I have no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity

Transcription

1 OFF THE RESERVATION Shaquita Bell, MD Chair, Academy of Pediatrics Committee on Native American Child Health Clinical Associate Professor, Department of Pediatrics, University of Washington Interim Medical Director, Center for Diversity and Health Equity, Seattle Children s Hospital

2 Disclosure slide I have no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity I do not intend to discuss any unapproved/investigative use of a commercial product/device in my presentation

3 Learning Objectives Identify the unique needs of Native populations living in urban settings Utilize Urban Indian Health Centers in a more coordinated fashion Advocate for improved funding for Urban Indian programing

4 Water is Life

5 A population Almost 1 million people 70% of people who identify as AI/AN live in Urban settings 25% of those folks are covered by an Urban Indian health Organization Higher risk of mental health and substance abuse issues May lack family and traditional cultural environments

6 Unique Issues of Definition Who is Indian Who is an Urban Indian When you are born in a city, what is your identity Historically fragmented Diverse set of values, beliefs, and needs

7 Historical Trauma Also called generational Relocation Unethical research Blood quantum Indian Reorganization act of 1934 Incarceration rates Foster care/out of home placement rates ACES and epigenetic factors

8 Historical context Boarding schools Federal Policies Environment Health Care

9 Health needs More chronic disease Cardiovascular disease Diagnosis of Diabetes Smoking Obesity >15% of UI s frequent mental distress 20% of UI s report engaging in binge drinking

10 Nationwide Epidemic

11 Socioeconomic 23% of UI s are likely to lack a HS/GED 23% have incomes that fall below the poverty line 12% are unemployed Homelessness

12 Violence

13 Violence Rate of law enforcement killings, per million population per year, (published 2014, CDC)

14 Indian Health Service Formation Mission HHS Funding information

15 Section 3 of P.L , the Indian Health Care Improvement Act, declares that it is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to ensure the highest possible health status for Indians and urban Indians

16 Urban Indian Health Organizations 33 UIHI s Receive subcontract IV funding from HIS This is approximately 2% of overall budget Individual grants IHS funding in general

17 Urban Indian Health Organizations

18 Minneapolis Indian Health Board Integrated Trauma Informed Behavioral Health Tobacco Cessation Centrally located Little Earth Dental Services

19 Seattle Indian Health Board Serving over 150 tribes Over a thousand kids a year Family Practice Residency UIHI Youth services Thunderbird Center Traditional Medicine services

20 Urban Indian Health Institute Tribal Epidemiology Center One of 12 in the country Monitor and study diseases of concern Disease prevention Gather health information and communicate it Coordinate with other public health organizations

21 First Nations Community Healthsource

22 Northwest Portland Area Indian Health Board Serving 43 tribes Oregon, Washington, Idaho Northwest Tribal Epidemiology Center Hepatitis C project

23 Advocacy State level Federal Level Take your business there

24 Ceremony How do we foster cultural connections in urban settings Cultural camps Language classes Pow wows Living communities

25 Academic The need for collaboration Participation Community engagement

26 Resources and Thanks IHS.org UIHI CDC Department of Justice AAP CONACH AAP Federal Affairs office Marc Boyer Rochelle Van Dijk and her very cute kids