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Lesson Overview
Featured Article: “Fed Up With Deaths, Native Americans Want to Run Their Own Health Care”
The Indian Health Service, which provides government medical care to 2.2 million American Indians and Alaska Natives, is widely judged to provide substandard care. Some tribes have tried models of self-determination and are creating and controlling their own hospitals.
In this lesson, students will learn about the history of the Indian Health Service and the many problems it faces. Then they will further investigate an alternative model of care in Alaska based on self-determination.
Warm Up
Look at the statistics below, detailing life expectancy in the United States by race and ethnicity. What do you notice? What do you wonder? What story do you think these statistics tell?
57 years — Native Americans in South Dakota
75.4 — African-Americans
76.9 — Native Americans
78.9 — Whites
83.3 — Latinos
87.1 — Asian-Americans
Sources: Geography of Opportunities Report (PDF) and The New York Times
Questions for Writing and Discussion
Read the article, then answer the following questions:
1. What happened in 2016 when 6-month-old James Ladeaux’s mother took him to Sioux San Indian Health Service Hospital? What does this experience reveal about the issues that patients have faced at Indian Health Service hospitals nationwide?
2. Who took over Sioux San hospital’s operations over the summer? What are some of the positive outcomes of this change? What are some of the difficulties that have arisen?
3. The article cites several studies that relate to Native American health care and the Indian Health Service: vacancies of medical positions, death rates for preventable diseases, health care spending per patient and life expectancy. Which of the findings from these four studies did you find the most striking or interesting? Why?
4. What are the origins of the Sioux San hospital? What purpose was it built for and how did that change over time? How have longtime patients reacted to recent attention to the conditions within the hospital?
5. What has happened to tribal members who have sought health care services outside of the Indian Health Service? What did Dr. Brook Eide, an emergency room doctor, say about his experience treating patients who went outside of I.H.S. for health care?
6. Representative Tom Cole, Republican of Oklahoma and a member of the Chickasaw Nation, said, “My personal feeling is that if you are a tribe it is better to run your own health care system.” In the article, what are some examples of tribes running their own health care systems?
7. Charmaine White Face, a member of the Oglala Sioux Tribe, is not certain that the change in management is a good idea. What are some of her concerns?
Going Further
Watch this seven-minute promotional video from the Alaska Native Tribal Health Consortium that shows the history of its health care system and how its programs try to respond to community needs.
Do any of the services offered through the Alaska Native Tribal Health Consortium feel as though they respond to needs or concerns that were raised in the article? In the video, the consortium gives specific reasons it offers certain food, preventive care and education services. What values seem to be important to its health care system?
Did you notice anything in the video that you think might be relevant to other tribal communities considering whether to create their own approach to health care services?
What opportunities and challenges do tribes face when considering whether to take over their own health care systems?
