by Nancy J. Mellem and Valerie Anderson Minority Nurse Writer
Did you know that within the United States of America there are several functioning governments? American Indian and Alaska Native (AI/AN) tribes possess a nation-within-a-nation status, meaning that the U.S. Constitution recognizes American Indian and Alaska Native tribes as distinct governments. There are more than 560 federally recognized tribes in the U.S. , and the nation's estimated 2.6 million members live mainly, but not exclusively, on reservations and in rural communities in 35 states.
Unfortunately, the AI/AN people have experienced a lower health status in comparison with other Americans. Their lower life expectancy (almost six years less than the “all races” population expectancy) and the disproportionate disease burden (see the Mortality Rate Disparities chart for details) have been rooted in economic adversity and poor social conditions. There is an organization working to remedy the disparity.
Providing Health Services
The Indian Health Service (IHS), an agency within the Department of Health and Human Services, provides a comprehensive, health service delivery system to approximately 60% of the AI/AN population living in the United States . Their stated goal is to “ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people.” To that end, the IHS actively assists tribes in developing their health programs.
AI/AN people now have access to health care services in 49 hospitals and over 500 other facilities. A combination of U.S. federal funds allocated to the IHS through the Snyder Act of 1921, Public Law 93-638 self-determination contracts, and more than 9,000 contracts between tribes and independent health care providers have made this possible.
The IHS ensures that preventive measures involving environmental, educational and outreach activities are combined with therapeutic measures into a single national health system. Within these broad categories are special initiatives in traditional medicine, elder care, women's health, children and adolescents, injury prevention, domestic violence and child abuse, health care financing, state health care, sanitation facilities and oral health.
Career Opportunities Abound
With so many responsibilities, the IHS employs a large staff to meet the diverse needs of the American Indian and Alaska Native population they serve. The agency employs approximately 15,000 people, including members of virtually every discipline involved in providing health care and social and environmental health services. They currently have a vacancy rate of about 12% for health professionals, so there are many career opportunities available.
Individuals with health-related degrees can join the IHS as civil servants or as commissioned officers in the Public Health Service (PHS). All Indian Health Service jobs, along with some tribal and urban Indian health program positions, are listed on-line at the IHS Web site (www.ihs.gov) under the Job Vacancies Database link. Additional IHS jobs can be located through an on-line search at FedWorld Federal Jobs Search and USAJOBS.
Each vacancy listing on IHS's Web site contains contact information for the position; get in touch with the person listed in order to apply. For most permanent positions, you must be a “status” candidate. Status candidates are Indian Preference eligibles, current permanent federal employees, reinstatement eligibles or applicants with special appointing authority. All IHS positions are subject to Indian Preference laws.
Education and Continuing Education Opportunities
The Indian Health Care Improvement Act, Public Law 94-437, authorizes the IHS to administer three interrelated scholarship programs to meet the health professional staffing needs of IHS and other health programs serving AI/AN people. The IHS also administers a Loan Repayment Program for the purpose of recruiting and retaining highly qualified health professionals to meet staffing needs.
The PHS Commissioned Officer Student Training Program and Extern Program provides students of the health professions the opportunity to gain experience in a health service environment during free periods of the academic year. The Indian Health Professions Program provides scholarships, loans and summer employment in return for agreements by students to serve in IHS, tribal or urban Indian programs. As a matter of law and policy, the IHS gives preference to qualified Indians in applicant selection and career development training. And the PHS National Health Service Corps offers scholarships to medical students who agree to enter primary care specialties and to sign on for a minimum two-year tour of duty in PHS programs, including IHS direct and tribal programs.
In a speech given at the Montana/Wyoming Tribal Leaders Council Meeting this past April, Charles W. Grimm, DDS, M.H.S.A, and interim director of the IHS asserted his personal goals and the spirit of the goals of the IHS. He states, “I am committed to raising the health status of American Indians and Alaska Natives—and it is not just about access to care, or just about improving the educational opportunities for our people, or establishing a safe community, or building homes. It is about all these things, and many more that are interdependent and necessary. One Aspect of well being builds on another. Each of these things requires all of these things.”