3.7.6: The Indian Health Services (IHS)
The United States has had a long history of mistreatment of its indigenous peoples. Early colonization efforts and the Westward Expansion movement caused the decimation of tribes, reappropriation of their lands, obliteration of food sources, and forced relocation of those that remained. Additionally, European settlers introduced infectious diseases and harmful substances like alcohol - to which many Native Americans have genetic predispositions to heavy dependence (Ehlers, 2013). Up until the early 20th century, the U.S. still had a warring relationship with different tribes. The Bureau of Indian Affairs, originally housed in the War Department, was moved to the Department of the Interior in 1849. It still wasn’t until 1921 that the Snyder Act created an official public health agency specifically for American Indians and Alaska Natives, and later in 1954 when it was settled within the United States Public Health Service (now part of the U.S. Department of Health and Human Services).
Some of the actions of different health initiatives both before and after the Snyder Act were beneficial - such as providing smallpox vaccines. Yet many others were incredibly harmful, and further damaged the psychological and social health of tribes. Poverty, substance abuse, and lack of resources on reservations, and incidences of child abuse and neglect prompted health agencies to attempt to “assimilate” young Native Americans. One of the ways that this was accomplished was by taking children from their parents and tribes and placing them in boarding schools, where they were punished for speaking their native tongue or engaging in tribal practices. Even after these boarding schools were shut down in the 1960s, children were still often taken from their families (sometimes for purposes of child protection) and placed into foster care. In 1978 this practice was ended, yet the traumatic impact to individuals, families, and tribes persists.
The present iteration of the IHS allows for more local control of funds and services, and has helped to decrease disparities in health outcomes of Indigenous Peoples, yet several challenges still exist. The program still uses a discretionary funding model (in contrast to the entitlement model of Medicare and Medicaid) and skilled professionals are difficult to recruit and retain - especially in remote or rural areas (Kruse et al., 2022).