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Issues Affecting Public Health Delivery Systems in American Indian and Alaska Native Communities

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Although great strides have been made in reducing morbidity and mortality rates of American Indians and Alaska Natives, significant gaps remain in health status between these populations and the general U.S. population. Public health approaches must be tailored to these groups, while bearing in mind, there will be regional variations in disease risk and lifestyles. Because Indian tribes are sovereign nations, they have a unique relationship with the federal government. People working with tribes should understand the history and laws that underlie health services to American Indians and Alaska Natives. Sections of the Indian Self-Determination and Education Act (P.L. 93-638) allow tribes to take over the operation of programs previously operated by the Indian Health Service or the Bureau of Indian Affairs. People working in this area should understand the implications of the Act and how to best help tribes exercise their rights while working to improve tribal health. Finally, urban Indian programs do not command the same support as tribal programs, even though more than half of the Indian population lives in urban areas and not on reservations. It is important to understand the legislative and programmatic differences between urban and tribal services. There are several courses of action that states wishing to work with American Indian communities might consider.