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Tribal health officials meet with Gov. Bullock about health disparities in Indian Country

By B.L. Azure
THHS PIO

Prior to the meeting with Gov. Bullock tribal representatives met to discuss health issues among American Indians in Montana. (B.L. Azure photo) Prior to the meeting with Gov. Bullock tribal representatives met to discuss health issues among American Indians in Montana. (B.L. Azure photo)

HELENA — Tribal representative from five of the seven Tribal Nations in Montana met with Democrat Governor Steve Bullock last Thursday in the state capitol. The tribal representatives from the Flathead, Crow, Fort Belknap, Rocky Boys and Fort Peck reservations had health care on their minds. They presented their concerns to the governor and proposed a solution for the resolution of the health care disparity of Indian folks in the state. They want to be an active partner in the solution and want a permanent office in the Montana Department of Public Health and Human Services.

The group of health care officials from the five Tribal Nations pointed to the 2013 report entitled, “The State of the State’s Health – A Report on the Health of Montanans,” and the subsequent follow-up plan to improve the health of Montanans entitled, “Big Sky. New Horizons. A Healthier Montana: A Plan to Improve the Health of Montanans.”

The report strengthened what is generally well known in Indian Country: the health care available to American Indians in Montana is woefully inadequate in the sense of what type of health care that is available and access to that. Statistics in the report buttress that fact and it shines a light on the resulting poor health that is a result of inadequate health care access and health care options.

The follow-up plan maps out strategies to remedy the over all picture of the health of all Montanans and health care options they have. In general, access to health care providers is relatively bleak in the rural sectors of the state especially in the counties and areas where Indian reservations are located.

Gov. Steve Bullock listens to the concerns of the Tribal Health folks at last week’s meeting in Helena. (B.L. Azure photo) Gov. Steve Bullock listens to the concerns of the Tribal Health folks at last week’s meeting in Helena. (B.L. Azure photo)

Confederated Salish and Kootenai Tribes Tribal Health Director Kevin Howlett told Bullock that the Tribal Nations want to be a part of the plan to resolve the health disparity among American Indians that was noted in the report study. In all health category benchmarks articulated in the report American Indians are worse off than their Caucasian counterparts.

“We have made a commitment to be a part of the plan to resolve the health disparity among Indians,” Howlett told Bullock, adding that the report mentions the health care disparity among American Indians in the state but the plan for resolution of the issue lumps them into the generic designation of minorities — American Indians comprise 6 percent of the Montana population, other minorities comprise 1 percent and the rest are Caucasians. The tribal health care representatives at the meeting felt that the minority designation fades the potential for resolutions of the problems in Indian Country. “We want to collectively help you to help us.”

“Two years ago, we (American Indians) helped you get elected,” said CSKT Tribal Council Vice Chair Carole Lankford, “Now we want you to help us.”

The tribal officials said they want Gov. Bullock to include them not only in the plan for resolution of the inadequate health care availability and the resulting poor health conditions but also want a permanent office in the state capitol.

“We would like you to consider, through your office, the creation of the Office of American Indian Health (OAIH) in the Montana Department of Public Health and Human Services,” Howlett told the governor, adding, “We (tribal people) would like access to more state programs and access to state agencies. We would ask that you and (DPHHS Director) Richard (Opper) to provide tribes with a list of all state programs they are eligible for.”

Crow Tribal Health Director Todd Wilson comments on the issue of the health disparity among American Indians in Montana. Crow Tribal Council Vice Chair Shawn Backbone is on the right. (B.L. Azure photo) Crow Tribal Health Director Todd Wilson comments on the issue of the health disparity among American Indians in Montana. Crow Tribal Council Vice Chair Shawn Backbone is on the right. (B.L. Azure photo)

According to the 2010 census Montana’s population is 989,415. Unofficial tallies since show that approximately one million people now live in the state. Caucasians comprise 93 percent of the population, American Indians comprise 6 percent and other race designations comprise 1 percent.

American Indian population is younger than Caucasians population. The median age for Caucasians is 42 years, for American Indians it is 26 years. Twenty-one percent of Caucasians are under 18 years of age, for American Indians 36 percent are under 18. Sixteen percent of Caucasians are 65 years of age or older, 6 percent of American Indians are 65 or older.

The report says that approximately two-thirds of American Indians in Montana live in medically underserved counties. It also states that more than three times as many American Indians —115,000 — live in poverty compared to 26,500 Caucasians. Three times as many American Indians are unemployed when compared to Caucasians.

The wake-up call of the health disparity in Montana is the mortality rate. Caucasian men live 19 years longer than American Indian men — 75 v 56. Caucasian women live 20 years longer than American Indian women — 82 v 62. American Indian women live six years longer than American Indian women.

American Indians top the charts in all mortality rate causes — cardiovascular, cancer, respiratory, vehicle injury, all other injuries, suicide and homicide.

Some of the tribal officials at the meeting told Bullock about their experiences dealing with losing family members, friends and community members related to poor physical and mental health.

Tim Rosette of Rocky Boys Nation said when he was the Health Director he faced critical challenges everyday on the job and told about the youth suicide attempts on the reservation which are a sad reality in Indian Country. He added that Montana is a leader in suicides in the nation.

Tim Rosette of Rocky Boys tells Gov. Bullock that Rocky Boys has an unused facility that could be converted to better deal with mental health issues among the youth of Rocky Boys and other reservations in the state. (B.L. Azure photo) Tim Rosette of Rocky Boys tells Gov. Bullock that Rocky Boys has an unused facility that could be converted to better deal with mental health issues among the youth of Rocky Boys and other reservations in the state. (B.L. Azure photo)

“In north central Montana we don’t have mental health services available for these kids,” Rosette said, adding that Rocky Boys has an 18-bed justice center that has been setting idle for at least four years. He said the facility could be revamped to provide secure lockdown with mental health counselors for at youths who, among other things, attempt suicide. The nearest such facility for young American Indians in the state is in San Marcos, Texas but that costs from $400 to $500 a day. “We could provide some lockdown for their own safety. This facility could pay for itself. There is an opportunity to deal with this situation we just need some help to get over the hill.”

“We are tired of being the leaders in the death rate,” said Crow Tribal Health Director Todd Wilson. “We want to be leaders in the solution.”

The solution is stymied with the present monetary resources available through the Indian Health Service.

“The Indian Health Service is underfunded and are only paying for life or limb situations,” Wilson said. “There are state programs available that could help if they were tailored to us.”

“We Crows support you. We all have these stories,” said Crow Tribal Council Vice Chair Shawn Backbone. “It’s time to move forward to resolve them. We want to be winners in life and we only have one shot to make it right.”

Bullock said his concern for Indian Country does not come in step with the four-year election cycle. He has made concerted efforts in Indian Country to help improve local economies that are a key foundation to a better life.

“I appreciate not just your stories but your commitment to the health care issue,” Bullock said. “We need to talk about what this office would look like and how it could be successful making it through the legislature.”

“The governor is always trying to figure out the right thing to do for the people of Montana,” said DPHHS Director Richard Opper, adding that there are political roadblocks to that. “There is a disparity in health care and we need to close that gap. The statistics are so terribly painful. There needs to be more of a focus on Indians. We need to continue to partner together to resolve this.”

“We are aware of the issues and we are committed to resolve them. If we don’t do it, it won’t happen,” Howlett said, alluding to the tribal and state officials at the meeting.

DPHHS Director Richard Opper called the health care disparity among American Indians in the state, “terribly painful.” (B.L. Azure photo) DPHHS Director Richard Opper called the health care disparity among American Indians in the state, “terribly painful.” (B.L. Azure photo)

The heath care representatives from the Tribal Nations told Bullock they would prefer that the proposed Office of American Indian Health would be included in the budget that he’ll submit to the 2015 Montana Legislature that convenes in January. The inclusion of the OAIH in the Bullock administration budget would not totally de-politicize it but would add a layer of armor that would not be available through the legislative process if it were submitted as a stand-alone bill.

The budget has to finalized for submission to legislators by November 15, and Bullock would like the proposal with staffing and budget numbers for the OAIH by September 15.

In the end it will come down to financial resources versus the human resource. In the minds and hearts of the American Indian people the human resource has always outweighed the monetary resource — humane versus inhumane.

“We are tired of losing generations of people,” Howlett said. “We can do better.”

Tribal Health: Building Better Health Care.

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