TULALIP − “It’s about language and perspective. How issues are talked about. How issues are presented and received,” said Ryan Akin, one of the new additions to the child and family therapy team at beda?chelh. As he transitions into his position in the Tulalip community, Akin discusses his views on mental wellness and what it takes to get there.
“I’d like to explain a little bit about what I do,” he began. “I am a counselor, not a therapist. Therapy in practice works to identify a problem and help people fix that problem. Counseling moves away from the very sanitized and sterile practice of therapy, focusing on people. Everyone here is an individual. We respond to the person, not the issue.”
Grief counseling is one aspect of his job, and in an effort to understand the people he is working with, he was encouraged to attend a funeral service for a tribal member to experience the grief of the family and the community. He offered grief counseling to kids for a week following the funeral.
“This is so different than the institutionalized idea of people. Rather than learning about them and their needs, I live with them and experience who they are in order to understand their needs,” Akin explained.
The Tulalip community is unique, as are most tribes. They have a history of generational trauma intertwined with tradition and cultural revitalization.
“Understanding generational trauma is integral in helping people to wellness. You have to know that each piece that shapes behavior potentially stems from these traumas. It’s the difference between ‘and’ and ‘but’. I’m trying to be ok but I have this trauma, versus, I have this trauma and I will be ok.”
Ultimately, Akin’s goal is to help remove the generational trauma Tulalip people, and all Indian people, have been steeped in. Healing the community now will prevent the coming generations from experiencing these same traumas.
“We focus on the small steps towards healing, not the five to ten years it takes to get there. This is not a doctor’s office. There is no checklist or agenda. It is based on the person.
“For Indian people, the road to wellness is more like a filter. Holding on to what was, bringing that forward to what is now, and looking to what will come next, while continuing to bring the past forward,” he concluded.
Akin acknowledges the team of counselors he has joined. It is their joint work to promote mental wellness and work towards building a strong connection with the community in order to create a comfortable and safe environment for everyone.
“I want people to understand what we do here. I want anyone to be able to come and talk about things that we can help them with,” he said.
Thanksgiving may be the only time many of us are aware of the influence of Native American foods on what we eat. Yet, if some dietitians and devoted cooks had a say, that would change.
That’s because traditional American fare — from North, Central, or South America — contains a rich and colorful palate of heart-healthy foods, such as beta-carotene-packed pumpkin, fiber-loaded beans, and antioxidant-rich berries.
“Traditional Native American food [is] as varied as the Americas from which it originated,” Harold H. Baxter, DDS, author of the pending book Dining at Noah’s Table, tells WebMD.
Yet it’s all too easy to overlook Native American fruits and vegetables in our modern diets, experts say.
“We just don’t eat enough of most of these [traditional] foods any more,” says David Grotto, RD, author of an upcoming book on eating traditionally called 101 Foods That Could Save Your Life.
“Our cupboard used to be our medicine cabinet. A solution to a lot of what ails us may be getting back to these traditional foods.”
Here are five familiar Native American foods that would make healthy additions to any diet:
1. Corn
Traced back to Central and South America, corn has served Native Americans as both drink and diet staple; its husks as dolls, masks, even fuel. Along with squash and beans, corn makes up the revered trinity many Native Americans call “The Three Sisters,” vegetables frequently sown together.
“The corn provided a stalk for the bean vines to climb around, and the beans returned the favor by replacing the nitrogen in the soil,” Chief Roy Crazy Horse writes in an article on the Powhatan Renape Nation’s web site. “The squash spread out its broad shady leaves to keep other plants from crowding out the corn.”
Corn is also nutritious, containing vitamins C and K, phytochemicals, B vitamins, and fiber. Another bonus: Corn just may help to prevent cancer.
“One of corn’s phytochemicals, cryptoxanthin, was shown in one study to offer a 27% reduction in lung cancer risk,” says Grotto, who is also a spokesman for the American Dietetic Association.
Indigenous recipes for this ubiquitous food include sweet corn soup and chowder, cornbread, and popcorn. Enjoy ears fresh or roasted, and cut corn into salads or wraps. And try different colored corn when it’s available — those colors represent different body-boosting phytochemicals, says Grotto.
2. Berries
Growing wild across many parts of America, blackberries, strawberries, blueberries, and raspberries played a part in many native diets, including those of the Natchez and Muskogean.
Serving up healthy portions of fiber, vitamins, and minerals, berries have been shown by some research to help protect against stroke and heart disease. While blackberries and raspberries have nearly double the fiber of strawberries and blueberries, a cup of strawberries contains more vitamin C than you’ll need in a day.
“Blackberries, raspberries, and strawberries also contain several types of bioflavonoid phytochemicals,” says Elaine Magee, MPH, RD, the “Recipe Doctor” for the WebMD Weight Loss Clinic and the author of Comfort Food Makeovers.
“Blackberries, raspberries, strawberries, and blueberries contain some phenolic acid phytochemicals,” too, Magee adds. “These phytochemical families (bioflavonoids and phenolic acids) have powerful antioxidant duties in the body and may help protect us against cancer.”
Berries appear in Ojibwe and Sioux recipes for teas, puddings, and berry soup. You can also try mixing them into your own signature berry jam, as Magee does, or in pies, cakes, and muffins, and over hot or cold cereal.
3. Pumpkin
“I think pumpkin should be a core food in our culture,” Grotto says. “There’s so much goodness in it.”
Case in point: Just one cup of pumpkin is packed with potassium and fiber, and has more than 300% of the Recommended Daily Allowance of vitamin A. It’s also rich in the antioxidant beta-carotene, which may help slow aging and reduce problems related to type 2 diabetes, according to the American Dietetic Association.
Oneida recipes for pumpkin and squash include cranberry pumpkin cake and silky winter squash soup. You might also include pumpkin in stews, or try a Grotto trick for this bright treat: Carve mini pumpkins, stuff with red potatoes, then roast them. “Kids love them that way,” he says.
4. Mushrooms
Mushrooms aren’t usually thought of as especially nutritious. And while it’s true they’re not very nutrient-dense, that shouldn’t be the only way we look at a food’s value, says Grotto.
“If you look at the antioxidants in mushrooms, they’re just wonderful,” he says.
By helping to war off damaging free radicals — molecules that may play a role in the development of heart disease and cancer — antioxidants are what make mushrooms shine.
Even the lowly white button mushroom brings a lot of antioxidant pop to the table, as well as glucans, which may help lower cholesterol, Grotto adds.
While picking wild mushrooms is a hobby only for the well-informed, you can enjoy traditional foods with mushrooms found at the supermarket.
“Try a grilled Portobello and teriyaki sandwich instead of meat,” suggests Grotto. Mushrooms can also take center stage in sauces, stir-frys, soups, pates, and spreads. Or savor them over acorn squash with sage and onion — a perfect fall treat.
5. Beans
Completing the three sisters trinity, beans were a staple of the Navajo, Creek, Iroquois, and others.
Tiny nutrient powerhouses, beans like black, red, and pinto pack a healthy punch. Along with being fiber-rich, they’re good sources of cardiovascular-boosting potassium, B vitamins, and folic acid. An excellent low-fat source of protein, they’re cholesterol-free, too.
Reporting on a study that rated 100 foods for their disease-fighting antioxidant capacity, Grotto tells WebMD that small red beans topped the list, with red kidney beans and pinto beans following in third and fourth place. Black beans showed up in the top 20.
Traditional ways to enjoy them include succotash and bean salad. Beans of every stripe can also find their way into chili, soups, burritos, and tacos.
The curly tips of the fiddlehead fern can be found in early spring before they open to reveal a full taste akin to asparagus. U.S. Forest Service photo. –
By Kathryn Sosbe, Office of Communication, U.S. Forest Service, on November 15, 2013, USDA.gov
Elizabeth Nelson tasted then added more spice to a soup made with fiddlehead ferns, those curly leaves of a young fern that resemble the scrolled neck of a superbly crafted violin.
Although Nelson has made the soup hundreds of times before, her culinary prowess this day is being documented for a project called Mino Wiisinidaa!, or Let’s Eat Good! – Traditional Foods for Healthy Living.
“When we were kids, my mom would send us all out with a bucket. And she said, ‘Don’t you kids come back until that bucket is filled,’ ” said Nelson, a member of the Bad River Band of the Lake Superior Tribe of Chippewa Indians Reservation in Northwest Wisconsin. “And we would go and fill them with cow slips and fiddlehead ferns. And that was our supper for the night. That was how we lived.”
Documenting Nelson’s kitchen expertise is part of a three-year Great Lakes Indian Fish & Wildlife Commission project, funded by the Administration for Native Americans. The project will encourage healthy living by reintroducing food preparation taught by elders of the Anishinaabe people and based on recipes that are decades old.
“The Mino Wiisinidaa! Let’s Eat Good! project focuses on a return to traditional Anishinaabe foods in a new and healthy way,” said LaTisha Coffin, project coordinator. “We work with many elders from our member tribes that want to pass on knowledge about our traditional foods and stories about harvesting and the healthy lifestyle that came with gathering and processing your own food.”
One of the main goals of the program is to combat diabetes, obesity, and other chronic diseases. Native Americans are at higher risk at developing pre-diabetes and diabetes, especially type 2 diabetes. Type 2 is the most common form of diabetes, and many people are unaware they are at high risk. According to the American Diabetes Association, Native Americans have the highest age adjusted rate for diabetes at 16.1 percent while the overall United States rate is half that.
LaTisha Coffin, Mino Wiisinidaa! project coordinator, harvests fiddlehead ferns that will be used in a cooking demonstration. U.S. Forest Service photo.
To date, more than 70 recipes have been gathered that take advantage of plants that grow in the wild in and around and the Chequamegon-Nicolet National Forest. Many of the recipes are aimed at getting tribal members to rediscover traditional foods in a healthier way and talking about moderation and balancing meals, especially for diabetics. In order to test and try these recipes, the project staff harvests, or wildcrafts, with tribal elders. Wildcrafting is harvesting plants from their natural environment and serves as an economical way to find edible plants that can become healthy table fare.
“When we are out harvesting with a tribal elder, we make sure to listen and learn as much as we can from them. There are always certain ways to harvest foods, certain amounts you should take while leaving the rest to return for next year,” Coffin said. “The elders tell us how to care for natural resources that we gather and harvest, so that they will be around for us to harvest next year, and for our children to harvest, and their children to harvest.”
Foraging requires knowledge about plants. Some varieties of fiddlehead fern will make you sick, and are mostly used as a diuretic. Make sure to thoroughly research plants and their look-alikes before harvesting, or harvest with an expert.
The Northern Great Lakes Visitors Center on the Chequamegon-Nicolet has become the kitchen to test out such dishes as wild rice flour breads, watercress pesto, venison cabbage rolls, and a healthier version of Nelson’s fiddlehead fern soup.
Recently, during the forest’s annual fishing day event for kids, more than 100 people got to sample another project recipe: Mole Lake Lobster, which is actually white fish that is a traditional food in the Upper Great Lakes region. Event goers also got to take home the recipe for this traditional and microwavable dish.
Other published recipes are available in Great Lakes Indian Fish & Wildlife Commissiononline newspaper.
The Mino Wiisinidaa! project will continue to host cooking demonstrations through next spring and will create and distribute a cookbook with an instructional DVD that includes all of the collected recipes, including Nelson’s soup.
– See more at: http://blogs.usda.gov/2013/11/15/reaching-back-to-traditional-native-american-cooking-in-search-of-healthier-meals/#sthash.4mVkTWBw.dpuf
The Indian Health Service (IHS) and the Notah Begay III Foundation (NB3F) are collaborating on activities aimed at preventing childhood obesity in American Indian and Alaska Native youth. The partnership will include sharing best practices in implementation of community-based activities directed at addressing childhood obesity in Indian Country.
The collaboration, initiated Nov. 12, 2013, was developed in support of the Let’s Move! In Indian Country (LMIC) program, which is part of First Lady Michelle Obama’s Let’s Move! initiative. The LMIC seeks to advance the work tribal leaders and community members are doing to improve the health of Native youth.
“Today’s partnership is an important step towards helping Native American youth lead healthier lives,” said Sam Kass, executive director of Let’s Move! and White House senior policy advisor on nutrition. “With the LMIC, we’ve seen tribal leaders engage their communities by creating food policy councils and reintroducing sports like lacrosse into schools, but we know there is more work to be done to ensure all our children have the healthy futures they deserve.”
Obesity is a significant problem in Native communities. It is a risk factor for many chronic diseases, such as diabetes, cardiovascular disease, and cancer, which are among the leading causes of death for American Indians and Alaska Natives.
“Tribal leaders have asked us to focus more on prevention efforts, especially with our youth,” said Dr. Yvette Roubideaux, acting director of the IHS. “Our new partnership with the NB3F gives us an opportunity to identify and share best practices from all of our prevention efforts, including the successful activities and outcomes of our Special Diabetes Program for Indians grantees, to help in the fight against childhood obesity in the communities we serve. We are excited to partner with them as they establish a new national center focused on these issues.”
With a mission centered on reducing the incidence of type 2 diabetes and childhood obesity among Native American children, NB3F has developed community-driven, scalable, and replicable prevention models that have seen statistically significant outcomes among child participants in the areas of reduced body mass index or BMI (a measure of weight proportionate to a person’s height), increased self-confidence and endurance, and enhanced understanding of nutrition knowledge. In August of this year, NB3F launched a national initiative, Native Strong: Healthy Kids, Healthy Futures that functions as a national center focused on strategic grant making, research and mapping, capacity building, and advocacy to combat type 2 diabetes and obesity among Native American children.
“This unprecedented partnership between the Obama administration, the IHS, and the NB3F demonstrates the critical importance of leveraging partnerships and resources to tackle the health crisis facing Native American children,” said NB3F founder Notah Begay III. “With 1 out of 2 Native American children expected to develop type 2 diabetes in their lifetime, it is vital that effective strategies and best practices are accessible for all Native communities, so together we can turn the tide on childhood obesity and type 2 diabetes.”
About the Indian Health Service: The IHS provides a comprehensive health service delivery system for approximately 2.1 million American Indians and Alaska Natives who are members of federally recognized Tribes. The IHS is the principal federal health care provider and health advocate for American Indians and Alaska Natives, and its mission is to raise their health status to the highest level. For more information about the IHS, visit www.ihs.gov
About the Notah Begay III Foundation: In 2005, Notah Begay III established the Notah Begay III Foundation (NB3F), a 502c3 non-profit organization to address the profound health and wellness issues impacting Native American children and to empower them to realize their potential as tomorrow’s leaders. The mission of NB3F is to reduce the incidences of childhood obesity and type 2 diabetes and advance the lives of Native American children through physical activity and wellness programming. To this end, NB3F develops community-driven, sustainable, evidence-based, and innovative wellness programs designed by Native Americans for Native American children that promote physical fitness, wellness, and leadership development. For more information on Notah Begay III and NB3F, visit: www.nb3foundation.org.
Jessica Talevich inspects a healthy brain with organ lady, Shawneri Guzman. Photo: Andrew Gobin, Tulalip News
By Andrew Gobin, Tulalip News Reporter
Tulalip − The unsettling foreign smell of formaldehyde and isopropyl alcohol wafted from a table at the front of the room, lined with bottles, cans, jars of waste and toxins, and trays of human organs. Those who attended the CEDAR group meeting November 7th were disgustingly captivated by the uncanny presentation. Inside Out tells the gruesome truths of substance abuse, dispelling the misconceptions and myths society has about substances. Thursday’s show was unique, highlighting the effects of specific drugs.
Commonly referred to as the Organ Lady show, Inside Out begins with a glass of vodka and a raw egg. Shawneri Guzman, one of five Organ Ladies, cracks the egg into the glass for all to see, then sets it aside. From behind jars of tar and phlegm, Guzman picks up a set of human lungs, kicking the show into high gear as the audience leans in for a better look. She describes the different parts and facts about these lungs, which are grey and small, but they are healthy. Next she shows the lungs of a tobacco smoker, a marijuana smoker, and a heroin smoker, each looking progressively larger, shredded, and more black.
Bonnie and Bryce Juneau looking at a heart with a Gortex valve. Valve damage was due to heroin use. Photo: Andrew Gobin, Tulalip News
“The goal is to show healthy organs in comparison to damaged organs in order to help people understand what their choices are leading to, and hopefully help them make a change in their life,” said Guzman, an ER nurse at Providence Medical Center who sees people with these conditions on a daily basis.
The show continues with the heart, kidneys, liver, a tongue, and brains. Each specimen comes with a story, which Guzman tells while weaving in facts about drugs and how they are different and more dangerous today than they were ten, twenty, thirty years ago.
“The heroin on the street today is 60% to 70% pure, thirty years ago it was more like 20%. This means you can become addicted the first time, you can overdose the first time, you can die the first time. Today, heroin is commonly cut with horse tranquilizers, which is why so many people that use heroin look like zombies, they are essentially numbing their brain,” Guzman explained.
She continued to unveil brains, picking up slices that resembled Swiss cheese. Brains riddled with holes from heroin, meth, and marijuana, coupled with neural scans showing severe cognitive impairment illustrate a sobering reality. The damage shown in these brains is irreversible.
Guzman pointed out the misconceptions of drug use, such as smoking heroin is less addictive and less harmful than injection. If anything, smoking heroin is more harmful because of the drastic effect on the lungs.
It is important to know that second and third-hand marijuana exposure can cause you to test positive for THC, the chemical that comes from marijuana. Guzman referred to her experience in the ER, how many people come in after having tested positive for THC, and not knowing why it happened.
Bonnie Juneau hold up a pair of lungs ravaged by marijuana smoke. This 19 year old boy and had smoked everyday for five years. Photo: Andrew Gobin, Tulalip News
She explained, “We don’t realize how much our immediate environment affects us on a daily basis. Exposure to smoke is one example of how your surroundings affect your life. Even though you aren’t smoking, your body still feels the effects and it will show up on a test.” She noted that, “due to fertilizer and pesticides, marijuana today has more THC than what our parents would have smoked, meaning the effects and damage are both more drastic, and we are seeing more people test positive having only been exposed to third-hand smoke, which is the residue left on clothes, hair, furniture, and inside the car.”
As the show came to an end, Guzman picked up the egg floating in a glass of vodka. The vodka cooked the egg white in less than 90 minutes.
“Our brains do not stop maturing until we are about 25,” explained Guzman. “The egg white is immature protein, similar to a teen’s brain and other organs.”
She pointed out a liver from a 17 year-old girl that had drank since she was 13. It was hard and looked like a sponge in the middle.
Afterwards, people could put on gloves and examine the organs themselves, making the effects of substance abuse a tangible experience. Guzman continued to explain how these symptoms of organ damage manifest in living people, describing the signs to look for if you suspect someone is abusing substances. Awareness and understanding are crucial aspects in preventing addiction.
Jacqueline Pata, executive director of the National Congress of American Indians, says the Affordable Care Act is a “very good thing for Indian Country.”
There has been much controversy about the Affordable Care Act, what some call Obamacare. The politics are beyond intense. And those computer glitches are making it virtually impossible for people to enroll.
Promise or not, treaty or not, the entire history of healthcare in Indian Country has been defined by shortages. There has never been enough money to carry out that sacred bargain.
The modern Indian Health Service was created in 1955. And over the following decades, more clinics were built, more doctors were hired, and health care for Native people improved. Still, the agency never had enough money.
In 1965 when Medicare and Medicaid were enacted into law there wasn’t even consideration about how these programs would impact American Indians and Alaska Natives. The Indian Health Service could not bill the agencies for serving eligible services. Native Americans were essentially left out of that health care reform effort.
That history of shortages is critical context to understanding the Affordable Care Act. Because from the very beginning of the legislative process, the Affordable Care Act included Indian Country. This happened because a decision was made by tribal leaders to roll the Indian Health Care Improvement Act into the larger legislation.
“Let me tell you why it was different this time,” said Jacqueline Pata, executive director of the National Congress of American Indians. For nearly twenty years tribes urged Congress to reauthorize the Indian Health Care Improvement Act. Then the discussion began about a health care reform.
“We were sitting at an NCAI board meeting, tribal leaders around the table, and said we really have to engage in this health care debate this time around. There were those that said, “no, let’s stay where we are,’” she said. But former NCAI President Jefferson Keel knew the health care industry and he agreed with the broader approach. “So we immediately started to look at the overall health care bill, working with the members of Congress, to be able to find all those other places that it was important to insert ‘and tribes.’ So not only did we get Indian Health Care (Improvement Act) reauthorized permanently. But we were able to get provisions into Medicaid, we were able to get the tax exemption (for tribes that purchase insurance for members), we were able to include a lot of places where tribes should have been considered but probably wouldn’t have been if we didn’t integrate those two pieces of legislation.”
YouTube: Episode 1 of Treaty or Not? The Affordable Care Act & Indian Country
But there still is a question of why? Why American Indians and Alaska Natives need insurance of any kind when there is a treaty right, a statutory call to healthcare, that transcends this latest national experiment? Then recall the long history of shortages. The Indian health system has never been adequately funded, probably less than half of the appropriation that would bring about some sort of parity with other federal health systems.
The main idea in the Affordable Care Act is to require health insurance for all Americans because that lowers the cost for everyone, the so-called “mandate.” But American Indians are exempt from that mandate (even if the Indian health system does not count as insurance). So the way that exemption works, this year at least, is that American Indians and Alaska Natives will have to fill out forms for an exemption (once granted, it’s a lifetime deal). The good news here is that the whole website mess does not apply.
Then insurance itself is a complicated idea for Indian Country. What is called “third party billing” has been a small, but growing part of the financial resources for the Indian health system.
You see there is this odd American idea that links health insurance to our jobs. That’s how most Americans now get their health care — and will continue to do so even under the Affordable Care Act. But that one element is a big difference for Indian Country. Only 36 percent of American Indians and Alaska Natives have insurance purchased through work — that’s half the rate for most Americans — and 30 percent of us have no insurance at all.
But the Affordable Care Act is designed to change that. The new law offers incentives for people to get health insurance coverage at a reduced rate or even free. So why would American Indians and Alaska Natives purchase insurance?
“The Indian health system is only funded at about fifty percent,” said Valerie Davidson, senior director of legal and intergovernmental affairs at the Alaska Native Tribal Health Consortium in Anchorage.
“Anybody who’s ever been to a tribally-operated program or an urban program or an IHS facility, they know the services are limited. Unfortunately there isn’t enough funding. And so we rely on those third-party reimbursements (or insurance) to make those ends meet, to be able to keep the clinic’s lights on.”
She said the Affordable Care Act is an opportunity to make sure that American Indians and Alaska Natives have additional health care coverage. “So the things that the Indian Health Service funding typically doesn’t pay for is medically-necessary travel (unless it’s considered life or limb). So generally an emergency is taken care of,” Davidson said. “But it may not cover routine travel.” She said an example would be people who live in a community without a dentist — so the only available option requires travel. “Having that extra coverage could cover the medically-necessary travel,” she said.
Insurance that covers medical travel is one reason for individuals to purchase insurance — and there are other reasons as well. A diabetes patient who’s insured would get better care, more access to the wider selection of procedures and drugs.
But the problem is that the rules for the insurance marketplaces are doubly complicated for Indian Country. Who’s eligible? How much? And, just what are the rules?
But if the law is to be successful in Indian Country there has to be a greater effort at educating people about their options. The Government Accountability Office recently said it will take a major campaign to make that so. That means hiring more people, lots of people, to help Native Americans navigate through this maze.
But there are already models for this kind of campaign. The Census was effective with “Indian Country Counts.” And, as NCAI’s Pata points out, last year’s efforts to register Native American voters is the kind of operation that’s needed. “It’s so critically important that tribes get engaged in giving direction. Tribes need to think about this the way they would with their Native Vote campaign,” she said. “They need to be able to have sign-up fairs, where they can actually answer the questions.”
So will American Indians and Alaska Natives sign up for insurance? If that happens it won’t because of a working web site in Washington, D.C. It will happen because every clinic in the Indian health system explains to patients why insurance matters and how it means more money for all.
The most important insurance program for American Indians and Alaska Natives is Medicaid.
When the Supreme Court upheld the Affordable Care Act, the headline was that the majority affirmed the individual mandate. But the second part of that decision is that the United States could not force all 50 states to expand Medicaid coverage.
Medicaid is a particularly complex government insurance program for the poor. But what makes Medicaid so important is that its funding source is not appropriated by Congress. It’s an entitlement. If a person is eligible, then the money is there. Automatically.
Medicaid is also a partnership between a state government and the federal government.
But for American Indians and Alaska Natives, it’s an odd marriage. The federal government picks up 100 percent of the cost. But even though the bills are paid for by Washington, each state sets the rules for eligibility about who and what will be covered.
The result is that about half of Indian Country will be covered by states where Medicaid is expanding — and the other half live in states that have said no. This means that hundreds of thousands of American Indians and Alaska Natives will lose out on expanded insurance coverage that the Affordable Care Act was designed for.
So this means that the Indian health system will essentially be split in two. There will be more money for health care in states where Medicaid expands — and less in the states that have said no. In the “no” states that will be even less money for an already underfunded Indian health system.
Watch North Dakota and Arizona. Two conservative, red states, looked at their numbers — and especially their Native American population — have already decided to expand Medicaid. If the program works in those two states, then other states with large native populations, might join the party. But if not, there is always the possibility that Indian Country could be treated as a 51st state. (The Affordable Care Act even begins that consideration by allowing a beta test of sorts for the Navajo Nation.)
The numbers are huge. The GAO says: “Excluding those already enrolled, potential new enrollment in Medicaid could exceed 650,000 out of 2.4 million (27 percent) for those identifying as American Indians and Alaska Natives alone, and almost 1.2 million out of 4.8 million (25 percent) for those identifying as American Indians and Alaska Natives alone or in combination with another race.”
NCAI’s Pata says the Affordable Care Act also “makes it really important for tribes, as they look at their health care clinics, to think of them as businesses. And not just as businesses for their tribal members, but businesses for their community, particularly the smaller tribes.”
The flip side of that idea is a shift in power from the clinic to the individual. Once someone has insurance, either through Medicaid, the marketplace exchanges, or another program, then that person might not choose to remain in the Indian health system.
“That’s the other reason why tribes need to think of (clinics) as businesses,” Pata said.
In some ways the urban Indian clinics are ahead of the Affordable Care Act. Because so little IHS funding — about one percent — goes to urban clinics, they have had to act like business enterprises.
“The greatest challenge is balancing the historical manner in which we have provided services, which have been geared around the needs of the population, with the growing demand for reaching out to other communities to get sufficient volumes to get the revenues to keep the doors open,” said Ralph Forquera, executive director of the Seattle Indian Health Board. “That balance of natives to non-natives … has always been a complex thing to manage. Some clinics around the country have seen a dramatic drop-off in their Indian participation in their clinics because the economics just don’t work. They need to go out and seek non-native people and enroll them in their programs to keep the doors open.”
He adds that Seattle has been fortunate because it’s been able preserve that balance.
But Seattle has a larger population base, something that is not true in all communities.
“It does change the dynamic,” Forquera said. “Those are some huge challenges but they are not unique to us. The tribal community clinics may be in even more challenging situation if the dynamic changes.”
He said one thing to watch is a shift away from fee-for-service payments to clinics to a more managed-care approach. For managed care to work, there has to be a larger scale, more people. “In order to be able to work in that kind of environment, you have to enroll large numbers of individuals in order to generate the revenues to pay for staff and the facilities, all the things necessary to provide the services” Forquera said. That concept could make it more difficult for Indian programs with small numbers of people.
But the Indian health system does have one huge advantage over the larger health system — and that’s underfunding. Underfunding as an opportunity? Yes. Because it’s already led to smarter, more efficient ways of operating. It’s made innovation possible.
Alaska’s dental health therapist program is a great example of that kind of thinking. “We recognized that we’re not going to be able to have a dentist in every community,” said Davidson. “So we developed a two-year training program to be able to train people to provide mid-level oral health care. Most of their work is in prevention, but they can also do exams, develop treatment plans, they can do fillings, and simple extractions.”
The payoff? “The tribal health system has been innovative by necessity. And a lot of these programs can and have served as models for the rest of the United States,” Davidson said. “Tribes have shown time and time again that we are a really good investment. We can do more with less. If you take a look at what we are able to do today, compared with what we were able to do before we were able to assume ownership of our own system, the difference is tremendous. We can take innovation to a whole different level.”
So will the Affordable Care Act work?
It’s too early to know that answer. But this is not new in history. More than sixty years ago the Bureau of Indian Affairs ran health care programs. It was awful. One doctor wrote: All we really need are good doctors, facilities and pharmaceuticals. I am weary.” Congress finally got the message in 1955 and created the Indian Health Service. But that shift — as dramatic as the one today — worked and it significantly improved the quality of life for American Indians and Alaska Natives.
In an effort to promote healthy living across Indian country, U.S. Department of Health & Human Services Secretary Kathleen Sebelius released the following statement in honor of National Native American Heritage Month this November.
Each November, we recognize National Native American Heritage Month—celebrating the diverse histories and cultures of American Indian and Alaska Native people. This year’s theme, “Guiding Our Destiny with Heritage and Traditions: Leading the Way to Healthier Nations,” speaks to the vital role that cultural heritage plays in strengthening families and communities.
In July, I had the opportunity to visit the Navajo Nation in Arizona and meet with key leaders to discuss the health concerns of the Navajo. I attended a Special Session of the Navajo Nation Council and heard from the delegates about health issues such as diabetes, cancer, and HIV/AIDS. I also visited the Indian Health Service (IHS) Gallup Indian Medical Center, which was recently designated as a Level III Trauma Center, the first in the Indian health system. IHS work at this center, and throughout Indian Country, saves countless lives every year.
Our Administration is committed to ensuring the health and well-being of all Americans, which is why we are working with our tribal partners to reduce the health disparities that have historically burdened American Indians and Alaska Natives.
In order to address these issues, we need to make sure that American Indians and Alaska Natives have access to affordable coverage so they can get the care they need.
The Affordable Care Act is critical to that effort, partly by permanently reauthorizing the Indian Health Care Improvement Act, ensuring that IHS is here to stay.
Additionally, the new Health Insurance Marketplace made possible by the Affordable Care Act will make more affordable, quality options for health coverage available to uninsured Americans, including First Americans. IHS has trained staff to help its American Indian and Alaska Native patients enroll in Medicaid or purchase affordable insurance that they can use to continue to receive care at IHS facilities. If more IHS patients have health coverage, additional resources from reimbursements at the local facilities will help expand services for all patients served by IHS.
Health care is just one area in which we are working to increase support for Indian Country.
The Administration for Native Americans recently invested in new and continuing tribal programs to preserve Native American languages. We believe that language revitalization and continuation are important steps in preserving and strengthening a community’s culture.
We are also investing in Head Start and child care programs, innovative substance abuse and mental health initiatives, suicide prevention efforts, job training, economic development campaigns, and programs for seniors.
Please join me in celebrating National Native American Heritage Month and bolstering our commitment to ensuring that all American Indian and Alaska Native people have the opportunity for a stronger and healthier future through improved health care opportunities and partnerships that respect their culture and traditions.
When Arizona voters banned smoking indoors several years ago, the law didn’t cover Native American land. Now, an anti-smoking activist is trying to pass smoking ban that will cover the Navajo Nation.
Dr. Leland Fairbanks is president of Arizonans Concerned About Smoking, which helped push through the Smoke-Free Arizona Act in 2006.
“55 percent of the reservation people, who are part of Arizona, voted for the Smoke-Free Arizona Initiative, but they said it doesn’t apply to them because they’re independent nations,” Fairbanks said. “So unfortunately they’ve already voted; they would like to have what we have in the rest of the state.”
Now, he’s trying to collect about 10,000 signatures to get an initiative on the 2014 Navajo ballot banning indoor smoking.
“Only Navajos who are registered voters can sign. It does include, though, Navajos who are off reservation,” Fairbanks said. “If you’re a Navajo registered voter and you’re working down here in Maricopa County or some other county, you can sign that initiative and you can vote.”
Fairbanks says the signature drive is set to begin in January.
November 2, 2013-MapLight, a nonpartisan research organization that tracks money’s influence on politics, has updated the campaign finance data on the ballot intiatives in Washington state to make labeling of foods containing GMOs mandatory.
A MapLight analysis of campaign finance data from the Washington Public Disclosure Commission as of October 30, 2013 shows the Top 10 contributors on the supporting and opposing side and the geographic origin of the contributions.
From MapLight’s Voter’s Edge in Washington State
I-522: GMO Labeling
(Requires labeling of food products made from genetically modified organisms).
Contributions from Supporting Interests
Total Raised: $7.7 million from 10,500 donors
1 DR. BRONNER’S MAGIC SOAPS $1,840,635
2 CENTER FOR FOOD SAFETY ACTION FUND $455,000
3 MERCOLA.COM HEALTH RESOURCES LLC $300,260
4 ORGANIC CONSUMERS ASSOCIATION $298,076
5 PRESENCE MARKETING, INC $260,000
6 PCC NATURAL MARKETS $230,274
7 NATURE’S PATH FOODS USA INC $178,700
8 FOOD DEMOCRACY NOW $175,000
9 WASHPIRG $168,121
10 WEILAND WILLIAM T. $150,000
Background: The initiative, I-522, is a sibling to California’s 2012 Proposition 37 (GMO Labeling): many of the major contributors in this race also contributed to committees for or against Proposition 37, and the recent spike in opposition dollars echoes last year when the opposition to Proposition 37, according to the LA Times, “bankrolled” a “media blitz” in the final stretch.
LaTisha Coffin, Mino Wiisinidaa! project coordinator, harvests fiddlehead ferns that will be used in a cooking demonstration. U.S. Forest Service photo.
