by Jesse Harding
NCUIH Legislative Update
by Danielle Delaney

 

 

 

 

As part of a commitment to raise awareness of Urban Indian issues and expand outreach to diverse audiences, NCUIH attended for the second year in a row the Annual Session of the United Nations Permanent Forum on Indigenous Issues.  UNPFII's VII session took place in New York in late April. This year's theme was climate change, bio-cultural diversity and livelihoods.

A special session was devoted to the urbanization and migration of Indigenous communities.  Last year NCUIH approached the representative for the North American Region, Ms. Tonya Gonnella Frichner, ESQ, to bring to her attention the serious health care situation of the Urban Indian population and the hardships of those Indians that remain in Tribal lands. Using this information as a basis for her speech, Ms. Frichner made an intervention on the dire situation of our population during the session devoted to the creation of the 2008-2009 Agenda on June the 2nd (watch video on youtube here).

Throughout the two weeks of the Session representatives from a number of indigenous communities across the globe offered testimonies speaking of the injustices associated with the clean development projects. The respect of indigenous peoples rights to self-determination and to decide on mitigation and adaptation measures in their lands and territories were other topics that the representatives dwelled on.In an effort to build new relations and seek new sources of technical assistance, NCUIH also approached a number of agencies such as the World Health Organization, the Pan-American Health Organization, the European Commission, and the Organization for International Migration to inform them about the widely unrecognized situation of the Urban Indians. Moreover, NCUIH established burgeoning relationships with representatives of sister communities in other countries such as Canada and New Zealand (Maori).

The meeting with the Maori delegation from New Zealand was of special interest to NCUIH. The Maori population is generally considered the most progressive and advanced in terms of incorporating their traditional health care system and values into the framework of the mainstream healthcare system. NCUIH plans to further strengthen relations with the Maori of New Zealand to learn and exchange best practices with them.

At the closing session, it was decided that the implementation of the UN Declaration on the Rights of Indigenous Peoples should become a permanent item on the Forums agenda. NCUIH is currently working on its application to become a full UNPFII member for next years (the 8th) Session, which will focus on economic and social development, indigenous women and the Arctic region.

The Tribal Leaders Diabetes Committee (TLDC) is charged with advising the Director of the Indian Health Service on all matters related to the Special Diabetes Program for Indians (SDPI), including funding allocation. During the quarterly TLDC meeting in May2008, the main topic of discussion was the large amount of carryover money in SDPI. Carryover money is funds that have not been expended by the end of the approved budget periods. At this time there is an extraordinarily large sum that is considered carryover money. This carryover amount is cumulative over the entire life of the SDPI grant program.

A subcommittee consisting of four tribal leaders and a NCUIH representative was appointed at the last TLDC meeting and charged with finding solutions to this rather contentious issue. The subcommittee both looked to identify why the carryover money has not been spent down and to provide solutions for ways in which to quickly spend down the funding. It is recognized by TLDC that funding must be spent down in order to approach Congress to request additional funding as well as a longer reauthorization period.

The urban side of this issue is faring pretty well, even if some programs have carryover money which must be dealt with. However, it is encouraging to note that urban programs receive 5% of the total of SDPI funding while only making up 2.5% of the total carryover amount.One of the main and potentially systemic issues with the SDPI program is that the financial reporting does not match the actual drawdown amount in the financial management system. This problem also occurs with our urban programs. In the coming months, programs will need to have a plan to spend down money during the FY2009 funding year. Programs should also be aware that carryover money must be exhausted by 9/30/09. One of the issues identified by the subcommittee as a barrier to spending down involves obtaining the actual approval from Grants Management Office (GMO). However, GMO has committed to providing training in order to make the approval process as painless as possible. NCUIH and NIHB may also have a role in this training as recommended by the TLDC.

As the Urban Representative of TLDC, NCUIH received a copy of the urban programs funding amounts, reporting amounts, and actual drawdown amounts. This information can be obtained from your local NCUIH representative.

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The Air Native N7, Nikes new shoe designed specifically for the American Indian, was introduced at the National Indian Health Boards consumer conference in the fall of 2007. This marks the first time Nike has designed a sneaker for the Native American, let alone for any specific race or ethnicity.  Named the N7 to represent Natives and the Seven Generation philosophy, the shoe has a star pattern design on its sole and is lined on the inside with a feather pattern.

Designers and researchers from Nike have invested two years of research to map the distinct shape of the American Indian foot and to produce a shoe that more comfortably fits its anatomy. During this research it was found that the American Indian foot is both much wider and taller than the average shoe accommodates for.  As a result, the Air Native N7 is wider with a larger toe box. The shoe has fewer seams for irritation and a thicker sock liner for comfort.

Nikes premise follows the simple notion that all people have a need for athletic footwear. In the case of American Indians there is a need for cheap, form-fitted footwear that promotes physical fitness and well-being. The Air Native N7 is expected to be particularly helpful to our Indian communities where problems with obesity, diabetes and related complications are reaching pandemic levels.

Dr. Rodney Stapp, CEO of the Urban Inter Tribal Center of Texas and a board member of NCUIH, originally made contact with Nike to inform them that one of their cross training shoes was helpful to his diabetes patients who were unhappy with the look of the shoes normally made for diabetics.  Later Nike contacted Dr. Stapp to help them form part of the team responsible for the design of the shoe. 

Nike has committed to offering 10,000 pairs of the Air Native N7 at a wholesale price. The shoes will be distributed through tribal schools and wellness programs, and they will be priced at $42.80 a pair.  Ideally this should allow individuals to purchase the shoes at a nominal cost or for no money at all. To further show the companys commitment to Indian Country, all profits which were at first projected at $200,000 will be reinvested into Indian communities in the Let Me Play programs which focus on sport and active living. The shoe will only be available to Native Americans.

According to Sam McCracken, who heads Nikes Native American Business branch, Through the Nike Air Native N7 we are stepping up our commitment to use our voice on a local, regional and national level to elevate the issue of Native American health and wellness. We believe physical activity can and should be a fundamental part of the health and wellness of all Native Americans."

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Unity and knowledge sharing make a difference. NCUIHs 2007 Annual Conference, which took place in Washington DC in September last year, was a living proof of both.  The conference was attended by NCUIHs membership, spiritual leaders, tribal and urban representatives, as well as our Board of Directors. This group of committed individuals gathered to discuss current challenges and opportunities in the Urban Indian Health sector. The conference was designed to allow for the sharing of practical and technical knowledge rooted in the participants own unique experiences. This collaborative and synergistic framework generated a high level of participation and energy throughout the whole event.  

The main objective of the 2007 Conference was twofold: to update and improve. The term update referred to keeping the NCUIH membership up to date on the legislative, political and financial situation of both the organization and the Indian sector itself. The improving was aimed at creating increased awareness of the importance of unity and knowledge sharing both at the conference level and beyond. The importance of unity was particularly emphasized and served as a common thread throughout the conference for the Urban Indian Health Programs and our reservation-based counterparts. The urban-tribal relationship thus received special attention through direct dialogue with tribal leaders and sessions aimed at strengthening our common Indian identity. Similarly, the role of communication and knowledge sharing was extensively reviewed by a number of speakers, both external and internal to Indian Country.

Senator Tester from Montana was one of the conferences key note speakers. His speech focused on the importance of reauthorizing the Indian Health Care improvement Act as well as his own dedication to combating the attitudes that have prevented the reauthorization of the Act in the past.  The speech set an example of the kind of political commitment NCUIH and the greater Indian cause enjoy in Washington even if many battles still remain ahead of us.

Addressing the success of the Annual Conference Geoffrey Roth, NCUIH Executive Director, stated that the goal of this conference was to provide relevant technical expertise to our programs while instilling in them a sense of the support that they have here in Washington. Expounding on the importance of the conference for NCUIH and its membership, Roth further expressed that this was not merely rooted in an organizational pledge to elect a new board every year, but also because this event is a way for NCUIHs members to gain greater insight into the political processes in Washington. The conference is a platform for exchanging experiences and information, making valuable contacts with peers and being better informed about how urban Indian health is supported, Roth said.

As in years past, elections were held for the coming years Board of Directors. NCUIH would like to belatedly thank the out-going board for its hard work to ensure the continued prosperity and success of the Urban Indian Health Programs and welcome the new board to a year of continued challenges, high productivity and success.
 

The TeenPEACE Project is a violence intervention model within the Peace Mentors Program, which caters to teens that have experienced, witnessed or perpetrated violence in relationships. The program has been in operation for more than five years and had by its first year already served 180 teens.

Teaching youth to think differently about violence and how violence influences their lives are some of the central tenets of TeenPEACE. Domestic violence starts and influences you when youre young, says TeenPEACE Project Coordinator Tara Dowd. and thats why TeenPeace targets the youth for prevention.

Participation in the program takes place on a rolling basis. Referred to the program either by a school, parent, the juvenile system or themselves, TeenPEACE is open to participants of all ethnicities. Approximately 50% of all participants are of color. Groups usually consist of 5-15 teens who meet weekly for 12 weeks.

In the past, TeenPEACE has organized groups according to sexual orientation (the gay/straight alliance) or ethnicity (all AI/AN groups). But groups are also regularly divided along the lines of age and gender as this is sometimes a better way of engendering and building trust. During meetings group facilitators popularly referred to as peace mentors use a psycho-educational approach. This approach allows the teen to make up his or her mind what should be the correct behavior in a given situation. It is in this system that trust is being built and that healing can begin. The intrinsic value of TeenPEACE is the close relationship between mentors and kids. It is through building a trust relationship in a non-judgmental manner that the true success of the program can be measured, explains Tara Dowd.

Although TeenPEACE doesnt have the means to measure the success of the project through follow-ups (as in how many participants finish high school, how many return to the juvenile system, and what are repeated rates of violence amongst the participants) the project does perform pre- and post-tests to evaluate the development of participants throughout the life cycle of the program.
An integral part of TeenPEACE is the acknowledgement of historical trauma as a part of their idea about violence.  For instance the influence of racism on the development of the understanding of violence, says Dowd. TeenPEACE teaches them how to develop healthy ideas. Everybody has prejudices, but its the process of becoming aware of them that is important.

The TeenPEACE Project in Spokane is a collaborative effort between three agencies (requirement from grants): The N.A.T.I.V.E. Project, Volunteers of America's Crosswalk and YFA Connections.

TeenPEACE is funded by: an IHS Domestic Violence Grant and a grant from Spokane County Community Network.

by Alejandro Bermudez- Del Villar 

Information and research on urban Indian health issues is extremely scarce.  A recent study sponsored and carried out by NCUIH  shows that less than 150 documents on this very topic
have been published in the past twenty years. Moreover, most of these documents are of limited scope and focus, and thus unviable to serve as a scientific basis for NCUIHs educational efforts.
Recognizing the need for higher outputs of quality research, NCUIH has supported and actively participated in the selection of candidates for the Johns Hopkins Summer Indigenous Research Institute. The Research Institute aims to explore common means to overcome major health challenges that threaten indigenous cultures and communities. The Research Institute was inaugurated in 2007 and is spearheaded by the Johns Hopkins Center for American Indian Health with the support, among others, of the National Indian Health Board (NIHB), the National Congress of American Indians (NCAI), Indian Health Services (IHS) and NCUIH.

NCUIH is aware that today more than ever research is paramount to the Urban Indian Health sector. With the backing of scientifically accurate information NCUIHs educational initiatives will carry more leverage with policymakers and, ultimately, will have an impact on the public policies affecting Indian Country. In continuation of our mission to promote quality research on urban Indian health issues, NCUIH is proud to support the Research Institute in its preparation for the 2008 summer sessions, which will be taking place from June 30 to July 11 2008.  This year, which is the second in a three year cycle, topics will center on Community Based Participatory Research.

New Horizons?

Another attractive component of the Research Institute is its international outlook, which helps fostering partnerships, collaboration and knowledge sharing across territorial boundaries. This year the Institute will again include many international participants from New Zealand, Canada and Australia, which share similar historical experiences. Rooted in last years international experience, NCUIH has initiated contact and dialogue with urban Aboriginal health organizations in Australia and New Zealand. It is our hope and expectation that these new international contacts and connections will be mutually beneficial for the organizations and for the populations they serve.

Like last year, where two urban Indians participated in the Research Institute, NCUIH will help in the process to recruit and select candidates through its member programs.  NCUIH will also

continue supporting Johns Hopkins Universitys inclusion of urban Indians in projects that most certainly will both increase and disseminate urban Indian research and knowledge.

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Former Executive Director of the Salt Lake Walk-In Center (2003-2007), Dena Ned, was one of only two Urban Indians to participate in the 2007 Johns Hopkins Summer Indigenous Research Sessions, which focused on the Social Determinacy of Health in Indigenous Populations.

NCUIH NEWS recently spoke with Dena about her thoughts and impressions from the program.
The whole package, Dena Ned says with a smile in her voice in response to my question of what were the most memorable aspects of the Research Institute. After trying to describe the readings and resources provided to the participants, the comparative examples and lectures, she just says the whole package.

The impact of the 2007 Summer Indigenous Research Sessions on Dena Ned is unmistakable. From the programs overall effort to provide useful tools for the participants to take back to their respective communities to the inspiration gained from interacting with other indigenous populations from around the world and learning about their particular health care issues and challenges.
Ned says, When I left I thought to myself, Okay, I need to learn more now. Because once you have that first week under your belt, it inspires you to get to the next level of whats out there. You start thinking.

The Research Institute also fit well into Ms. Neds passion for the topic of higher education and advocacy for minority students, including access for American Indians and Alaska Natives. In her work, Ms. Ned has written quantitative papers looking into how native people are affected today by federal Indian policy, colonization and Post Traumatic Stress Disorder. Thus putting the
social and medical well being of AI/ANs into a historical context some of the answers to the issues plaguing the populations in Indian Country can potentially be unveiled.

In that regard, the program was an awakening says Dena Ned, and continues: It was an introduction to what is out there in terms of knowledge But more importantly, it allows you to start thinking about how important it is for indigenous people to start doing our own research to make our reality more accessible to the world at large.

Dena Ned encourages anyone passionate about the health care situation of urban Indians to apply to this years Research Institute and other similar opportunities. While the process of writing an application letter can seem daunting, it makes an impact on the admission committee when they realize how much you know about your community and the struggles it is facing. Telling your story in a well thought, organized manner can actually open up some doors, she says. There are tons of these opportunities out there and we just have to apply and start to bring in that urban perspective. 
The international component of the Research Institute, however, was the most influential to Dena Ned. Seeing the differences and similarities of the situation of indigenous peoples around the world our shared history gives hope for collaboration well into the future. I strongly believe we need to start looking globally at other indigenous populations and to what they are doing, and supporting their work, their research and initiatives so we get their support in turn Ned says. What is working for them?

Finally with a nod to our domestic situation and seeing what other governments are providing their indigenous peoples Ned flatly says, We [the United States government] are so far behind what these other governments are doing. And so the struggle to secure proper health care and life conditions for AI/ANs continue but now we can rely on the support of an international community of indigenous peoples.

For more information about the Johns Hopkins Summer Indigenous Research Institute please visit: http://www.jhsph.edu/academics/continuing_ed/Summer_Institutes.html
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The 2007 National American Indian and Alaska Native Heritage Month took place in November and was highlighted by the signing of a Memorandum of Understanding (MOU) between the US Health and Human Services (HHS) Secretary, Mike Leavitt, and Canada's Minister of Health, Tony Clement. This MOU, which is a continuation of the five-year MOU signed in 2002, focuses on enhancing indigenous health care delivery and access.

The signing marks the continued will of the two nations to build upon the work that has already been accomplished. A fact which was further supported by Secretary Levitt who explained that there had been, made important strides in raising the health status of indigenous people in the United States and Canada through the sharing of health information, education, and training over the past five years of this partnership.

The MOU also encourages organizations like NCUIH to engage and share knowledge and expertise with our Canadian brothers and sisters. Over the past few years, NCUIH has initiated a series of collaborations involving indigenous populations from Canada and other regions of the world. In fact, one of NCUIHs goals for 2008 is to monitor and develop opportunities which may enhance and increase dialogue between urban Indian groups in the United States and parallel organizations in Canada.

The signing of the 2007 MOU took place inside the HHS national headquarters in Washington DC in the presence of a diverse delegation of Indian Country leaders and NCUIH staff.

IHS and the First Nations and Inuit Health Branch, its corresponding Canadian agency, will be administering the MOU activities for the United States and Canada respectively.
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This is a brief overview of legislative developments relating to NCUIHs work and membership.
Congress Appropriations

For the second consecutive year, the Urban Indian Health Program has received an increase in funds after originally being zeroed out of the Administrations budget. This year it is an increase from the original House numbers for Urban Indian Health as it appeared in the Interior Appropriations Bill for FY2008. Urban Indian Health is now slated to receive $34.547 million. This amount takes into account a 1.56% recession that was performed across the board for all funded agencies.

Presidents FY2009 Budget
For the third year in a row the Administration has zeroed out the Urban Indian Health Program in its FY2009 budget. The justification given for this elimination is essentially the same as in previous years. The only exception is that the Urban Indian Health Program is not only held to be duplicative of the services performed in HRSA administered health centers, it now also duplicates all other local, state, and federal health resources. NCUIH has actively opposed this erroneous belief by preparing testimony and briefing papers, which have been presented to the Senate Indian Affairs Committee, the House Interior Appropriations Subcommittee, the Senate Budget Committee, and to individual members of Congress. NCUIH has also collaborated with individual Congressional offices in a strong effort to secure reinstating funds for the program.
 
Additionally, policymakers in both Houses have worked to secure the support of their peers. Senators Barbara Boxer and John Thune co-authored a Dear Colleague letter, which was signed onto by 17 other Senators and later submitted to the Senate Interior Appropriations Committee. A similar letter presented to the House Interior Appropriations Committee was co-authored by Representatives Jim McDermit and Heather Wilson and supported by 36 of their colleagues. NCUIH remains in close contact with individual Congressional offices and the respective Congressional Committees as the appropriations process moves forward.
Finally, NCUIH will once again be organizing a letter writing campaign in support of the Urban Indian Health Program. We urge you to contact your local urban Indian clinic for details of how to help.

Indian Health Care Improvement Act
On January 22, the Senate version of the Indian Health Care Improvement Act (IHCIA), S.1200, went to the floor. Senators Murkowski, Stevens, Kyl, Baucus, Dorgan, Bingaman, Stabenow, Klobuchar, Nelson, Brownback, Reid, Thune, Johnson, Salazar, and Murray all gave strong statements in support of the passage of the Indian Health Care Improvement Act. Senator Brownback and Senator Nelson both signed on as co-sponsors of S.1200.  Senators Salazar, Thune, Reid, and Murray spoke on the necessity and essential nature of the Urban Indian Health Programs and expressed their strong support.  On February 15 the Indian Health Care Improvement Act passed the Senate on a stunning 83-10 vote, an undeniable veto-proof margin.The House version of the Indian Health Care Improvement Act, H.R. 1328, has just been discharged from the House Energy and Commerce committee without coming before the full committee for a vote. However, during subcommittee the Minority representatives expressed continued reservations with H.R. 1328, specifically Title V, which is the provision that funds the Urban Indian Health Program.

NCUIH anticipates the possibility of three amendments on the floor of the House: Firstly, to strike Title V in its entirety, secondly to strip appropriations authority for the Urban Indian Health Program, and thirdly to amend the definition of urban Indian to exclude state recognized tribes.
With the House Energy and Commerce Committee discharging H.R. 1328/IHCIA without bringing the bill before the full committee for a vote, all that remains is for House Ways & Means Committee to either favorably report out the bill or otherwise discharge the bill without further consideration. If Ways & Means reports out a version of IHCIA the bill must move to the House Rules Committee before it can move to the floor of the House. Thus reconciling differences between the Natural Resource Committees version of the bill and any version that Ways & Means reports out of committee. If the House Ways & Means Committee simply follows the lead of the Energy & Commerce Committee and discharges the bill IHCIA can proceed directly to the floor of the House.
NCUIH continues to work closely with NIHB to ensure that the bill will move to the floor of the House after reaching the deadline.

Health Centers Renewal Act

On May 7, the House Energy and Commerce Committee favorably reported H.R. 1343, the Health Centers Renewal Act of 2007, to the full House by a voice vote. H.R. 1343 extends the

330 grant funding for Community Health Centers until fiscal year 2012. The bill has 248 co-sponsors, including 80 Republicans, and is not expected to meet significant resistance on the floor of the House.

The Senate Health, Education, Labor, and Pensions (HELP) Committee submitted its written report, S.R. 110-274, to accompany the Senate version of the bill, S. 901, to the Congressional Record on March 12. S. 901 has 69 co-sponsors including 25 Republicans and both Independents. It is also currently waiting floor time. Democratic leadership both the House and Senate has not indicated when they intend to move the Health Centers Renewal Act to their respective floors of Congress.

Special Diabetes Program for Indians
A yearlong extension for the Special Diabetes Program for Indians (SPDI) was successfully attached to the Medicare legislation, which passed at the very last moment before Congress went on recess for the Christmas holidays. NCUIH continues to work with NIHB and the American Diabetes Association for the reauthorization of this vital program.

Substance Abuse and Mental Health Services Administration Reauthorization
The Reauthorization of the Substance Abuse and Mental Health Services Administration has unfortunately hit a holdup in the legislative process. After failing to come to markup in the Senate Health, Education, Labor, and Pensions (HELP) Committee on January 30, there has been no other movement on this bill due to continuing concerns over provisions relating to religious entities.