Thirty-four years later: An interpretive policy analysis of perspectives on Title V of the Indian Healthcare Improvement Act

The Background: The Indian Health Care Improvement Act (IHCIA) established the federal obligation to advance the health status of federally recognized American Indian people. Title V of the IHCIA seeks to make health services more accessible to urban American Indians through urban Indian organizations. Today, urban Indians continue to experience significant health disparities compared with the general population, and chronic diseases are on the rise creating more challenges for the people and the system (Roubideaux, 2004). Intent of Study: There is a lack of research on the outcomes of Title V. Traditional policy analysis looks to assess whether a policy is “working.” Utilizing Interpretive Policy Analysis (Yanow, 2000), this study seeks to identify the different communities of meaning about Title V. According to Yanow (2000), different communities of meaning provide alternative views in which there is no single “correct” formulation of a policy statement. Therefore, we must unlock the perspectives of stakeholders to provide the meanings that are hidden and are missing from the assumptions of policymakers. I will identify and present these communities of meanings so that they can be translated and used for health service delivery policy making. Specifically, this study will provide an understanding of urban Indian health, and explain why health disparities remain prevalent. In this era of healthcare reform and impending Congressional reauthorization of the IHCIA, it is imperative to focus attention on a long-lasting urban Indian health crisis. Identifying the cultural understanding of this population's health inequalities may lead to socially just policy.