MCH in Indian Country - Partnerships to Identify and Address Health Disparities

14th Annual MCH Epidemiology Conference December 10, 2008

Judith Thierry, DO, MPHIndian Health Service

Stacy BohlenNational Indian Health Board

Albuquerque

PortlandBillings

California Phoenix

Oklahoma

Nashville

NavajoTucson

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)

Urban Areas67%

Rural Areas33%

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 CountryU.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 2004Percent 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

Violence2003NNHS

2003BIA

2003AZ

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% 31% 28.1% 28.7%

Enrolled in PE classes 29.4% 48% 37.9% 55.7%

Compiled by Donna R. Perry, MD, FAAP, FSAM, Chinle Service Unit

Infant Mortality by UIHO Service Areas

0

5

10

15

20

25

Lo

s A

ng

eles

CA

Oak

lan

d C

A (

Par

tial

)

Tu

cso

n A

Z

Den

ver

CO

(P

arti

al)

Ph

oen

ix A

Z

Alb

uq

uer

qu

e N

M

UIH

O T

ota

l (P

arti

al)*

US

TO

TA

L*

San

Die

go

CA

Sea

ttle

WA

*

Fre

sno

CA

(P

arti

al)

Milw

auke

e W

I

Min

nea

po

lis M

N*

Ch

icag

o IL

*

Ra

te p

er 1

,00

0 L

ive

Bir

ths

All RacesAI/AN

UIHO - AI/AN: 8.8

US - AI/AN: 8.9

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 2004Urban Indian Health Institute, a division of the Seattle Indian Health Board

Six-year Averages, 1995-2000

Birth Rates among Mothers with Diabetes, CY 1999-2001

IHS total 49.0/1000

US all-races 29.3%

Mothers Who Smoked During Pregnancy, CY 1999-2001

Percent of Mothers Who Smoked (All Births)

Percent of Mothers Who Smoked (LBW)

US all-races 12.2%