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Number One Health Problem is not Disease
20 September 2004
Story and photo by Dennis J. Neumann

BISMARCK, ND - The number one health care problem in American Indian communities is not a particular disease. It's not diabetes, alcohol and drug abuse, or cardiovascular disease, though they are epidemic in Indian Country.

      It's a problem with access to health care services, according to a leading health researcher.

Dr. Spero Manson
Dr. Spero Manson, University of Colorado, spoke September 8 at the United Tribes Intertribal Summit Conference.

      "Its not a single disease that's the number one problem," said Dr. Spero M. Manson. "It's the lack of access to appropriate and timely care."

      Manson is Professor of Psychiatry and head of American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center.

      In a speech to tribal leaders at the United Tribes Intertribal Summit in Bismarck, Manson said American Indian health care suffers from major economic issues. He described the situation with breast cancer.

      "American Indian women have a lower incidence of the disease. It occurs one-point-eight times less frequently than in white women," he said. "Yet American Indian women are more than two-point-six times as likely to die from it as their white, female counterparts."

      "Why is that? Because women in American Indian communities do not have access to early detection and treatment of breast cancer," he said. "As a consequence of the distances involved and lack of resources in tribal communities, they're very unlikely to take advantage of the extremely sophisticated and rapidly improving treatments becoming available."

      Manson pointed out that American Indian health care systems have historically not done a good job at recovering reimbursable costs of care and ancillary expenses.

      "Consider the participation rates for Medicare and Medicaid. Nationally the rate is 92 percent," he said. "The rate for American Indians is 62 percent."

      Tribes and the Indian Health Service have not capitalized on what is rightfully due to Indians as U. S. citizens by developing the infrastructure and providing the resources to recover funds, he said.

      A model program is the Access Project of the National Indian Council on Aging, Albuquerque, NM. He said the program demonstrated how to reach American Indians who are eligible for Medicare and Medicaid and how to develop effective reimbursement procedures.

      Manson described how state block grant funding could yield more resources if tribes pursued separate, independent funding on their own for alcohol, drug treatment and mental health programs.

      He also said the coordination of care across service sectors was another major area where structure, financing and access play a role in health care problems for American Indians.


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