Millions of American Indians and Alaska Natives living in or near cities throughout the United States are seemingly invisible to health care providers and federal and state policy-makers and yet face significant heath care disparities, according to a new report, Invisible Tribes: Urban Indians and Their Health in a Changing World. The report will be released today by the Urban Indian Health Commission (UIHC), a select group of leaders convened by the Robert Wood Johnson Foundation and the Seattle Indian Health Board's Urban Indian Health Institute to examine health care issues facing urban American Indians and Alaska Natives.

Nearly 67 percent of the nation's 4.1 million self-identified American Indians and Alaska Natives, or about 2.8 million people, call U.S. cities home. However, there is no uniform policy regarding urban Indian health, and current federal executive policy actually aims to eliminate funding for urban Indian health within the Indian Health Service.

"The collective health of this growing population continues to suffer, and disproportionately, compared to other Americans," said Ralph Forquera, M.P.H., director of the Urban Indian Health Institute. "The Commission's report illustrates the need for health care providers; policy-makers; and local, state and national private and public sector leaders to work together to provide better care to this seemingly invisible population."

The report reviews the prevalence of three diseases—depression, diabetes and cardiovascular disease—in the American Indian and Alaska Native population. Top-line findings from each disease include:

• Up to 30 percent of all American Indian and Alaska Native adults suffer from depression, and there is strong reason to believe the proportion is even greater among those living in cities.
• Compared to the general U.S. population, American Indians and Alaska Natives have a higher prevalence of diabetes, a greater mortality rate from diabetes and an earlier age of diabetes onset.
• Cardiovascular disease is the leading cause of death among American Indians and Alaska Natives and kills more American Indians and Alaska Natives age 45 and older than cancer, diabetes and unintentional injuries—combined.

According to the report, it is common for an urban Indian to suffer from more than one of the aforementioned diseases, which ultimately interact with, amplify and perpetuate one another. Many of the underlying causes, markers and barriers to treatment of these diseases are shared, at above-average rates, by other diseases and afflictions suffered by American Indians and Alaska Natives.

A big challenge for urban Indians is accessing high-quality, appropriate health care. The vast majority of American Indians and Alaska Natives living in cities are ineligible for or are unable to use health services offered through the Indian Health Service or tribes. And even when urban Indians do manage to access health care, they must overcome additional barriers to receiving appropriate care. Cultural misunderstandings, a lack of respect and communication obstacles often interfere with—and inhibit—the delivery of high-quality health care to urban American Indians and Alaska Natives.

"We can't ignore this population in our efforts to improve the quality of American health care," said Michael W. Painter, J.D., M.D., senior program officer at the Robert Wood Johnson Foundation. "The nation cannot truly improve health care quality without also reducing disparities. Although we continue to make some in-roads in reducing racial and ethnic disparities in health care, these efforts have largely overlooked American Indians and Alaska Natives living in or near cities. We must make sure that the work to reduce disparities and improve the quality of care explicitly includes our nation's first people, no matter where they might currently live. If we don't, future generations will and certainly should judge us harshly."

The UIHC report recommends informed dialogue and targeted action. The public and private sectors must recognize and assist urban Indians in order to improve their access to appropriate care and health services, work to enhance data collection and research pertaining to American Indians and Alaska Natives living in cities, support funding initiatives, and identify and institute best practices in urban Indian health care. Most importantly, Americans must understand that the quality of health care for all will not improve without addressing—and reducing—disparities.

"Decades ago, tribes exchanged their land and its vast resources for federal promises of better life and better health," Forquera said. "The government has not delivered on its promise. We, as a nation, have a duty to right these wrongs, and illuminate this invisible population."

Access the report, Invisible Tribes: Urban Indians and Their Health in a Changing World, or view a Webcast of the report release briefing event.

The Urban Indian Health Commission is a select group of leaders convened by the Robert Wood Johnson Foundation and the Seattle Indian Health Board's Urban Indian Health Institute to examine health care issues facing urban American Indians and Alaska Natives.

The Urban Indian Health Institute (UIHI) was established in July 2000 as a division within of the Seattle Indian Health Board, a community health center targeting urban American Indians and Alaska Natives. The UIHI provides centralized nationwide management of health surveillance, research and policy considerations regarding the health status deficiencies affecting urban American Indians and Alaska Natives.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in our lifetime.