Alaska Native healthcare systems: 'elevating health and wellness'.

• Author: Evans-Dinneen, Laurie
• Position: ALASKA NATIVE CORPORATIONS

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Health and wellness in Alaska has had its growing pains, particularly for the Alaska Native community. The soothing, compassionate doctor who made house calls in the middle of the night, birthing children or treating dire illness, is not a scene reminiscent of life on the tundra or the harsh northern coastline or the Aleutian chain--that scene hardly played out in Anchorage or Juneau. Pre-contact, well-being was traditional healing and the wisdom of the elders in the remote Native communities of Alaska. Post-contact, there was illness that had never been seen before, and well-being became healthcare, which meant a substandard and poorly funded healthcare system dictated by the federal government in offices far removed from Alaska.

The historical relationship between the federal government and Alaska Native healthcare has been one of love-hate, of entitlement and poor service. Because the US government was responsible for the country's pioneering westward expansion, taking away land from the indigenous people of the Lower 48 and creating the reservation system, the federal government is forever responsible for Native healthcare, which was captured in the Constitution in 1787, Article 1, Section 8. The long misunderstood concept about free healthcare for American Indians and Alaska Natives was just part of the Difficult Dialogue series, originally funded by the Ford Foundation's initiative of the same name and facilitated by faculty of the University of Alaska Anchorage and Alaska Pacific University under the 2008 theme, Alaska's Native Peoples: A Call to Understanding. "Free healthcare," however, doesn't necessarily mean top of the line services.

Who Defines Healthcare

Indian Health Services (IHS), which was formed in 1955 and removed healthcare oversight from the Bureau of Indian Affairs, was the controlling force in indigenous healthcare, providing and dictating health and social services on a national level, The effort was to consider health issues on the local level and on the national level, and often the national level won out based on theories and research toward mainstream culture and assimilation, which followed the funding. The IHS relied on the US Public Health Services' Commissioned Corps of professionals who wanted to work with the underserved and disadvantaged populations. Some would say these were the best efforts, and others knew services could be better.

"There is still the common stigma of tribal healthcare that you won't be seen until it is too late or you are too sick," says Donna Bach, director Public Relations and Intergovernmental Affairs for Yukon Kuskokwim Health Corporation (YKHC). "The old saying was, 'You better hope you get sick in October before the money runs out by June,'" she laughs. The focus was on symptoms rather than on prevention.

In 1975, the Indian Self-Determination Act was passed by the US Congress, which allowed for Alaska Natives and American Indians to determine their own path for wellness and the well-being of their people. The Act allows for the tribes themselves to have greater control in decisions regarding their own welfare rather than allocating the decision making to government officials. Once the Act was passed, this opened the door for Alaska's indigenous people to begin to chart their own course toward health and well-being. Alaska Native tribes had taken over all contractible functions from IHS because it was considered substandard.

"The real benefit is extraordinary empowerment to control their own health services programs,"...