We are all familiar with the notion of health inequity and disparities. This isn’t new information as the issue has been on the radar for a very long time. In Montana, this is true about health disparities in Indian Country. I won’t bore you with the nitty gritty detailed statistics. Personally, I am tired of hearing about particular health disparities in Indian Country. You know, those stats that are so alarming that the numbers will trump any other group’s disparity numbers. I am talking suicide, heart disease, traumatic injury, diabetes, infant mortality, and on and on. I get it. Message received. Issue identified loud and clear. So here’s the real conundrum – how do we change it?
It’s time to move the conversation and the action. According to a report released by the Association of State and Territorial Health Officials (Athos), “the social determinants of health need to be addressed within the larger public health infrastructure.” The report goes on to make specific recommendations on how to achieve this, but these recommendations are lofty, especially when you apply them to Indian Country. States and tribes have a long history of not getting along. States aren’t typically scrambling to join forces with tribes to figure out a way to end health disparities in Indian Country. Why? Isn’t that the Indian Health Service’s responsibility? Aren’t tribes sovereign entities? Why is it the state’s problem?
Here’s why it matters to the states. American Indians, whether living on or off reservations, are also state citizens. Citizens who have the full rights of state protection of their well-being, no different than someone who is Irish, Hmong, Guatemalan, Norwegian, dual-citizenship Canadians, and so on.
Fortunately, in Montana, we are starting to do something about it. In June, Governor Bullock made an announcement that he has formally established, through an executive order, the Office of American Indian Health within the Director’s Office of the Department of Health and Human Services with the objective to close the health disparity gap that exists in Indian Country. Looking at the official memorandum, it appears that the objectives of this new office meet the recommendations to address health disparities made by the Athos report. And better yet, this plan respects tribal sovereignty and community-based problem solving. It approaches the issue as a supportive partner, with special attention to following guidance from stakeholders in Indian Country.
Just like our great state, this is big. Vast. Governor Bullocks mandate is one serious piece of proactiveness; complete with an action plan, tribal partnerships, service coordination, consultation, and annual updates on progress. As Kevin Howlett, Director of CSKT Tribal Health, describes it, this office will identify challenges and develop solutions. That’s what makes this plan cutting-edge.
Some states have come close to this level of commitment, but not this close. In the 1980s, California recognized that the health status of many American Indians was not adequate. In 2009, New Mexico adopted the Department of Health State-Tribal Consultation, Collaboration and Communication Policy, which comes closer to Governor Bullocks plan, but not quite. Montana’s plan looks to be the first of it’s kind to make a commitment to roll up the sleeves and really dig in and get some work done. This plan has specific, measurable deliverables that will help reduce tribal health disparities. This plan recognizes that tribal citizens are also Montana citizens. This plan is a remarkable demonstration of a genuine state-tribal partnership.
Hats off to Governor Bullock for stepping up and making a real move to close the health disparity gap in Indian Country.