The Technology Assessment Board approves the release of this report. The views expressed in this report are not necessarily those of the Board, OTA Advisory Council, or individual members thereof. 13. T22/22 In 2/3/Sum. Foreword American Indians and Alaska Natives have a unique historical and legal relationship with the Federal Government. Through treaties and statutes, the Federal Government acts as a trustee for Indian tribes. In this "government-to-government" relationship, Federal programs for Indians are administered principally by the Bureau of Indian Affairs in the Department of the Interior, except for medical and health-related services, which are provided through the Indian Health Service, a component of the Public Health Service in the Department of Health and Human Services. The health of Indian people still lags behind the health status of the general U.S. population, and there are substantial differences in health status and causes of illness among the nearly 300 Indian tribes and more than 200 Alaska Native villages in the United States. Continuing concerns over the health of Indian people led the House Energy and Commerce Committee and its Subcommittee on Health and the Environment to request that OTA examine the health status of Indians and the services and technologies that are provided to them through Federal Indian health programs. The request was also supported by the Senate Select Committee on Indian Affairs and by the Chairman and Vice-Chairman of OTA's Congressional Board, one of whom was also acting in his capacity as Chairman of the House Committee on Interior and Insular Affairs. An advisory panel, chaired by Rashi Fein, Professor of the Economics of Medicine, Harvard Medical School, provided guidance and assistance during the assessment. Also, four public meetings were held (in Portland, Oregon; Phoenix, Arizona; Rapid City, South Dakota; and Tulsa, Oklahoma) to provide tribes and their representatives the opportunity to comment on assessment activities and to confirm the information that OTA had collected. Site visits to nearby reservations and health facilities were also conducted as part of these activities. A large number of individuals from Indian tribes and organizations, the Federal Government, academia, the private sector, and the public provided information and reviewed drafts of the report. OTA gratefully acknowledges the contribution of each of these individuals. As with all OTA reports, the content of the assessment is the sole responsibility of OTA and does not necessarily constitute the consensus or endorsement of the advisory panel or the Technology Assessment Board. Key staff responsible for the assessment were Lawrence Miike, Ellen M. Smith, Denise Dougherty, Ramona M. Montoya, and Brad Larson. Indian Health Care Advisory Panel Rashi Fein, Chair Department of Social Medicine and Health Policy NOTE: OTA appreciates and is grateful for the valuable assistance and thoughtful critiques provided by the advisory panel members. The panel does not, however, necessarily approve, disapprove, or endorse this report. OTA assumes full responsibility for the report and the accuracy of its contents. 4 |