On March 3, 2023, the National Council of Urban Indian Health (NCUIH) submitted comments to the Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) regarding the HHS Initiative to Strengthen Primary Health Care (the Initiative). The Initiative aims to improve health equity and reduce barriers to care for traditionally underserved populations, included American Indians and Alaska Natives (AI/ANs). As part of the Initiative, OASH has hosted listening sessions with Urban Indian Organizations (UIOs) and tribal leaders to collect input and inform HHS regarding the needs of AI/AN stakeholders and beneficiaries.
Launched in September 2021, the goal of the Initiative is to develop a federal foundation for the provision of primary health care aimed to improve health outcomes and advance health equity for the improved health and wellness of patients, families/caregivers, and communities. Access to high-quality primary health care has been shown to improve health equity and health outcomes, and is essential for addressing key priorities, including mental and substance use disorder prevention and care, prevention and management of chronic conditions, addressing the impact of gender-based violence, and maternal and child health and well-being.
Generally, AI/ANs throughout the country experience the most significant health disparities of any group, when compared to the general population. Further, AI/ANs living in urban areas experience greater rates of chronic disease, maternal and infant mortality, and suicide compared to all other populations and they are less likely to receive preventive care and are less likely to have health insurance.
NCUIH recent comment and recommendations to OASH regarding the Initiative are based on NCUIH’s consultations with UIOs, and listening session held with UIO leaders on February 2, 2023, and NCUIH’s subject matter expertise. NCUIH reiterated that input from UIOs is vital for OASH effectively gather comprehensive feedback, share critical information, and build mutual trust.
In NCUIH’s comments to OASH regarding the Initiative, NCUIH recommended the following priorities:
- Develop a better understanding of the health inequities pervasive in Native communities
- Ensure primary care is culturally competent
- Improve CMS Programs ability to serve American Indian and Alaska Native beneficiaries
- Address workforce shortages at UIOs
- Ensure that notices of funding opportunities are accurate and that UIOs have the technical assistance necessary to apply
- Facilitate referrals of AI/AN patients in and out of the Indian health system, as well as within it
- Establish an agency-wide Urban Confer Policy
NCUIH thanks OASH for hosting a UIO listening session and greatly appreciates the opportunity to provide feedback on the Initiative. We are heartened by HHS’ commitment to improving health equity and reducing barriers to care for the AI/AN community. We are especially grateful that OASH demonstrated this commitment by addressing NCUIH’s prior recommendation to host a meeting with UIOs regarding the Initiative.