By Joe Sammen
Every year since 1990, the President has designated Novemberas a time to honor American Indian heritage and culture. This year, on Oct. 31, President Obama signed the proclamation and urged us to celebrate the incredible impact American Indians have had on the shaping of the U.S. while not ignoring the painful history they have endured. He finished the proclamation by calling for a new generation of leadership that works together to “ensure this country’s promise is fully realized for every (American Indian).”
This month we should all set time aside to reflect on the struggles and celebrate the incredible contributions and rich histories of the hundreds of American Indian tribal communities in our country. It is also an apt time to reflect on the unique health experiences of Colorado’s American Indian community.
Today, over 110,000 American Indians call Colorado home. Nearly half of Colorado’s American Indian population lives in the Denver metro area, although almost every county across the state has seen an increase in the American Indian population over the past 10 years. Only a small percentage of Colorado’s American Indian population resides on the state’s two tribal reservations, the Southern Ute and Ute Mountain reservations. However, the Four Corners and Colorado Plateau regions have a long history of American Indian culture and heritage, which influences much of southwestern Colorado.
A deeper look into the health and health care experiences of American Indian Coloradans reveals troubling inequities. One in four (24 percent) American Indian Coloradans reports that they are in fair or poor health, compared to 13 percent of all Coloradans. In addition, American Indian Coloradans are more likely to live in poverty, to not graduate from high school and to be unemployed compared to all Coloradans. Last year, the Colorado Coalition for the Medically Underserved published a series of issue briefs that explored the links between these social determinants of health, such as educational attainment, income, race, access to health care and health insurance.
The precarious socio-economic reality facing many American Indians in Colorado affects how they access the health care system. Although the rate of American Indians with health insurance in Colorado is nearly equal to the statewide rate, 31 percent of American Indian Coloradans struggled to pay their medical bills last year compared to 18 percent of all Coloradans. And 15 percent of American Indian Coloradans simply did not receive the care they needed last year because they lacked viable transportation options or the distance to care was too great, compared to 4 percent of all Coloradans.
American Indians living in the Denver metro area face even greater disparities, as 32 percent are uninsured and 32 percent do not have a usual source of care compared to 17 percent and 20 percent of the general metro area population, respectively.
Further complicating health care access for American Indians is the various health systems they must navigate. The Indian Health Service (IHS) provides culturally-sensitive health care services to over 2 million American Indians across the country through tribal hospitals, health centers—including ones in Towaoc and Ignacio, Colorado—and Urban Indian Health Programs, such as Denver Indian Health and Family Services.
While IHS provides a vital role in providing quality health care services to the American Indian population, the agency has struggled to secure sufficient financial resources to meet the needs of all American Indians and has been especially hit hard in sequestration funding cuts. Per-capita spending on the health of American Indians is a fraction of government spending on the general U.S. population, and, since IHS isn’t protected from sequestration cuts like other federal health programs—namely Medicare and the Veterans Administration—the disparity in funding may continue to grow.
Colorado’s American Indian population lags behind in key population health indicators as well. Three out of four American Indian Coloradans are overweight or obese compared to 50 percent of white Coloradans, making American Indians the most overweight or obese racial and ethnic group in the state. American Indian Coloradans also had the second-highest rate of unintended pregnancies among major racial and ethnic groups. And American Indians living in the Denver Metro Area have higher rates of diabetes, smoking, infant mortality and mental distress.
Colorado has made a commitment to become the healthiest state in the nation. We are pursuing this commitment by promoting prevention and wellness, expanding coverage opportunities through recent reforms, increasing access to care, and improving the quality and value of health care. American Indians utilize the health care system in a unique way as they navigate between Indian Health Services and their local community health systems. The Affordable Care Act offers new opportunities for many American Indians to gain health insurance coverage and improves funding for IHS in important ways. In order to achieve our lofty goals, we must build on these recent milestones and double down our efforts to address the inequities in our health care system so that American Indians in Colorado can maximize their health.
Access the infographic at: https://www.ccmu.org/AmericanIndians.
Joe Sammen is the director of community health initiatives at the Colorado Coalition for the Medically Underserved.