member of the Three Affiliated Tribes of North Dakota, and has worked as a nurse in the IHS and other health systems. She now teaches at the University of Buffalo in New York.

"I guess there’s preconceived notions," Moss says, "and so you could run into prejudices and some actual racism because they are judging based on what they think American Indians are."

She says that’s more common in places with relatively large Native American populations. In places where Native people are less common, Moss says, there’s a perception that American Indians only exist in the past, and people are surprised to actually meet one. But there’s a common perception in both environments, she says.

"Unfortunately ideas about American Indians often fall into two camps," Moss says, "the romanticized - everybody wants to wear turquoise and have fringe and so forth - and then, unfortunately the, ‘lo, the poor Indian,’ and 'they're alcoholics,' and so forth. So you never know what you're going to get, and either way is sort of destructive for a patient to be thought of ... by health professionals."

So, there’s problems when the health care system recognizes American Indians, Moss says, and, "there is another kind of discrimination in not even recognizing American Indians. Not even asking for anybody to identify, so you don't know how to take care of that person, it never enters your mind. So, mis-identification in urban and other areas is also rampant, so it's another factor of that invisibility. And  that’s another form of discrimination."

But the news about healthcare in Indian Country isn’t all bad. A study published this year by the American Medical Association shows that, nationwide, life expectancies in nearly all counties with tribal communities increased from 1980 to 2014.

And one area with a big Alaska Native population saw the biggest increase in life expectancy over that period. Life expectancy rose more than 18 percent in that Aleutian island community.

Click here to see a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public health about discrimination across the country, and how it’s perceived by different ethnic groups.