The Indian Health Service and the Continuation of the Exploitation of the Native American People in the Twenty-First Century

By Fiona Poth '24 

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During the previous three years, the COVID-19 pandemic has disproportionately affected the Native American population. The Indian Health Service reports that this population experienced infection rates that were three and one-half times greater than those experienced by the White (non-Hispanic) population. Once infected, Native Americans were four times more likely to be hospitalized and died at a rate nearly twice that of White Americans (“Coronavirus”; Lakhani). The Center for Disease Control and Prevention (CDC) reported in August 2022 that the Cumulative U.S. Covid death rate for Native Americans aged sixty-five and over was nearly 2,000 deaths per 100,000 people while the rate for non-Hispanic Whites was approximately 1,100 deaths per 100,000. This increased mortality rate was true for all Native American age categories with even those Native Americans in the 18-to-39 age category dying at a rate of approximately 125 per 100,000 compared to Whites, who experienced a death rate of approximately 20 per 100,000 in this age category (Lopez and Wu).  The Navajo Nation has lost more than 2,000 people during the pandemic, which is equivalent to losing one in every 80 people on the reservation (Lakhani). At an individual level, Carol Schumacher of the Navajo Nation has lost more than 42 family members to the pandemic (Lopez and Lu). The National Center for Health Statistics confirmed this in an August 2022 report which showed that the life expectancy of Native Americans has been reduced by almost seven years, from 71.8 years in 2019 to 65.2 years in 2021, in only two years. The average life expectancy of a Native American is now equivalent to the average life expectancy of a White American in 1944.

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At first, these facts might be dismissed as an anomaly or assumed to reflect a low vaccination rate among the Native American population. However, the CDC reported as of September 2021 that 47.5 percent of the Native American population was fully vaccinated. This vaccination rate is nearly 10 percent more than that for Whites (non-Hispanic), which had a full vaccination rate of only 37.8 percent as of this date. This high vaccination rate among the Native American community has been attributed to the traditional values of this community for putting the well-being of the community over self and to respect for and a strong desire to protect the elders of the community (Silberner).

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Instead, researchers and tribal members have attributed these high COVID-19 infection rates and morbidity to the high poverty and unemployment rates of the Native American population and the lack of adequate health care readily available to this population (Kelliher; Lopez and Wu). The reservation poverty rate for Indian families is 36 percent compared to the national family poverty rate of 9.2 percent (“American Indians and Alaska Natives”). Native Americans have a poverty rate of 25 percent, the highest poverty rate among all ethnic groups. Unemployment is also a chronic problem among the members of this population. For example, in November 2022, the unemployment rate for the Native American population was nearly double that of the entire United States population (6.2 percent compared to 3.7 percent) (Kelliher). 

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Exacerbating this poverty is the fact that Native Americans living on reservations also face a lack of basic resources like running water and electricity. It is estimated that 14 percent of the Native American population does not have electricity (Slanger). For example, today, nearly 20,000 people living on the Navajo Nation in the America Southwest live without electricity (Lee). The Rural Electrification Act of 1936 did not include many tribal lands. It is estimated that 58 of 1,000 native American homes do not have indoor plumbing (Tebor). Approximately, 60,000 people living on the Navajo Nation do not have access to piped water to their homes, which makes them more at risk for health issues related to contaminated water ("Providing Safe Drinking Water in Areas with Abandoned Uranium Mines").

The Indian Health Service (IHS), an agency run by the United States government, provides health care service to the Native American population, which includes approximately 2.6 million people who belong to one of the federally recognized tribes and who live in 37 states. Since its establishment in 1955, the IHS has traditionally been underfunded. For example, the IHS was funded at about $6 billion in 2021. This is approximately $4,078 for each member served. However, the U.S. government spends approximately $15,309 for each member of Medicare, a government-run health plan for U.S. citizens 65 and over. Often, Native Americans must travel long distances for medical care, and the care they receive is inadequate. 

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During the pandemic, the effects of this underfunding were exacerbated. Facilities lacked beds, were understaffed, and did not have necessary equipment. IHS care facilities usually were not sent protective equipment for staff. Patients were often sent home with an inhaler and an oxygen tank instead of receiving appropriate care in a hospital or clinic (Walker). However, poor health care services were common before the pandemic. For decades, the Native American population on reservations throughout the United States has struggled to receive adequate health care.

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This substandard care is caused by staffing and facilities issues. The IHS hospitals and health centers have trouble hiring staff because of their remote locations and are unable to offer competitive salaries because of limited government funding.  The IHS has a history of hiring doctors to serve these populations who later prove to be both negligent and incompetent. More than 170 practicing IHS doctors have been accused of negligent care, have been involved in lawsuits, or have been sanctioned by a state medical board (Weaver). In addition, IHS doctors have been accused of sexually abusing patients (Weaver). Since 2006, the United States government has had to pay about $55 million in settlements in “163 malpractice cases at Indian Health Service hospitals” (Weaver). These cases of incompetent care have resulted in the death of at least 66 Native American people. In addition to staffing problems, IHS services and clinics usually do not have emergency departments and necessary imaging equipment such as MRI or CAT scan to make accurate diagnoses.  Ambulances can take up to two hours to reach the reservation, and an emergency room can be equally far away. Even for nonemergency care, Native Americans struggle to make appointments, face language and cultural barriers to care, and do not receive medications in a timely manner (Lopez and Wu; Treisman).

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The problems faced by the Native American population today—inadequate health care, poverty, unemployment, and lack of infrastructure—are a lasting effect of practices begun nearly five hundred years ago by the European colonization of North America, the forced relocation and taking of the Native Americans’ land and resources, and the marginalization of this population (Farrell et al.; Wolfe).

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By 1492, the year that Christopher Columbus, a Spanish Explorer, reached the Bahamas and declared that he was the discovering the “New World,” there were already an estimated sixty million Native Americans with approximately ten million people living in the area that is now considered the United States in more than five hundred separate nations or tribes (“Native American Cultures”; “American Indians and Alaska Natives”). The ancestors of Native Americans, Paleo-Indians, are thought to have crossed Beringia, a land bridge connecting Asia and North America, and sailed along the coasts of North America to establish settlements.

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The practices of these people varied by geographic location with some being hunters and gatherers and others having established complex irrigated agrarian-based societies. These Pre-Columbian Native Americans used fire in their daily lives and had domesticated a variety of plants and animals, including beans, corn, dogs, and turkeys. Their societies were sophisticated and well organized. They had governing bodies, laws, moral codes, and religious beliefs. Their settlements had as many as 200,000 residents (Pauls). Although many different individual groups or tribes existed, they believed that the land was a shared resource, they worked collectively for a common good, and they valued community.

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Christopher Columbus’s discovery and exploration would ultimately lead to the exploitation and colonization of these people first by the Europeans and later by the United States. ¹ During the one hundred and fifty-years that followed Christopher Columbus’s discovery, the indigenous population of the Americas is estimated to have dropped from nearly 60 million to 6 million. This dramatic loss of population was caused primarily by epidemics. The Europeans brought with them new diseases to which the indigenous people had not developed an immunity and for which they had no effective treatment. These diseases included smallpox, measles, influenza, and cholera. For example, the Wampanoag tribe was one of the tribes that was seriously impacted by disease. Historians believe that the Wampanoag population in the New England area of the United States was nearly destroyed by a smallpox outbreak in the early 1600s.  As a result, English Pilgrims settled on Wampanoag land when they arrived. Thus, the Europeans took land from Native Americans by both force and disease.

 

This land dispossession and forced migration were common tactics used throughout history by settlers to control new lands and the Indigenous people who occupied them.  For example, the early Greek, Persian, and Roman empires practiced similar strategies, and the British Empire later did so when establishing colonies in Africa. The imperialistic practices and oppression of Native Americans begun during European colonial expansion were continued by the United States even after it became an independent nation following the Revolutionary War. 

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Although the Native American societies in America were highly developed, these imperialist policies and practices were often justified by beliefs that the English settlers were superior to the Native Americans. The English colonists arrived in America with a preconceived notion of what being civilized or cultured meant.  They saw themselves as different from the Native Americans and viewed the Native Americans as uncivilized. This view became established as a stereotype that was ultimately ingrained in American culture. The colonists reinforced this belief by referring to the Native Americans as “savages” (Pauls). 

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This Euro-superiority in thinking and misunderstanding of the Native American culture can be seen in the fact that, even until the twentieth century, many American researchers believed that the Native American cultures were not advanced enough to have built such structures as the Mounds in the Ohio River Valley (Pauls). The views that Native American people were inferior and ignorant were used to rationalize the displacement of these people from their lands and the taking of those lands.

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One of the most significant relocations of Native Americans was the Indian Removal Act of 1830. This act forced the relocation of five southeastern tribes consisting of about 50,000 people to Oklahoma (“The New England Colonies and the Native Americans”). This relocation provided 25 million acres of fertile land to White settlement in Georgia, Florida, North Carolina, Tennessee, Alabama, Mississippi, and Arkansas. More than 4,000 Native Americans died on the journey to Oklahoma, which is now called the Trail of Tears. This name suggests that Native Americans lost land and valuable resources when they were forced by the United States government to relocate.

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Although it is difficult to estimate the original land holdings, a 2021 study by a team of researchers led by Justin Farrell, a sociology professor at Yale University, set out to do so by studying land records and conducting surveys. They found that the Native American populations in modern-day United States have lost 98.9 percent of their original lands. Further, 42 percent of tribes from the historical period now have no land at all. The tribes that do have land only have about 2.6 percent of what they had originally.  They found that most of the Native American tribes do not hold land where they once did.  Many of them are now forced to live on land that is 70 to 1,723 miles away from where they once lived.  In many instances, the lands that these tribes occupy now are less desirable than the original lands in that they are often subject to higher temperatures and receive less rain. Furthermore, the lands that the Native Americans were moved to are less desirable and less useful in terms of both underground minerals and arability. Therefore, imperialism and its policies are still having a negative effect on the lives and fortunes of Native Americans today.

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This forced migration and land dispossession of the Native Americans were precursors to the vulnerabilities this population faces today in food security and health care. This historic imperialism continues today in another form.  Adequate healthcare is denied these people. In much the same way that early deaths of Native Americans were caused by the spread of such diseases as smallpox brought by the colonizers, today’s Native Americans are victims who suffer and die because of discrimination and marginalization. Meaningful change is needed to ensure that Native Americans receive adequate and effective healthcare. The Biden Administration’s 2022 infrastructure bill includes $13 billion to address some of the healthcare and infrastructure needs of Native Americans; however, this amount probably still is not enough. The National Indian Health Board, a nonprofit advocacy group of Native Americans, is lobbying for $48 billion for the 2024 fiscal year to fund healthcare for the Native Americans. This lack of adequate healthcare is killing Native Americans and destroying their diverse cultures. Specifically, the elders of these communities are dying at a faster rate. The individuals who can teach the native tribal languages and can pass down the cultural beliefs and practices by story and example are dying. For example, more than 25 percent of those killed by COVID-19 in the Northern Cheyenne tribe in Montana were native Cheyenne speakers. The Cherokee nation has lost more than 35 Cherokee native speakers.  In this way, the imperialism continues, and these Native Americans are being silenced again. The United States Government has a legal obligation to fix these wrongs and make healthcare for these individuals equal to that available to others. In July 2003, the U.S. Commission on Civil Rights declared that the difference in healthcare services provided to Native Americans was a clear violation of their rights. When science is manipulated or access to science is not equal, it can lead to a situation in which one group exerts its superiority over another. Rather than being used by one group of people as a means of manipulating or controlling another group of people, science should be used to improve the lives and increase the wealth of all.