Disparities hurt Native Americans' health

This population has higher rates of diabetes, cancer, childhood respiratory disease and deaths from injuries. Experts blame poverty, education levels and poor access to care.

By Victoria Stagg Elliott, amednews staff. Aug. 25, 2003.

Some of the villages where Ted Mala, MD, provides care to Alaska Natives do not have running water. He travels mostly by plane because there are no roads. And when he arrives, he works in clinics held together by duct tape.

It's a sad state of affairs, and he believes this affects his patients. They are so disempowered they take no responsibility for their own care.

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Link delivers drugs in remote areas
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"Within the Indian health system, there are hospitals that are over 100 years old that are still running," said Dr. Mala, past president of the Assn. of American Indian Physicians and director of tribal relations at the Alaska Native Medical Center in Anchorage. "The system itself lends it to subservience and saying, 'Doctor, fix it.' "

He and others say this circumstance is the story behind the numbers released by the Centers for Disease Control and Prevention this month. According to several papers published in Morbidity and Mortality Weekly Report, Native American and Alaska Native children have twice the rate of death caused by injuries or violence as do other children in the United States. More Native American and Alaska Native children are hospitalized for bronchial infection than any other group. The diabetes rate among these adults and children is double that of the rest of the country. Cancer rates among those in some regions are also significantly higher.

Numerous factors including poor access to quality care, lower education levels, high rates of poverty and lack of even the most basic infrastructure such as running water likely are to blame. Some even suspect that the population might have high rates of untreated depression leading to self-medication with food, causing obesity and diabetes; with alcohol, leading to traumatic injuries; or with tobacco, triggering lung cancer and respiratory disease.

"The behavioral choices that people are making are problematic, and the question is why are people making those choices?" said Craig Vanderwagen, MD, the Indian Health Service acting chief medical officer.

IHS funding is 60% of the amount needed.

There are also basic characteristics of the American Indian and Alaska Native community that might contribute to health disparities. A large number live in rural areas, where the health status generally lags behind even for non-Indians. Health care access can be limited. Many receive care through the IHS, but according to an agency fact sheet, federal funding is only 60% of what is necessary to provide health services equal to the rest of the country.

Much of the problem, however, is blamed on socioeconomic issues. The poverty rate is double that of the general population, and many experts think that this is what needs to be addressed the most, although it is unknown whether this will completely solve the problem.

"Even if you wipe the slate clean of differences in income and education, there would probably be differences in care because of cultural differences and misunderstandings," said Thomas Sequist, MD, research fellow in the department of health care policy at Harvard Medical School.

But although there is significant bad news in this area, health officials also say there are some encouraging signs. The same issue of the MMWR offered data that vaccination rates among Alaska Native children exceeded the Healthy People 2010 goal of 90%. Infant mortality is similar to the general population and, although life expectancy is lower, it also is much higher than ever before.

ADDITIONAL INFORMATION:

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Poverty rate: 26% among American Indians and Alaska Natives; 13% among the overall U.S. population

Life expectancy: 70.6 years for American Indians and Alaska Natives; 76.5 years for the overall U.S. population

Diabetes rate: 15.3% among American Indians and Alaska Natives; 7.3% among the overall U.S. population

Source: Morbidity and Mortality Weekly Report, Aug. 1

Link delivers drugs in remote areas

The Dept. of Health and Human Services has approved the use of remote drug dispensers to get prescription drugs to patients in isolated areas of Alaska, according to a statement issued this month.

Public health agencies long have documented significant health disparities among Alaska Natives and have tied them to health care access issues in the remote, rural areas where many live.

This demonstration project will allow physicians at medical clinics that are hundreds of miles from a drug dispensary to fax prescriptions to an Anchorage pharmacy. A pharmacist will then transmit a command via computer link back to a locked machine in a secure area of the clinic. The machine bottles the medication and dispenses it to a technician who labels it and delivers it to the patient.

"Access to health care is not just about being able to see a health care provider, it also includes the ancillary services that help patients stay healthy or get better," said Elizabeth M. Duke, PhD, administrator of the HHS Health Resources and Services Administration.

The network will serve native and non-native patients within the Indian Health Service's Anchorage Service Unit.

The project is part of a 2-year-old initiative to look for ways to make buying prescription drugs easier. Other pilot projects have been approved for Georgia, Minnesota, Mississippi, New York state and Washington state.

Weblink

"Surveillance for Health Behaviors of American Indians and Alaska Natives: Findings from the Behavioral Risk Factor Surveillance System, 1997-2000," Morbidity and Mortality Weekly Report, Aug. 1 (www.cdc.gov/mmwr/preview/mmwrhtml/ss5207a1.htm)

Assn. of American Indian Physicians (www.aaip.com)