The 2.5 million Native Americans living in the United States face significant health problems, including high rates of infant mortality, diabetes and alcoholism. Conquest and the resulting system of reservations characterized by poverty and hopelessness go far in explaining the compromised health of Native Americans, but many factors are at work.
Solutions to the health problems of Native Americans have been elusive. Since the 1800s, the U.S. government has had the obligation to provide health care services for American Indians. Before the 1950s, this obligation was characterized by extreme neglect, and worse. Even with the establishment of the Indian Health Service in 1955, resources have remained scarce. Native American groups form sovereign nations and have their own beliefs and traditions. Programs designed to improve the health of Native Americans, if they are to be effective, must respect these beliefs and traditions and be culturally sensitive. With these precepts in mind, the Robert Wood Johnson Foundation funded two national programs to improve the health of American Indians.
In this chapter of the Anthology, Paul Brodeur, a veteran writer for The New Yorker and a frequent contributor to the Anthology series, examines these two programs. The first, Improving the Health of Native Americans, allowed grantees to develop projects addressing any type of health problem they chose. The second, Healthy Nations, focused on substance abuse. Both programs gave tribes and Indian organizations wide latitude in developing strategies consistent with their own values.