A Political History of the Indian Health Service

Abstract

One of the few bright spots to emerge from the history of relations between American Indians and the federal government is the remarkable record of the Indian Health Service (IHS). The IHS has raised the health status of Indians to approximate that of most other Americans, a striking achievement in the light of the poverty and stark living conditions experienced by this population. The gains occurred in spite of chronically low funding and can be attributed to the combination of vision, stubbornness, and political savvy of the agency’s physician directors and the support of a handful of tribal leaders and powerful allies in the Congress and the White House. Despite the agency’s imperfections and the sizeable health problems that still exist among American Indians and Alaskan Natives, the IHS is an example of one federal program that has worked.

The Politics of Public Health Policy

“…Together with Enthoven and Lynn Etheredge, Ellwood later formed the Jackson Hole Group whose proposals established the basic approach of managed competition taken by the Clinton plan and a rival bill introduced by Rep. Jim Cooper in 1994 (64,185). Abraham Bergman, a pediatrician based at the University of Washington, worked closely with his home state senators Warren Magnuson and Henry Jackson to establish the Consumer Product Safety Commission, the National Health Service Corps, federal research into sudden infant death syndrome, and an expansion of the Indian Health Service to Native Americans living away from tribal lands (15,16,150). John Goodman, a professor at the University of Dallas, promoted the concept of medical IRAs to build on an Internal Revenue Service ruling in 1984 that granted modest tax benefits for flexible spending accounts.…”

Public health investments and the infant mortality gap: Evidence from federal sanitation interventions on U.S. Indian reservations

“…60 Even with perfect credit and information, and a well-functioning government, it seems likely that a poor tribe in the 1950s would have chosen to invest its scarce resources elsewhere. Bergman, Grossman and Erdrich (1999) note that Senator Alan Bible (D-Nev.) had received complaints from some white constituents about contamination of their water supply from tribal lands. 60 I repeat the exercise performed in Section 5.…”

Sustainability and the politics of calculation: technologies of 'safe water,' subject-making, and domination

“…During that time, the Eisenhower Administration and some in Congress sought to terminate the Federal government's special relationship with native tribes through several termination acts. Many of the advocates of termination policies believed that the Bureau of Indian Affairs (BIA) had fostered dependency among America's native populations, and that assimilating them into dominant society was the only way to cease this trend (Jorgensen 1996;Kunitz 1996;Bergman et al 1999). …”

“…The Indian Health Care Improvement Act of 1976, which made the Indian Health Service (IHS) responsible for the construction of safe water and sanitary waste disposal facilities (U.S. Congress 1994), specifically stated a policy of maximum community participation in planning and management while also reaffirming the Federal responsibility towards tribes (Bergman et al 1999).…”