Resource: Data on Infant and Maternal Health Disparities in Native Communities

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The National Council of Urban Indian Health (NCUIH) recently released an infographic showcasing data on infant and maternal health disparities in American Indian/Alaska Native (AI/AN) communities. Unfortunately, AI/AN communities throughout the country, including urban AI/AN communities, experience significant maternal and infant health disparities compared to the general population.

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AI/AN Infant and Maternal Health Disparities

A report by the National Center for Health Statistics noted that between 2005 and 2014, American Indian/Alaska Native was the only racial or ethnic group that did not experience a decline in infant mortality.[1]

AI/AN Infant and Maternal Health Disparities

Urban AI/AN Infant and Maternal Health Disparities

Over half of urban Indian organizations (UIOs) provide care for maternal health, infant health, prenatal, and/or family planning. A study of Natives in UIO service areas found that while birth rates, in general, were lower in the urban Native population (12.8 and 16.5 per 1,000 population, respectively), premature birth rates for both urban and non-urban AI/AN were higher than those of all other races and ethnicities combined (12.3% of live births among AI/AI in urban areas and 10.9% among the general population in the same area).[2]

AI/AN Infant and Maternal Health Disparities

Contributing Factors to AI/AN Infant and Maternal Health Disparities

AI/AN Infant and Maternal Health Disparities

  • Cost, discrimination, and lack of cultural competency are all contributing factors to the stark infant and maternal health disparities among AI/ANs.
  • 41% of AI/AN women cite cost as a barrier to receiving the recommended number of prenatal visits.[3]
    • AI/AN women are 3-4x more likely to begin prenatal care in the third trimester.[4]
  • 21% of AI/AN women ages 15-44 are uninsured, compared to 8% of white women.[5]
  • 23% of AI/ANs report they have faced discrimination in clinical settings due to being an AI/AN.[6]
    • 15% report avoiding medical care for themselves or family members due to fear of discrimination.[7]
  • Access to culturally appropriate care can be difficult for AI/ANs living in urban areas, as most IHS clinics and hospitals, as well as Tribal healthcare facilities, are located on reservations.[8]

UIO and NCUIH work in AI/AN Infant and Maternal Mortality

UIOs provide a range of services such as primary care, behavioral health, traditional, and social services— including those for infants, children, and mothers. At least 23 of these clinics provide care for maternal health, infant health, prenatal, and/or family planning. They also provide pediatric services and participate in maternal-child care programs such as WIC and the Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting program (MIECHV).

NCUIH has engaged in extensive advocacy on behalf of AI/AN mothers and infants and for increased funding and support to the UIOs which provide maternal health, infant health, prenatal, and family planning services to AI/AN mothers and infants. On March 9, 2022,  NCUIH signed on to a letter to Congress led by the National Home Visiting Coalition in support of reauthorizing HRSA’s Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and doubling the Tribal set-aside— which includes UIOs.

Also, in March, NCUIH submitted comments to the HRSA Advisory Committee on Infant and Maternal Mortality (ACIMM), which advises the Secretary of Health and Human Services (HHS) on department activities, partnerships, policies, and programs directed at reducing infant mortality, maternal mortality and severe maternal morbidity, and improving the health status of infants and women before, during, and after pregnancy. In August, NCUIH submitted comments to HRSA’s Maternal and Child Health Bureau (MCHB) regarding the Pediatric Mental Health Care Access Program in August. In our comments, we have continued to stress the critical importance of including urban Natives populations in HRSA’s overall efforts of improving health outcomes for all AI/ANs living on and off reservations.

On September 14, 2022, NCUIH’s Vice President of Public Policy, Meredith Raimondi, testified before the HRSA ACIMM on urban Indian disparities and policy changes to address these disparities. Photo of Meredith Raimondi, NCUIH’s Vice President of Public PolicyRaimondi highlighted that “over half of urban Indian health centers provide care for maternal health, infant health, prenatal, and/or family planning. However, due to chronic underfunding, many of these health centers only have the capacity to carry out these services for the early stages of pregnancy.” She continued to say, “despite desiring to do so, many urban Indian health clinics cannot expand their services to provide complete care for mothers and infants from conception to birth due to underfunding.” Raimondi provided the following recommendations to the Advisory Committee:

  • Reauthorize MIECHV at a higher amount and double the Tribal set-aside from 3% to 6%.
  • ACIMM and other stakeholders should collaborate with UIOs to gather critical and accurate information on urban AI/AN populations.
  • Advise the HHS Secretary to lead the establishment of an urban confer policy across all HHS agencies.
  • Include a Tribal and UIO health provider representative on the ACIMM and create an ACIMM subcommittee dedicated to addressing AI/AN infant and maternal health disparities.

 

 

[1] Mathews TJ, Driscoll AK, Trends in infant mortality in the United States, 2005–2014, (2017) available at: https://www.cdc.gov/nchs/data/databriefs/db279.pdf

[2]Castor ML, Smyser MS, Taualii MM, Park AN, Lawson SA, Forquera RA. “A nationwide population-based study identifying health disparities between American Indians/ Alaska Natives and the general populations living in select urban counties.” Am J Public Health, 2006;96(5)

[3] National Partnership for Women and Families, American Indian and Alaska Native Women’s Maternal Health: Addressing the Crisis, (2019), https://www. nationalpartnership.org/our-work/resources/health-care/maternity/american-indian-and-alaska.pdf

[4] Urban Indian Health Institute, Community Health Profile: National Aggregate of Urban Indian Health Program Service Areas, (2016), http://www.uihi.org/wp-content/ uploads/2017/08/UIHI_CHP_2016_Electronic_20170825.pdf

[5] National Partnership for Women and Families, American Indian and Alaska Native Women Face Pervasive disparities in Access to Health Insurance, (2019), https:// www.nationalpartnership.org/our-work/resources/health-care/AIAN-health-insurance-coverage.pdf

[6] Harvard T.H. Chan School of Public Health, Poll finds more than one-third of Native Americans report slurs, violence, harassment, and being discriminated against in the workplace (2017), https://www.hsph.harvard.edu/news/press-releases/poll-native-americans-discrimination/

[7] Id.

[8] See Mental Health America, Native and Indigenous Communities and Mental Health – Prevalence, https://www.mhanational.org/issues/native-and-indigenouscommunities-and-mental-health (last accessed Aug. 20, 2022).

NCUIH Submits Comments to the Indian Health Service on the Creation of an Urban Indian Interagency Workgroup

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On September 12, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments and recommendations to the Indian Health Service (IHS) regarding the formation of an Urban Interagency Workgroup with other federal agencies. The agency held an Urban Confer on July 13, in response to a letter sent to President Biden and Vice President Harris from several Senators, requesting the formation of such a workgroup. NCUIH supports the development of an Interagency Workgroup and believes that this would be a key step to increasing support and resources to American Indians/Alaska Natives (AI/ANs) living in urban areas.

NCUIH Recommendations to IHS

NCUIH noted in the comments that Tribes have a unique government-to-government relationship with the federal government and it is essential that any group does not disrupt this. Furthermore, NCUIH supports the federal government in its attempts to better uphold the trust responsibility it has to AI/ANs living in urban areas, which requires more complete involvement of urban Indian organizations (UIOs). However, this does not mean that resources and funding should come at the expense of Tribes. Rather, the government should broaden and deepen the services it provides to all AI/ANs while additionally further meeting the trust responsibility to urban-dwelling AI/ANs.

NCUIH provided the following recommendations to IHS in response to the Urban Confer:

  • Respect Tribal Sovereignty and the government-to-government relationship in the formation of an Interagency Workgroup.
  • Create a committee within the White House Council on Native American Affairs (WHCNAA) focused on how federal agencies can better serve AI/ANs living in urban areas.
    • The White House Council on Native American Affairs (WHCNAA) was established to improve outcomes for AI/AN communities through a stronger relationship between the federal government and Native people.
    • Developing an Interagency Oversight Committee on Urban Indian Affairs within WHCNAA would allow cross-collaboration across all agencies and ensure that all other WHCNAA committees are accurately incorporating urban Indian communities into their work.
  • IHS should provide technical assistance to federal agencies to develop Urban Confer policies.
    • Urban Confer policies or UIO-specific consultations do not supplant or otherwise alter Tribal Consultations and the government-to-government relationship between Tribes and federal agencies. IHS should provide support and assistance to federal agencies as they begin the development of such policies.

Background

The formation of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban AI/AN populations has been a priority for NCUIH. On February 3, 2022, Senator Van Hollen, along with Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of this workgroup. NCUIH worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of AI/ANs who do not reside on Tribal land.

The Senate Appropriations Subcommittee directed IHS to continue to explore the formation of this interagency working group in its Fiscal Year 2023 Interior Appropriations bill, noting that “in addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.”

The Work Group would help identify federal funding strategies to better address the needs of urban AI/ANs, advance the development of a wellness-centered framework to inform health services, strengthen support for practice-based traditional healing approaches, improve Urban Confer policies at Health and Human Services and associated agencies, and ensure that Urban Indian Organizations can regularly meet with federal agencies to address relevant topics of concern.

NCUIH will continue to monitor for any further development on the formation of an Urban Interagency Workgroup. NCUIH will also continue to engage with IHS, the White House, and Congress on moving this proposal forward.

VA Expands Health Care Eligibility for Veterans under the PACT Act, Native Veterans Encouraged to Check Eligibility for Benefits

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On September 28, 2022, the Department of Veterans Affairs (VA) announced that it will expand and extend eligibility for VA health care for certain Veterans of the Vietnam, Gulf War, and post-9/11 eras pursuant to the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act (S. 3373). As a result of the PACT Act, generations of Veterans will now have access to VA health care and benefits they earned and deserve, including American Indian/Alaska Native (AI/AN) Veterans who serve in the military at a higher rate than any other population. For more information on how to apply for health care or learn more about what the PACT Act means for Veterans or their families visit: VA.gov/PACT.

Expansion Details:

Beginning on October 1, 2022, post-9/11 Veterans who did not previously enroll in VA health care will have a 1-year window to enroll if they:

  • Served on active duty in a theater of combat operations during a period of war after the Persian Gulf War, or
  • Served in combat against a hostile force during a period of hostilities after Nov. 11, 1998, and
  • Were discharged or released from active service between Sept. 11, 2001, and Oct. 1, 2013.

The following groups of Veterans will also be eligible for care beginning October 1:

  • Gulf War Veterans who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War. This includes Veterans who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by federal statute or executive order.
  • Vietnam-era Veterans who served in the following locations and time periods : The Republic of Vietnam between Jan. 9, 1962, and May 7, 1975 Thailand at any U.S. or Royal Thai base between Jan. 9, 1962, and June 30, 1976; Laos between Dec. 1, 1965, and Sept. 30, 1969; Certain provinces in Cambodia between April 16, 1969, and April 30, 1969; Guam or American Samoa (or their territorial waters) between Jan. 9, 1962, and July 31, 1980 ; Johnston Atoll (or on a ship that called there) between Jan. 1, 1972, and Sept. 30, 1977

Background on the PACT ACT

On August 10, 2022, President Biden signed the bipartisan PACT Act into law, authorizing one of the largest expansions of VA health care and benefits in U.S. history.  Before the PACT Act’s passage, many Veterans’ claims for healthcare services and other benefits were denied by VA because Veteran claimants had difficulty proving a connection between their ailment and their service. The PACT Act is intended to remove barriers to Veterans getting care, expanding the number of Veterans who are eligible for care and streamlining the process for proving a service connection for certain conditions related to toxic exposure.

The PACT Act will bring the following changes:

  • Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras
  • Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
  • Adds more presumptive-exposure locations for Agent Orange and radiation
  • Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care
  • Helps VA improve research, staff education, and treatment related to toxic exposures

AI/AN Veterans

There is an urgent need to ensure that all AI/AN Veterans have access to the benefits they earned through their service.  According to a 2020 VA Report, AI/AN Veterans served in the Pre-9/11 period at a higher percentage than other Veteran populations.  Despite a distinguished record of service, VA’s statistics also show that AI/AN Veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to Veterans of other races.  In addition, in Fiscal Year 2017, AI/AN Veterans used Veterans Benefits Administration benefits or services at a lower percentage than veterans of other races.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to advocate on behalf of AI/AN veterans living in urban areas and to strengthen its partnership with VA. Thanks to NCUIH’s work with VA, urban Indian organizations (UIOs) are now eligible to enter the VA Indian Health Service/Tribal Health Program (THP)/UIO Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. In October 2021, Sonya Tetnowski, President of NCUIH and CEO of the Indian Health Center of Santa Clara Valley, Army Veteran, and member of the Makah Tribe was appointed to the VA’s first-ever Advisory Committee on Tribal and Indian Affairs to represent the voice of urban Indians.

NCUIH Attends Swearing-In of New IHS Director Roselyn Tso

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Group photo of Francys Crevier, Roselyn Tso, Walter MurilloOn September 27, 2022, NCUIH attended the swearing-in of the new Indian Health Service (IHS) Director Roselyn Tso (Navajo). NCUIH’s CEO Francys Crevier (Algonquin) and Board President-Elect and CEO of Native Health in Phoenix, Arizona Walter Murillo (Choctaw) were in attendance. Prior to Director Tso’s swearing-in, IHS was without a permanent director for 21 months.

Director Tso is a citizen of the Navajo Nation. She began working for IHS in 1984 and most recently served as the Director of the Navajo Area and Director of the Office of Direct Services and Contracting Tribes until her confirmation. Prior to her work in IHS, much of her professional career was spent in Portland, where she served in several capacities, including working with the three urban programs in the Portland Area that provide services ranging from community health to comprehensive primary health care services. Director Tso holds a Bachelor of Arts in interdisciplinary studies and a master’s degree in organizational management from Marylhurst University in Portland, Oregon. As the IHS Director, Tso is responsible for administering a nationwide health care delivery program that is responsible for providing comprehensive health care services to AI/ANs through IHS, Tribes, Tribal organizations, and urban Indian organizations (UIOs).

The absence of an IHS Director had prevented Tribes, Tribal organizations, and UIOs from addressing the health care needs of their Native American populations, which directly falls under the responsibility of IHS. Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs. NCUIH has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

“We are delighted by the recent swearing-in of Roselyn Tso as the Director of the Indian Health Service. We look forward to working with Ms. Tso to achieve the highest health status for all American Indians and Alaska Natives and move us closer to fulfilling the federal government’s trust responsibility to our people. We will continue to advocate for the elevation of this position to Assistant Secretary for Indian Health within HHS to bring better representation for the health needs of Natives,” – Francys Crevier (Algonquin), CEO, NCUIH.

Next Steps

NCUIH looks forward to building a working relationship with Director Tso as we continue to work towards our shared goal of improving the health of urban American Indians and Alaska Natives.

NCUIH Submits Comments on Executive Order 14053 About Missing and Murdered Indigenous People

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On September 8, the National Council of Urban Indian Health (NCUIH) submitted comments on Executive Order 14053 “Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People.” This comment was in response to the Department of Homeland Security’s (DHS) correspondence dated May 25, 2022, seeking input and recommendations on the policy directives outlined.

NCUIH requested the following:

  • NCUIH requested that DHS honor E.O. 14053 by including urban Indian organizations (UIOs) in policies, procedures, and projects to address Missing and Murdered Indigenous People (MMIP).
    • Working with UIOs is specifically required by E.O. 14053 itself
    • According to the National Missing and Unidentified Persons System (NamUs), as of August 1, 2021, most missing and unidentified cases involving American Indian/Alaska Native (AI/AN) persons occurred off tribal land. AI/AN individuals living in urban areas face many, if not all, of the same violent crime and MMIP issues as AI/ANs living on reservations or tribal Iand.
    • In particular, UIOs can be critical partners in DHS’ efforts to address cross-border and jurisdiction issues.
    • We note that UIOs have already been working on addressing human trafficking through programs and services to victims and their families. For example, First Nations Community Healthsource in Albuquerque, New Mexico, has an Education and Advocacy against Sex Trafficking (EAST) program dedicated to supporting AI/AN victims of sex trafficking in the area and surrounding Tribal communities.
  • NCUIH recommended that DHS hosts an Urban Confer Regarding DHS’ Plan to Address MMIP.
    • To assist DHS collaboration with UIOs in fulfillment of the goals and directives of E.O. 14053, NCUIH recommends that DHS host an Urban Confer with UIOs regarding E.O. 14053. Urban Confers are an established mechanism for dialogue between the federal government and UIOs that are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that resulted in seventy percent (70%) of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons.

Background

EO 14053

EO 14053 is a landmark pledge “to strengthen public safety and criminal justice in Indian Country and beyond, to reduce violence against Native American people, and to ensure swift and effective Federal action that responds to the problem of missing or murdered Indigenous people.” NCUIH is particularly encouraged by DHS’s efforts to communicate with Tribes as DHS continues to grow its efforts to support public safety in Tribal communities. NCUIH agrees with the Biden-Harris Administration that challenges faced by Tribes are best met by Tribally-driven solutions and appreciates that the DHS hosted several Tribal Consultation sessions from July to August 2022 seeking input and recommendations concerning DHS’ efforts to address the unacceptably high rate of violent crime in AI/AN communities. These efforts advance President Biden’s directive in E.O. 14053, to engage in “[c]onsistent engagement, commitment, and collaboration,” with AI/AN people and communities to “drive long-term improvement to public safety for all Native Americans” is essential to ensure AI/AN voices are included in issues that directly affect their communities at dipropionate rates.

E.O. 14053 specifically directs the federal government to “build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans,” because “approximately 70 percent of American Indian and Alaska Natives live in urban areas and part of this epidemic of violence is against Native American people in urban areas.” Furthermore, E.O. 14053 also instructs the federal government to “work closely with Tribal leaders and community members, Urban Indian Organizations, and other interested parties to support prevention and intervention efforts that will make a meaningful and lasting difference on the ground.” Despite E.O. 14053 recognizing that the federal government must develop solutions for AI/ANs living in urban areas and that UIOs must be included in the development of these solutions to address the unacceptably high rate of violent crime and MMIP, DHS has not made any efforts to work with UIOs to date.

  • NCUIH Efforts on MMIP On May 19, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments on Executive Order (EO) 14053— Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People.  NCUIH outlined recommendations for HHS including communication and collaboration with UIOs, engagement with UIOs as critical stakeholders in HHS’ comprehensive plan to address the MMIP Crisis and violent crime, and the establishment of an agency-wide Urban Confer policy.
  • May 5, National MMIP Awareness Day, Secretary of the Interior Deb Haaland and Deputy Attorney General Lisa Monaco hosted an event to announce the U.S. Department of the Interior (DOI)’s Not Invisible Act Commission (Commission). The Commission is led by the Departments of the Interior and Justice and is aimed at reducing violent crime against American Indians and Alaska Natives. Members of the Commission include Sonya Tetnowski (Makah), the National Council of Urban Indian Health’s President-Elect and the Chief Executive Officer of the Indian Health Center of Santa Clara Valley. NCUIH supported the nomination of Ms. Tetnowski who also serves on the S. Department of Veterans Affairs (VA) Advisory Acommittee on Tribal and Indian Affairs Commision Member Tetnowski said “I am honored and proud to be appointed to the Not Invisible Act Commission. In this role, I will work hard to shed light on the devastating impact of violence against American Indians and Alaska Natives (AI/ANs) living in urban areas.
  • On April 15, 2022, NCUIH submitted written comments and recommendations in response to the Department of Justice’s (DOJ) Dear Tribal Leader Letter seeking stakeholder input on DOJ’s efforts to address the unacceptably high rates of violent crime in American Indian and Alaska Native communities and the missing and murdered Indigenous persons (MMIP) crisis. In its comments, NCUIH noted the need for the federal government to also work with Urban Indian Organizations (UIOs) to address these issues. NCUIH further offered to assist DOJ in establishing strong working relationships with UIOs as it works to address these pressing public safety issues.

Next Steps

NCUIH will continue to advocate for and comment on UIO inclusion in addressing the MMIP crisis.

NCUIH Submits Comment on Consistent Application of the Indian Child Welfare Act

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On September 7, the National Council of Urban Indian Health(NCUIH) submitted written comments to the Bureau of Indian Affairs (BIA) and the Administration for Children and Families (ACF) on the BIA and ACF’s efforts to promote the consistent application of the Indian Child Welfare Act (ICWA) and protect children, families, and Tribes.

In the submitted comments, NCUIH made the following specific comments, requests, and recommendations to ACF and BIA in response to the July 8, 2022 correspondence:

  • Ensure that urban child welfare and judicial systems are aware of and able to implement ICWA appropriately
    • According to the National Indian Child Welfare Association (NICWA), American Indian/Alaska Native(AI/AN) children continue to be overrepresented in the state foster care system at a rate 7 times higher than their non-Native peers. Because more than 70% of AI/AN people live in urban settings, this overrepresentation undoubtedly includes AI/AN children living in urban areas.
    • To properly implement ICWA, state courts must determine whether a child is an “Indian Child” for the purposes of ICWA as a threshold determination in the proceedings. There are states with experience in the application of ICWA and making applicability determinations. However, some state courts and child protective agencies may not be aware of this requirement or may make incorrect assumptions about a child’s “Indian child” status based on physical appearance or distance from their Tribe. This process needs to be standardized across all states to ensure the safety of these children
    • An AI/AN child’s physical location should not affect whether they receive ICWA’s protections. Specifically, NCUIH requests that ACF and BIA provide technical assistance on ICWA to state social service and child welfare agencies and courts located in urban areas.
  • Actively inform urban child welfare and judicial systems about urban Indian organizations (UIOs) as a potential resource for ICWA proceedings
    • NCUIH recommended that, as part of their efforts to strengthen and implement ICWA, ACF and BIA actively inform state child welfare and judicial systems located in urban areas about UIOs as a potential ICWA resource.
    • While UIOs are healthcare organizations, they often provide culturally competent services that state child welfare services and courts can refer parents to in accordance with ICWA’s “active efforts” requirements. For example, various UIOs provide the following services: family support services, parenting classes and groups, gender-based violence programs, and breastfeeding support.
    • Because UIOs are AI/AN organizations, they may be able to provide useful contacts or other information when a state child welfare agency throughout the child welfare process, including during the initial “Indian child” determination phase.
    • The UIO connection may be particularly useful in areas, such as Chicago, where there is an active UIO but no federally recognized Tribes nearby, and urban systems may not know where to start with the ICWA process.

Background

Congress enacted ICWA in 1978 to re-establish tribal authority over the adoption of Native American children (25 U.S.C. § 1903.) The goal of the Act was to strengthen and preserve Native American family structure and culture. Studies conducted in advance of ICWA’s drafting showed that between 25% and 35% of all Native children were being removed from their home by state child welfare and private adoption agencies. Of those, 85% were placed with non-Native families, even when fit and willing relatives were available. ICWA was established as a safeguard that requires:

  1. Recognition of Tribal jurisdiction over decisions for their Indian children;
  2. Establishment of minimum Federal standards for the removal of Indian children from their families;
  3. Establishment of preferences for placement of Indian children with extended family or other Tribal families; and
  4. Institution of protections to ensure that birth parents’ voluntary relinquishments of their children are truly voluntary.

According to NICWA, ICWA “[l]essens the trauma of removal by promoting placement with family and community . . . [p]romotes the best interest of Indian children by keeping them connected to their culture, extended family, and community, which are proven protective factors . . . [and] [p]romotes placement stability by ensuring that voluntary adoptions are truly voluntary.”

Next Steps

NCUIH will continue to advocate for  the appropriate application of ICWA to all welfare proceedings involving AI/AN children, regardless of whether the child is located in an urban or rural community.

 

 

USDA Publishes 2022 Tribal Resource Guide

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On August 16, 2022, the United States Department of Agriculture (USDA) released the 2022 edition of the USDA Resource Guide for American Indians and Alaska Natives (Resource Guide). The Resource Guide provides information regarding USDA resources and services available to tribal governments, citizens, and organizations. The Resource Guide covers four categories of USDA programs: 1) agriculture, food sovereignty, and traditional foods; 2) Indian Country economic development; 3) conservation and forestry; and 4) research, extension, and outreach. Additionally, the USDA released the Native Youth Resource Guide (Youth Guide). The Youth Guide summarizes USDA scholarship opportunities, internship programs, cultural summer camps for Native youth, afterschool activities, and resources for employment in the federal government.

Background

The USDA is a federal executive department responsible for food, agriculture, natural resources, rural development, nutrition, and related issues within the United States. The USDA plays an important role in the development of tribal nations and self-governance.  Funding from the USDA helps grow new tribal agricultural ventures, promote traditional food ways, and benefit Indigenous health through foods tailored to American Indian/Alaska Native dietary needs. As a federal agency, the USDA helps advance the federal trust responsibility to Native American communities.

The newly published Resource Guides seek to provide transparency to tribal nations. “These guides can introduce our tribal nation partners to the many USDA funding opportunities and resources that can benefit them and their communities,” remarked Secretary of Agriculture, Tom Vilsack. NCUIH recommends tribal nations use the Resource Guides to help facilitate growth within Indian Country.

Senate Confirms Roselyn Tso as Director of the Indian Health Service

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Tso’s confirmation comes after almost two years without a permanent IHS Director.

Today, September 21, 2022, Roselyn Tso (Navajo) was confirmed as the Director of the Indian Health Service (IHS) by voice vote in the Senate. Her confirmation comes after 21 months without a permanent IHS Director. Elizabeth Fowler (Comanche) has been serving as the Acting Director of IHS since the resignation of the previous Director, Rear Admiral Michael Weahkee (Zuni), in January 2021. The National Council of Urban Indian Health (NCUIH) welcomes Ms. Tso’s confirmation and continues to urge for the elevation of the role to Assistant Secretary within the Department of Health and Human Services (HHS) to bring better representation for the health needs of American Indians/Alaska Natives (AI/ANs).

“We are thrilled to have a confirmed leader for the Indian Health Service, and we graciously thank Liz Fowler for her tireless service during a pandemic that has been devastating our people. We look forward to working with Roselyn Tso to carry out the mission of IHS in fulfilling the trust responsibility to provide health care equity for all American Indians and Alaska Natives. We continue to work with Congress and this Administration to elevate this position within HHS where it belongs to lift Native voices and improve health outcomes,” – Francys Crevier (Algonquin), CEO, NCUIH.

Background

Roselyn Tso

Ms. Tso is a citizen of the Navajo Nation. She began working for IHS in 1984 and most recently served as the Director of the Navajo Area and Director of the Office of Direct Services and Contracting Tribes until her confirmation. Prior to her work in IHS, much of her professional career was spent in Portland, where she served in several capacities, including working with the three urban programs in the Portland Area that provide services ranging from community health to comprehensive primary health care services. Ms. Tso holds a Bachelor of Arts in interdisciplinary studies and a master’s degree in organizational management from Marylhurst University in Portland, Oregon. As the IHS Director, Ms. Tso is responsible for administering a nationwide health care delivery program that is responsible for providing comprehensive health care services to AI/ANs through IHS, Tribes, Tribal organizations, and urban Indian organizations (UIOs).

On March 9, 2022, President Biden announced the nomination of Ms. Tso as Director of IHS. On July 13, 2022, the Senate Committee on Indian Affairs (SCIA) voted to advance her nomination in a business meeting after she appeared before the Committee for her nomination hearing on May 25, 2022.

SCIA Hearing: Confirmation Needed to Address Health Disparities & Tribal Needs

The absence of a confirmed IHS Director has prevented Tribes, Tribal organizations, and UIOs from addressing the health care needs of their Native American populations, which directly falls under the responsibility of IHS. Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs. NCUIH has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

During the SCIA hearing to consider her nomination as Director of IHS, Ms. Tso highlighted how Native communities have been disproportionately impacted by COVID-19, which has been made worse given the absence of a confirmed Director. She stated, “I am reminded of the many health disparities facing American Indians and Alaskan Natives – health disparities that in many cases were made worse by COVID-19. For example, sadly, today, too many Navajo families still do not have access to running water in their homes. Access to clean, safe drinking water is essential to the health and well-being of our people.”

In addition, Ms. Tso stated during the hearing that she intends to utilize IHS resources to not only address the disparities caused by COVID-19, but to also “improve the physical, mental, social, and spiritual health and well-being of all American Indians and Alaskan Natives served by the Agency.” To achieve this goal, Ms. Tso said she would prioritize strengthening and streamlining business operations to create a more unified health care system, develop centralized systems to improve patient outcomes, accountability, and transparency, and finally address the needs and challenges experienced by the workforce. To conclude her testimony, Ms. Tso said that if confirmed as the Director of IHS, she would update agency policies and programs, as well as utilize the oversight authority of IHS to best serve each Tribal community.

Today’s full Senate consideration for the nomination of Ms. Tso as Director of IHS is the last step in her confirmation process.

Department of Veterans Affairs Seeking Nominations for IHS Billings Area Committee Member for the Advisory Committee on Tribal and Indian Affairs

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On September 16, 2022, the Department of Veterans Affairs (VA) issued a notice seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (“the Committee”) to represent the Indian Health Service, Billings Area. The Committee is composed of 15 members with at least one member of the Committee representing urban Indian organizations (UIOs) nominated by a national urban Indian organization.  Appointed members of the Committee are invited to serve a two-year term. Nominations for membership on the Committee must be received no later than 5:00 p.m. EST on October 7, 2022, and should be mailed to the Office of Tribal Government Relations, 810 Vermont Ave. NW, Suite 915H (075), Washington, DC 20420 or emailed to tribalgovernmentconsultation@va.gov.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to strengthen its partnership with the VA and has ensured UIO input is included in VA efforts. In October 2021, Sonya Tetnowski, President of NCUIH and CEO of the Indian Health Center of Satna Clara Valley, Army Veteran, and member of the Makah Tribe was appointed to the VA’s first-ever Advisory Committee on Indian Affairs. On January 25, 2022, during the first meeting of the Committee,  Ms. Tetnowski highlighted that American Indian/Alaksa Native (AI/AN) Veterans face significant barriers in accessing health care and other benefits. In an effort to ensure the Committee can represent the needs of all AI/AN Veterans, NCUIH recommends that UIOs consider working with Tribes and Tribal Organizations to nominate a Committee member.

Committee Objectives and Scope

In accordance with Public Law 116-315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations and Native American Veterans.  According to the Office of Tribal Government Relations Director, Stephanie Birdwell, the Committee “…gives tribal leaders as well as American Indian, Native Hawaiians and Alaska Native Veterans a place at the table with the highest levels of leadership within the VA…” and “[i]t offers an unprecedented voice in how programs, policies, and services may be delivered and provided.”

Committee responsibilities include, but are not limited to:

  • Identifying evolving issues of relevance to Indian tribes, tribal organizations and Native American Veterans relating to programs and services of the Department;
  • Proposing clarifications, recommendations and solutions to address issues raised at tribal, regional and national levels, especially regarding any tribal consultation reports;
  • Providing a forum for Indian tribes, tribal organizations, UIOs, Native Hawaiian organizations and the Department to discuss issues and proposals for changes to Department regulations, policies and procedures;
  • Identifying priorities and providing advice on appropriate strategies for tribal consultation and UIOs conferring on issues at the tribal, regional, or national levels;
  • Ensuring that pertinent issues are brought to the attention of Indian tribes, tribal organizations, UIOs and Native Hawaiian organizations in a timely manner, so that feedback can be obtained;
  • Encouraging the Secretary to work with other Federal agencies and Congress so that Native American Veterans are not denied the full benefit of their status as both Native Americans and Veterans;
  • Highlighting contributions of Native American Veterans in the Armed Forces;
  • Making recommendations on the consultation policy of the Department on tribal matters;
  • Supporting a process to develop an UIO confer policy to ensure the Secretary confers, to the maximum extent practicable, with urban Indian organizations; and
  • With the Secretary’s written approval, conducting other duties as recommended by the Committee.

NCUIH Comments on the IHS Urban Indian Infrastructure Study

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On August 23, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments regarding additional funding for the Urban Indian Infrastructure Study (Infrastructure Study) provided by the Consolidated Appropriations Act, 2022. The additional fiscal year (FY22) funding for the Infrastructure Study is approximately $800,696. NCUIH supports the appropriation of the additional funding and it recommended that IHS disseminate the findings of the FY21 Infrastructure Study, already in progress, to UIOs prior to making any decisions regarding the use of the additional funding. NCUIH also requested that the Office of Urban Indian Health Programs (OUIHP) create a timeline of when the Infrastructure Study will be released to UIOs, the contracting process necessary to use additional funding, and the deadline for obligation of the additional funding. Lastly, NCUIH requested that IHS host an additional Urban Confer after the release of updates about the scope and results of the FY21 Infrastructure Study.

Background

In 2021, Congress allocated $1 million in funds for IHS to conduct an Urban Indian Infrastructure study through the Consolidated Appropriations Act, 2021. The purpose of the Infrastructure Study is to further understand the most critical deficiencies facing UIOs. IHS contracted with The Innova Group, a healthcare consultancy entity, to conduct the Infrastructure Study.

On March 15, 2022, Congress provided $800,969 in additional funding to IHS for the Infrastructure Study through the Consolidated Appropriations Act, 2022. As of September 2022, the results from the Infrastructure Study have not been released by IHS and The Innova Group. On June 16, 2022, IHS requested input regarding the additional funding from 2022 and how these funds can be utilized by IHS. On June 23, 2022, UIO Leaders and NCUIH attended an Urban Confer where IHS explained that the Infrastructure Study will be completed by December 31, 2022, with results to be released in January 2023.

NCUIH’s Recommendations to IHS

NCUIH made the following recommendations regarding the Infrastructure Study:

  • Provide UIOs with the findings from the first Infrastructure Study prior to making any decisions regarding use of the additional funds
    • It is crucial that UIOs are aware of the scope, results, and usefulness of the Infrastructure Study before they make any recommendations regarding the use of the further funding.
    • Given the timeline presented during the Urban Confer, there should be an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their release in January 2023 and decide as to the best use of the additional funding
  • OUIHP should provide a timeline of the Planning Process to UIOs
    • NCUIH requested a timeline be released to UIOs delineating when the initial Infrastructure Study will be released, the contracting process necessary to use the additional funding, and the deadline for the obligation of the additional funding.
    • The requested timeline will provide clarity to UIOs. With a clearer picture in mind, the planning process and use of the additional FY22 funds for the Infrastructure Study becomes more cooperative between UIOs and IHS.
  • IHS should host an additional Urban Confer after releasing the results of the Infrastructure Study.
    • NCUIH notes that informed feedback from UIOs creates a scenario where the additional funding can be best used to support the needs of UIOs.

NCUIH continues to advocate for transparency in the process of the Infrastructure Study and greater support to address the critical infrastructure needs at UIOs. NCUIH will continue to keep UIOs informed as more information is made available from IHS.