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The Role of Tribal Colleges and Health of Native American Population

By Natalia Rekhter
Assistant Professor. Director Health Services Administration Program Lincoln College 715 W. Raab Rd. !ormal "L #17#1 e$mail% nre&hter'lincolncollege.ed( office% )*+$,#-$.)1+ cell% )17$.1*$)1.-

Introduction For more than two centuries Native Americans have had to depend on the federal government for their health care provision. In 1954, Congress created the Indian ealth !ervice "I !# which toda$ administered provision of health care to the appro%imatel$ 55& of the '.5 million Native Americans "(ivers, Fottler, ) *ar+er, ',,5#. In addition to the I !, two ma-or acts have pla$ed a su.stantial role in providing health care for American Indians and Alas+a Natives "AI/AN# . In 1905 congress implemented the 1Indian !elf23etermination and 4ducation Assistance Act5 6*u.lic 7aw 98298:2 which made it possi.le for the !ecretar$ of the !tate 3epartment of ealth and uman !ervices to contract with the Native American tri.es for the deliver$ of their own health programs. ;he following $ear, Native Americans health care provision was aided .$ the implemented of the 1Indian ealth Care Improvement Act52 *u.lic 7aw 9424802 which aimed to find the most efficient wa$ of meeting the health care needs of Native Americans. ;he acts of 1905 and 1909 have helped in addressing some of the health care pro.lems of AI/AN, while a shortage of <ualified health care professionals among the Native Americans has e%perienced a stead$ growth over the past few decades "Allison, (ivers, ) Fottler, ',,0#.

3espite the efforts, the health of the AI/AN population has .een lagging significantl$ .ehind that of the general population in the =nited !tates. Native Americans are two times as li+el$ as general =.!. population to die from dia.etes, 1.9 times as li+el$ to .e o.ese, 1.8 times as li+el$ to have high .lood pressure and 1.' as li+el$ to have heart disease "Allison, (ivers, ) Fottler, ',,0> ?arton, ',,9> ;he @ffice of Ainorit$ ealth, ',,9#. Also, the AI/ANs have 1the third highest rate of AI3! diagnosis in the =nited !tates, despite having the smallest population5 "Aar-ane, ',1,, p.'#> their rate of tu.erculosis is more than five times higher than for non2 ispanic whites. Additionall$, AI/AN suffer from a higher than other ethnic group predisposition for mental illnesses, suicide, su.stance a.use, infant mortalit$, sudden infant death s$ndrome "!I3!#, and teenage pregnancies ";he @ffice of Ainorit$ ealth, ',,9#. Conclusivel$, 1geographic isolation, inade<uate sewage disposal, low income5 ";he @ffice of Ainorit$ ealth, ',,9# as well as inade<uate num.er of culture sensitive healthcare providers and pu.lic health professionals prevent AI/ANs from o.taining <ualit$ health care services. Bhile different efforts are made to close this gap, the pro.lem of educating <ualified healthcare providers and pu.lic health professionalsC remains. @ne of the strategies suggested .$ Native American tri.e leaders and representatives of I ! is to create partnerships .etween 3epartments of *u.lic ealth and 1local -unior colleges and technical schools to train tri.al mem.ers in various health professions including nursing5 "Allison, (ivers, ) Fottler, ',,0, p.8,0#. Another idea is to engage ;ri.al Colleges in cultivating programs attuned to tri.al health related traditions, cultural values, and historic .elieves. In this paper I aim to development a .etter understanding of ;ri.al Colleges and =niversities ";C=# in the =!. ;his should help in researching and evaluating ;C=sC efforts of

addressing health disparities of Native American population .$ adapting the polic$ of improving and increasing educational opportunities.

vervie! of Tribal Colleges and "niversities #TC"$ First ;ri.al College2Nava-o Communit$ College in ;saile, AriDona2was founded in 199:. ?$ 190' there were si% other tri.all$ controlled communit$ colleges that together formed ;he American Indian igher 4ducation Consortium "AI 4C# "Erumm, 1995#. In order to .e classified as a ;ri.al College, the student .od$ must .e comprised of at least 51 percent Native Americans. Currentl$ there are thirt$ seven ;C=s serving AI/AN students educational needs in 14 states "Bhite ouse Initiative on ;ri.al Colleges and =niversities ;ri.al Colleges and =niversities Address 7ist, ',1,#. !i% ;C=s offer .accalaureate degrees and two offer masterCs degrees programs in 1.usiness, li.eral studies, protective services, education, Native American studies, and computer science5 "Erumm, 1995, p.5#. ealth related education is t$picall$

included in either vocational certification programs or into two2$ear Associate degree "!later ) @C3onnel, 1995#. ;ri.al Colleges are t$picall$ small institutions situated on reservation land, marred .$ the limited access to educational and other resources, and have an enrollment .etween two hundred and one thousand students. As of ',,5, there were 10,,,, full2 and part2time students enrolled in ;C= with appro%imatel$ 8: percent of facult$ and staff .eing Native Americans. A t$pical ;C= student is a single mother commuting to college from a distance of eight to :5 miles, wor+ing full2time outside of her home, and living on the edge of povert$ "*residential ;C= (eport ',,42',,5#, ',,9, Erumm, ',,4, Aichael et all, 1999> @C7auhghlin, ',,'> @rtiD ) ?o$er, ',,8#.

;ri.al Colleges, as part of sovereign nations, are not located on state or count$ owned land and, as the result, arenCt eligi.le for funding from state or countr$ ta%es. Funding for these institutions comes primaril$ from federal grants and federal appropriations, followed .$ endowments, private donations, some state grants, and tuition. As nescient institutions, ;C=s can hardl$ harvest an$ lavish alumni gifts and contri.utions, or en-o$ dividends from successful long2term investments portfolios and centur$2old endowments "Core$, ',,4> @C7aughlin, ',,'> *residential ;C= (eport, ',,42',,5#. @C7aughlin "',,'# pointed out to the common misconception that 1;ri.al Colleges receive considera.le funds from gaming5 "p. 989#, as tri.es often use proceeds from gaming for the .enefits of their families and reservations. Additionall$, ;C=s federal funding is .ased on the num.er of the Native American students enrolled as opposed to the siDe of their full student .od$. As the result, no funds are availa.le to the non2 Native students, although the$ often represent almost half of the ;C= studentsC population. "@C7aughlin, ',,'#. ;he mission and values of ;C=s are focused on 1promotion of Native culture and advancement of specific and uni<ue ;ri.al needs and attri.utes5 "Core$, ',,4, p.8#. ;he$ aim to lin+ the wisdom and wa$ of thin+ing of Native Americans with Bestern scientific approaches, however, the focus on Native culture, its centralit$, pla$s an essential role in ;C= studentsC success "Core$, ',,4> *residential ;C= (eport, ',,42',,5# According to *residential ;C= (eport "',,42',,5#, ;ri.al Colleges are helping students to succeed .$ treating cultural traditions as a student asset, as well as .$ valuing strong famil$ and communit$ ties, ;C=s help students succeed at higher levels than non2;C= AI/AN students. ;he stud$ reported that :, percent of those surve$ed who had initiall$ attended a mainstream universit$ did not complete their original program of stud$. Fet, more than half of students who attended a ;C= .efore articulating to a mainstream institution persisted, and 4, percent of students went on to gain a .accalaureate degree " p.:#.

Health Care Initiatives in Tribal Colleges ;ri.al Colleges demonstrated a variet$ of responses aimed at addressing the persistent disparities in the health of AI/AN and preparing <ualified healthcare professionals to address these gap and ine<ualities. 3r. 7ind<uiist2Aala, president of Can+des+a Ci+ana Communit$ College "CCCC#, divides ;C= responses to the aforementioned issues into three ma-or groupsG curriculum ad-ustments to educate more Native American health care professionals, communit$ education, and research "Barner, ) Hipp, ',,9#. !everal colla.orations and partnerships have .een esta.lished .etween ;C=s and the local universities, reservations schools and ?oards and 3epartments of *u.lic ealth to enrich curriculum options. For instance, !outh 3a+ota !tate =niversit$ and five !outh 3a+ota ;ri.al Colleges have developed 'I'I' partnership with the reservation high schools. ;he si%2$ear partnershipCs goal is to assist Native American students in o.taining seamless ?accalaureate degrees in critical field, including .iolog$ and nursing. Additionall$, the partnership is engaged in providing 1health and nutrition education to Native American communities and reservations across the state5 "@C7aughlin, ',,'#. !imilarl$, the Northwest Indiana College in colla.oration with the =niversit$ of Bashington, Bashington !tate =niversit$, and Northwest Bashington Indian ealth ?oard has esta.lished the Northwest Indiana College Center for ealth "NBICC # ";ri.al College Journal, ',1,#. ;he Northwest Indiana College intranet declared that 1the intention of NBICC is to encourage and support health2related programs and careers for NBIC facult$/students, and in that wa$, to serve the CollegeKs tri.al communities "httpL//nwicnet.nwic.edu/moodle/#. ;here are five local tri.al communit$ partnersG7ummi, Noo+sac+, !amish, !winomish and =pper !+agit. ?esides, the NBICC is engaged in research rooted in the needs of the local American Indians

communities. ;he initiative was funded .$ the Native American (esearch Center for ealth "NA(C #. *rior to the initiative, 3ine College in !hiproc+, New Ae%ico had colla.orated with the New Ae%ico 3epartment of *u.lic ealth and developed a non2clinical Associate 3egree in *u.lic ealth, the e%perience that is now .eing emulated .$ the CCCC. ;he National Institute of ealth "NI # has encouraged and funded several ;C=sC health initiatives where ;C=s were acting as a resource for providing health care education to the local American Indians communities. @ne of the pro-ects, the 3ia.etes 4ducation in ;ri.al !chools programs, had involved facult$ and students of eight ;C=s from seven different states. ;he participating institutions were charged with the creation of a dia.etes prevention curriculum for E21' children from the reservation schools. ;he pro-ect incorporated into curriculum the culture, traditions, and dietar$ preferences of Native Americans from each of the participating ;C=sC states into the curriculum ";ri.al College Journal, ',,0#. ;he =.!. !u.stance A.use and Aental ealth !ervice Administration "!AA !A# colla.orated with seven ;C=s for addressing issues of growing AI3! epidemic among AI/AN. ;he !AA !A also encourages program development .$ as+ing each institution to address the issue of IM/AI3! .ased on its communit$Cs specifics and needs "Am.er, ',1,#. I am cautious in m$ optimism, .ut conclusivel$, it seems that ;ri.al Colleges and =niversities are gaining the capacit$ in addressing the healthcare issues and disparities of Native Americans and Alas+an Indians. Aore of the ;C=s will pro.a.l$ tr$ to gain universit$ status, opening more opportunities for colla.oration, gaining federal and state funding and developing additional degrees and programs. As research portra$s, ;C=s are well positioned to .ecome leaders in educating culturall$ attuned health care professionals and creating culturall$ sensitive

health related programs. Com.ining these actions should assist in more aggressive $et sensitive tac+ling of health care needs of Native American communities.

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