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• W3166943849 abstract "Indian, once proud and free, is torn now between white and tribal values; between politics and language of white man and his own historic culture. His problems, sharpened by years of defeat and exploitation, neglect and inadequate effort, will take many years to overcome.- Excerpt from speech of Lyndon B. Johnson, 36th President of United States delivered on March 06, 1968, as Special Message to Congress on problems of Indian: Forgotten American (The Presidency Project- Peters G and Woolley JT, University of California. Santa Barbara).American Indians and Alaska Natives (AIAN) are original people of North America. Since Iroquois League of Five Nations (Mohawk, Oneida, Onondaga, Cayuga, and Seneca) was established in 1100s, individual tribal nations have undergone a series of upheavals. Since arrival of European colonists, they became aliens in their own land. It was not until June 2, 1924, that Indians were granted full citizenship when Indian Citizenship Act was signed into law by President Calvin Coolidge. However, it took another 22 years till US government recognized sovereignty of tribal nations. To show gratitude for their service in second world war, US government passed Indian Claims Act in 1946 to set up Indian Claims Commission that acted as a Judicial arbiter between US government and land claims of AIAN. The last of these claims were settled in early 21st century. Although it may seem that tribal nations exist as sovereign nations within a nation, disparities in economics, literacy, and healthcare continue to be an egregious challenge in 21st century. These disparities have been further laid bare with raging pandemic that has come to pass as a defining moment of this century. Despite progress being made in recognizing sovereignty of AIAN people, stark disparities between healthcare provided to people and non-Hispanic whites (NHW) have continued to exist. The first arrival of European settlers 500 years ago brought devastating diseases like smallpox, measles, yellow fever to virgin lands and wiped out multiple tribes over next two centuries, since recognition of right of Indian Nations to in 1832 (Supreme Court Chief Justice John Marshall, Worcester v. Georgia, 31 (6 Pet.) 515, 561 (1832), little changed in care allotment towards AIAN communities. The federal government continued to provide healthcare to AIAN community under various treaties, executive orders, and legal bases over next century. In 1849, AIAN community's healthcare passed from war department to department of interior. However, little change came about with transfer of responsibility. These treaties were broken numerous times, leading to high mortality and morbidity in AIAN community. It was not till 1921 when Snyder Act provided a clear mandate for delivering improved healthcare to AIAN community. It led to a concentrated effort towards providing healthcare rights of AIAN community.Post-second world war, under mandate of the highest attainable standard of health from World Health Organization (WHO) and Universal Declaration of Human Rights by United Nations, a progressive change began in Indian policy. The transfer of affairs from Bureau of Indian Affairs to Indian Health Services (IHS) in 1955 was a pivotal point in integrating services and administration of healthcare to AIAN community. Nixon-administration passed Indian Self-Determination and Education Assistance Act in 1975 and Indian care Improvement Act in 1976, which have been instrumental in improvement in of AIAN community.Since establishment of IHS in 1955, and through commitments shown by various governments in following years, of AIAN community has improved significantly. Better sanitation programs, increased immunization rates, increased use of antibiotics, and healthcare provision have reduced morbidity and mortality in AIAN community. An 82% decline in infant mortality rate (IMR) is an astonishing feat achieved since establishment of IHS. Although morbidity and mortality from communicable diseases have reduced since establishment of IHS, non-communicable diseases like obesity, diabetes, alcohol abuse have risen to forefront. Several 'social' parameters like poverty, low literacy level, unemployment, etc., remain higher amongst tribes than rest of country. Currently, these social disparities are main drivers behind numerous care disparities seen in AIAN community. This chapter reviews care disparities in AIAN community compared to non-Hispanic White (NHW) group. We also address AIAN community as indigenous people/tribe at various points for this review." @default.
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• W3166943849 date "2021-04-06" @default.
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• W3166943849 title "Clinical Practice Issues In American Indians and Alaska Natives" @default.
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