|Written by Eric Bothwell, DDS, MPH, PhD and Tamara James, PhD ,
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As the Obama administration winds down its eight years of oversight and support of the health care needs of American Indian and Alaska Natives (AI/AN) from federally recognized tribes, a brief reflection on what has been accomplished and what might still be accomplished is worthwhile.
AI/AN witnessed noteworthy milestones throughout the Obama Administration including the Annual White House Tribal Nations Conference and the Presidentís Executive Order requiring all federal agencies dealing with tribes to develop a tribal consultation policy.† From a funding perspective, the Indian Health Service (IHS) has fared comparatively well during a period when enhancements for such programs were hard fought in Congress. And federally recognized AI/ANs were also included in the Administrationís legislative accomplishment, the Affordable Care Act (ACA) of 2010, through the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA).
Unfortunately, many critically needed sections of the IHCIA have yet to be realized. One particularly opportune component is Section 1621V Part A that authorizes the development of an Office of Indian Menís Health. The logic of this proposal is compelling considering that AI/AN males on some reservations have the lowest life expectancy of any group in America. In addition,† AI/AN males experience death rates two to five times greater than AI/AN females for suicide, HIV/AIDS, homicide, unintentional injuries, diabetes, firearm injury, and alcohol-related deaths, and are 10 to 50 percent higher than AI/AN females for cancer, heart disease, and liver disease.
The inequities suffered by the AI/AN males can be seen in CDCís National Health Statistic Report (No. 20, March 2010) where AI/AN males displayed greater disparities in health status and general well-being than†any†racial group. AI/AN men reported the highest distress rates of ďfeeling hopeless and worthlessĒ of any of the groups. The devastating impact of this despair culminates in the high rates of suicide among these men.
†But before the lives of AI/AN males are taken by these causes, they suffer from multiple debilitating physical and mental conditions. It is clear that dead, sick, and incarcerated AI/AN males are compromised in fulfilling their roles as fathers, husbands, providers, leaders, and contributors to their communities.
We can no longer neglect our male health crisis.†In response, many private foundations, states, and cities have developed innovative initiatives and partnerships that specifically prioritize male health.††However, even with mounting concern across the country, no federal health-related agency has established an office committed to addressing male health disparities.
The Obama Administration can change the course of male health in America without new appropriations by directing federal agencies to implement offices of male health within existing structures. This should start with establishing the Office of Indian Menís Health within IHS as authorized by the IHCIA. In 2010, an internal IHS workgroup developed an approach to implement an Office of Indian Menís Health with as little as a 1.5 FTE commitment and charged with utilizing an†entrepreneurial/self-sustaining approach to developing partnerships and coalitions with other agencies and organizations committed to male health equity and leveraging resources. With an anticipated $6.5 billion budget in FY 2017, the IHS could begin the process of turning the curve on male health disparities.
The premature loss of someoneís husband, father, brother, friend, or son results in unmeasurable emotional toil and financial hardship. In addition,†the disproportion of U.S. males who have died or whose mental and physical health status compromises their ability to contribute to society represents a real threat to the U.S. successfully competing in the global economy.
The process should begin with†the implementation of the Office of Indian Menís Health authorized by the Indian Health Care Improvement Act.