On December 23, 2021, the National Council of Urban Indian Health (NCUIH) submitted comments to the Department of the Interior (DOI) regarding the agency’s Federal Boarding School Initiative (Initiative). NCUIH reiterated its ongoing support for the Administration’s efforts to address the legacy of boarding school programs, while urging the Administration to use the Initiative to address the public health impact of boarding schools on urban American Indian and Alaskan Natives (AI/ANs). NCUIH emphasized the importance of studying not only the impact of boarding school programs for survivors, but also the lasting impact of the intergenerational trauma caused by boarding schools within urban AI/AN communities.

Background

On June 22, 2021, DOI Secretary Haaland issued a memorandum directing DOI to prepare a report addressing the “intergenerational trauma, cycles of violence and abuse, disappearance, premature deaths, and other undocumented bodily and mental impacts.” This Initiative came weeks after the discovery of 215 Indigenous children’s remains were found at a boarding school site in Canada. Secretary Haaland noted that to “promote spiritual and emotional healing in [AI/AN] communities, we [DOI] must shed light on the unspoken traumas of the past…no matter how hard it will be.”

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into white American culture through federally funded Christian-run schools.

NCUIH’s Role

Following Secretary Haaland’s memorandum, NCUIH issued a statement commending Secretary Haaland for beginning the process of holding the United States to account for the effects of its boarding school policy.  NCUIH also reiterated its support of the Initiative’s ability to address Indian Country’s historical trauma. NCUIH recognizes the deeply sensitive and emotional impact that federal boarding schools have on the AI/AN community at large, including the continued impact on the many UIOs we serve and their constituents. NCUIH exists, in part, because of the historic oppression of the AI/AN population including federal boarding schools that resulted in the growing AI/AN populations in cities.

Additionally, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States. The Commission will provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government. NCUIH is in full support of this Commission and hopes to see DOI establish a similar commission in the Initiative that includes a UIO representative to represent AI/ANs who reside in urban settings.

Importance of Including Urban Indians in the Initiative

In its comments, NCUIH urged DOI and the Administration to address the ongoing effects of Indian boarding schools on AI/AN health.  Specifically, NCUIH requested that DOI incorporate the following items into the Initiative:

• Partner with AI/AN organizations, including UIOs, to fully study and understand the impact of boarding school trauma and assist survivors in healing from this trauma.
• Study the lasting impact of boarding school policies, including intergenerational trauma, on the social determinants of health of contemporary AI/AN communities, including those in urban areas
• Include the UIOs representing the seventy percent (70%) of AI/ANs living in urban areas in DOI’s process through urban confer
  • NCUIH’s comments recognized the importance of Tribal sovereignty and the government-to-government relationship as vital to the Initiative, but noted failure to include UIOs in consultation will leave a significant portion of the AI/AN population without a voice
• Ensure a comprehensive assimilation of data by making all AI/AN communities true partners in the Initiative.

The DOI report on the investigation is scheduled to be finished in April 2022. NCUIH will remain close to the investigation and monitor for updates. NUCIH will also continue to advocate for the inclusion of UIOs in the process and encourage DOI to incorporate a study of the impact of the boarding schools on urban AI/AN health into the Initiative.

On November 29, CDC strengthened its recommendations on who should aim to complete a booster dose of the COVID-19 vaccine. This new recommendation urges that everyone ages 18 and older should receive a booster at least 6 months post completion of a 2-dose regimen, or 2 months post a single dose inoculation.

With the emergence of the Omicron variant, the importance of vaccination, and the use of boosters, as a prevention method is even more important. CDC Director, Dr. Rochelle Walensky also encouraged those who are unvaccinated to change that as soon as possible. Dr. Walensky also highlighted the importance of getting tested should you experience symptoms.

For more information, the Coronavirus Resources Center on the NCUIH website includes links to any recent guidance  or updates from federal agencies about COVID-19.

On November 15, 2021, the Indian Health Service (IHS) sent out a Dear Tribal Leader and Urban Indian Organization Leader letter (DULL) that discussed the Special Diabetes Program for Indians (SDPI) for fiscal year (FY) 2021 and the upcoming changes for the program in FY 2022. As a grant program inclusive of all three components of the Indian Health Service/Tribal Health Program/Urban Indian Organization (I/T/U) system, SDPI has been a resounding and demonstrable success in reducing diabetes and diabetes-related illnesses in Indian Country.

Background

In 2004, Congress established the SDPI Demonstration Projects to translate research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction into AI/AN community-based programs and health care settings. In total,  The SDPI Demonstration Projects successfully translated diabetes science and reduced the risk of diabetes in high risk individuals, and reduced CVD risk factors in people with diabetes. In 2010, the SDPI Demonstration Projects transitioned into the SDPI Initiatives to continue their prevention work and begin disseminating the strategies and lessons learned to other I/T/U health programs.

Since the inception of SDPI, it has achieved real, demonstrable success, with a 50% reduction in diabetic eye disease rates,drops in diabetic kidney failure, and a 54% decline in End Stage Renal Disease.Given the high rates of diabetes and diabetes-related illnesses AI/ANs face, it is imperative that SDPI is administered in a way that continues to reduce these rates – and in a manner that is inclusive of UIOs. AI/ANs have the highest diabetes prevalence rates of all racial and ethnic groups in the United States, with AI/AN adults almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes.According to 2018 data from the Centers for Disease Control and Prevention, AI/ANs were 2.3 times more likely than non-Hispanic whites to die from diabetes and twice as likely to be diagnosed with end stage renal disease than non-Hispanic whites. SDPI is therefore a critical program to address the disparate high rates of diabetes among AI/ANs.

SDPI has directly enabled UIOs to provide critical services to their AI/AN patients, in turn significantly reducing the incidence of diabetes and diabetes-related illnesses among urban Indian communities. funding. Facilities use these funds to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally-relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. To continue the path of success in reducing the rate of diabetes in Indian Country, IHS must continue to provide this essential funding to UIOs.

NCUIH has long advocated for an increase in SDPI funds.  NCUIH

 

FY 2022 Changes and Updates

Starting in FY 2022, SDPI funding will reduce from $150 million to $147 million each year. This reduction is due to a mandatory sequester which reflects a required 2% reduction continuing through 2023 under current law. While the SDPI grant cycle was due to end on December 31, 2021, IHS learned of the time intensive requirements and IHS has determined that FY 2022 will constitute a 1-year extension of the current grant cycle, extending it to a seventh year. IHS believes this extension will allow more time to work on the notice of funding opportunity and decrease some of the administrative burden for SDPI grantees.

Tribal Leaders Diabetes Committee Meeting Held on December 8, 2021

On December 8, 2021, IHS held a Tribal Leader Diabetes Committee (TLDC) meeting to discuss the current SDPI Funding Distribution. This funding includes $130.2 million in Tribal and IHS grants. A portion of that total will go to 14 IHS grants as well as Technical Assistance services for 8 IHS areas.  Urban Grants will receive $8.5 million in funding with $100k going to Technical Assistance. The SDPI Funding Formula is used to determine how much of the $130.2 million goes to each Area for Tribal/IHS grants. This formula includes information about diabetes prevalence, user population (AI/ANs who have used IHS services at least once in the past 3 years), and the tribal size adjustment. The meeting also announced a new Notice of Funding Opportunity (NOFO) which allows for new and open competition. Urban Indian health programs operated by UIOs are eligible for this NOFO pursuant to a grant or contract with IHS.

 

The TLDC meeting also outlined a FY 2023 SDPI timeline and issues for consideration, including the potential risk for a decrease in annual SDPI grant amounts due to the open competition, how grantees can be held harmless under the current situation, whether there will be a change in the SDPI funding formula, and what the Tribal Consultation/Urban Confer process will look like moving forward.