Poor Cancer Care for Native Americans Might Be a Treaty Violation; the Indian Health Service Is Chronically Underfunded. as a Result, Colorectal Cancer Rates in Indian Country Are through the Roof

By Urken, Ross Kenneth | Newsweek, July 29, 2016 | Go to article overview

Poor Cancer Care for Native Americans Might Be a Treaty Violation; the Indian Health Service Is Chronically Underfunded. as a Result, Colorectal Cancer Rates in Indian Country Are through the Roof


Urken, Ross Kenneth, Newsweek


Byline: Ross Kenneth Urken

There's a cruel joke often told in Indian country: "Don't get sick after June." The sick truth beneath those words is that by summertime the Indian Health Service--tasked with providing basic health care to the nation's 2 million Native Americans and Alaska Natives--has typically blown its meager fiscal year budget for its Catastrophic Health Emergency Fund. Perhaps even more dangerous to the health of natives across the United States: The IHS does not typically provide coverage for preventive services. Without those types of checkups--the mammograms, colonoscopies and other services that are mandated by the Affordable Care Act--cancers don't get found until it's too late.

This infuriates many community advocates, like Donald Warne, the first Native American doctor to serve on the national board of directors of the American Cancer Society. "People are suffering and dying unnecessarily," says Warne, who is also the chairman of the department of public health at North Dakota State University, the only master's of public health program with a Native American concentration. "If someone does not have insurance, and they're dependent on IHS, a [cancer] screening does not occur."

Some in Indian country are doing their best to change that. In 1990, Greg LaFontaine was a construction worker struggling with a drinking problem when he moved into the Indian Neighborhood Club, a Minneapolis facility that houses 20 Native American men working through addiction. LaFontaine--a Sisseton Wahpeton Sioux--found sobriety there and decided to pay it forward. He got a job at the center, and by 2011 he was 57 and serving as its director. That's when he got a call from Joy Rivera, a health navigator for the American Indian Cancer Foundation (AICF), who wanted to drop by his center's morning Alcoholics Anonymous meeting to talk about the importance of colorectal cancer screening. "Why the heck not?" LaFontaine recalls thinking. During her presentation, he found out for the first time that, as a Native American, his risk for colorectal cancer was startlingly high.

Colorectal cancer is the second most common cancer among Native Americans, behind lung cancer, and it afflicts this population in an outsized way: Northern Plains Native Americans, for example, face an incidence of the illness 53 percent higher than non-Hispanic whites, and among Alaska Natives the incidence is 115 percent higher. Some of these risks are the result of genetics and lifestyle (obesity, alcohol and tobacco use), but poor care and lack of screening are also to blame. And much of that is due to appallingly meager funding for tribal health systems.

The passage of the Affordable Care Act in 2010 included a reauthorized Indian Health Care Improvement Act, an upgrade to the 1976 initiative. Before it could really go into effect, however, the government shutdown in 2013 further crippled an already-deficient tribal health system. The IHS had its budget cut by 5 percent. Three years later, that slash has had the cumulative effect of some 800,000 patient visits missed because of insufficient funds.

There's another sinister saying among Native Americans: If you need quality health care in Indian country, commit a crime. After all, the U.S. government's per capita investment for the IHS is about one-third of that for the Federal Bureau of Prisons--and even though it's not exactly world-class, health care inside correctional facilities is better than what natives typically receive outside.

"We have to take this issue into our own hands," says Rivera. She was one of the first three employees of the AICF, founded in 2011 by Dr. Dave Perdue, a Minneapolis-based gastroenterologist. The team has since grown to 15 people, who pound the pavement across the Northern Plains, from Minnesota and Wisconsin to Montana and the Dakotas. "They're really doing shoe-leather public health," says Perdue.

Rivera, who is Haudenosaunee and from Rochester, New York, is a former math teacher who drives around Indian country providing eight-hour workshops on the anatomy of the digestive system and colorectal cancer risk factors. …

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