Urban indian health organizations at risk: How policy impacts sustainable healthcare in urban indian communities

Nearly 70% of American Indians/Alaska Natives live in urban areas. Individuals in these communities suffer from chronic conditions such as diabetes, cardiovascular disease and mental health disorders at rates far above those of any other group. In the Federal budgets for 2007 and 2008 healthcare for Urban Indians allocated through the Indian Health Service (IHS) was cut to zero. This funding was restored in the 2007 budget, but 2008 is still undecided; it is unlikely that funding will be increased by the tens of millions of dollars needed to ensure that the 34 Urban Indian Health Organizations (UIHOs) which cater to Indian people in US cities will be fully funded and able to deliver needed services to these consistently underserved populations. As long as UIHOs are dependent primarily upon IHS funds to keep their doors open, these programs are endangered. This presentation will offer an overview of UIHOs, including discussion of the historic policy which led to the existence of large populations of Indian people in urban centers throughout the US and the important trust relationship that requires the US government not to abandon these communities. UIHOs face enormous challenges yet provide their communities with vital services and are the repositories of unique and valuable information about the health of the people they serve. Having gathered insights from UIHOs throughout the country, the presenter will suggest policy changes needed to ensure the sustainability of UIHOs and describe a plan for developing new models for funding and organization of UIHOs.