MCH in Indian Country - Partnerships to Identify and Address Health Disparities 14 th Annual MCH Epidemiology Conference December 10, 2008 Judith Thierry, DO, MPH Indian Health Service Stacy Bohlen National Indian Health Board

Albuquerque Portland Billings California Phoenix Oklahoma Nashville Navajo Tucson Alaska Indian Health Service Aberdeen Bemidji Service Population: 1.9 Million

Indian Health Service, DHHS Health Care System “ITU” Federal - 12 Area Offices, 31 Hospitals, 52 Health Centers, 31 Health Stations, 2 School Clinics Tribal - 15 Hospitals, 254 Health Centers, 166 Alaska Village Clinics, 112 Health Stations, 18 School Clinics Urban Indian Programs - 34 community to comprehensive health care programs

Urban Indian Health Organizations Nationwide (34)

Tribal Epidemiology Centers (TEC) Closing the Health Gap SIDS and Infant Mortality Initiative Building MCH Epidemiology Capacity Alaska Native Tribal Health Consortium -ANTHC Epi Center North West Portland Area Indian Health Board TEC Great Lakes Inter-Tribal Council TEC United South and Eastern Tribes TEC Inter Tribal Council of Arizona, Inc TEC Northern Plains Tribal Epidemiology Center AATCHB Seattle Indian Health Board/ Urban Indian Health Institute

Northern Plains Tribal Epi Center

“Native Americans rank at or near the bottom of nearly every social, health and economic indicator.” A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country U.S. Commission on Civil Rights

IHS

Percent of Population Below Poverty Level, 2000 Census AIAN (alone ) IHS total 29.2% US 12.4%

Percent of Males Unemployed, Age 16 and Older, 2000 Census AIAN (Alone) IHS total 16.3% US all races 4 %

Percent of User Population Under Age Five, FY 2004 US all races CY 2003 = 6.8% IHS Total-All Areas = 9.3

Percent of User Population Over Age 54, FY 2004 US all races CY 2003 = 21.9% IHS Total all Areas = 12.3%

YRBS 2003, Navajo Nation High Schools, BIE Funded Schools, Arizona Public Schools & the U.S. Unintentional Injury and Violence 2003 NNHS 2003 BIA 2003 AZ 2003 USA Attempted suicide in the past year 20%18%7.8%6.1% Smoke cigarettes in the past year 37.7%52%20.9%21% Offered drugs on school property 31% 28.1%28.7% Enrolled in PE classes29.4%48%37.9%55.7% Compiled by Donna R. Perry, MD, FAAP, FSAM, Chinle Service Unit

Infant Mortality by UIHO Service Areas Source: U.S. Centers for Health Statistics Notes: Results pertain to UIHO service areas with 10 or infant deaths to AI/AN mothers.*Significant difference between rates for AI/AN and all races combined. “Partial” refers to the inclusion of only those counties with a 1990 population of 250,000 or more. The Health Status of Urban Indians and Alaska Natives: An Analysis of Select Vital Records and Census Data Sources. March 2004 Urban Indian Health Institute, a division of the Seattle Indian Health Board Six-year Averages,

Birth Rates among Mothers with Diabetes, CY IHS total 49.0/1000 US all-races 29.3%

Mothers Who Smoked During Pregnancy, CY Percent of Mothers Who Smoked (All Births) Percent of Mothers Who Smoked (LBW) US all-races 12.2%