1. poster was supported by the Cooperative Agreement Number 5U50MN000025 funded by the Centers for Disease Control and Prevention.
aimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control
Prevention.
Urban Indian Health
A Crisis Among Bal6more’s Invisible Demographic
Samuel Chen 1 2, Kerry Hawk Lessard, MAA 3, Yvonne Bronner, MS ScD 1 4
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ACKNOWLEDGEMENTS
Termina6on Policy Era (1940s-1960s)
• In an effort to end treaty obliga0ons toward
American Indian/Alaskan Na0ve (AI/AN) groups,
the U.S. government enacted policies to slowly
overturn tribal sovereignty
• Ul0mate goal was integra0on of AI/AN into
mainstream America; essen0ally the “Kill the
Indian, Save the Man” of the modern era
• For urbanized AI/AN, services and support found
on the reserva0on were unavailable in the city
Indian Reloca6on Act of 1956
• Government incen0vized reloca0on from
reserva0on lands to ci0es by offering small
payment and voca0onal training
• During this period, the Lumbee moved from North
Carolina to Bal0more for economic reasons; many
now live on or along Broadway Avenue
• 1950s: Indian Health Service was created & tasked with providing health
care services to AI/AN; only 6% of AI/AN lived in urban areas at the 0me
• Today: 71% AI/AN live in urban areas.
Coordinate Systems of Care
• Four Maryland-based organiza0ons exist
to assist the AI/AN popula0on, yet
seldom collaborate to help Bal0more’s
Urban Indians
• Na.ve American Lifelines
• Bal.more Urban Indian Center
• Johns Hopkins Center for American
Indian Health
• IHS Headquarters in Rockville, MD
• Together, these organiza0ons can
advocate and form a safety net for
Bal0more’s at-risk na0ve community
Validate Through Research
• In urban studies, include AI/AN as an
important part of research demographic
• Treat Urban AI/AN as separate group
worth studying
Honor Treaty Obliga6ons
• AI/AN paid $14,488,000,000,000 for
guaranteed good health
• Be`er health care for AI/AN must be
treated as a na0onal duty
71%
29%
Figure 1A: Loca6on Distribu6on of
American Indians/Alaskan Na6ves, 2010
Urban
Non-Urban
91%
4%
4%
1%
Figure 1B: 2016 IHS Budget, By Category
Clinical Services
Preven6ve Health
Other Services
Urban Health
19.9
41.2
11.6
32.7
28.5
7.1
0
10
20
30
40
50
Bachelor's
Degree
<200% FPL Unemployed
Percent of Popula0on
Figure 2: Health Predictors; Urban AI/AN
Compared to All Races, 2010
Urban
AI/AN
All Races
• Lack of documenta0on (Proof of Indian Origin)
• Ignorance of AI/AN rights/en0tlements on the
part of health care providers
• “Invisible” minority in urban popula0ons
• Culturally-insensi0ve care
• Unfamiliarity with available resources & how to
navigate the urban health care system
• Distrust of medical establishments
I want to express my deepest gra0tude, firstly, to the
MCHC/RISE-UP Program staff and my fellow program
members in Bal0more, Cincinna0, South Dakota and LA.
A hearielt thank you goes also my Lifelines family, as
well as to Dr. Alec Hoon and his staff. Because of all
of you, my summer has been educa0on, enjoyable
and, ul0mately, unforge`able.
1 Kennedy Krieger Ins6tute/Maternal Child Health Careers/ Research Ini6a6ves for
Student Enhancement-Undergraduate Program,
2 Amherst College, 3 Na6ve American Lifelines of Bal6more, 4 Morgan State University
Health predictors, like
educa0on level, socio-
economic standing and
employment status, are all
significantly worse among
Urban Indians compared to
the general popula0on
Unique Barriers to Health Urbaniza6on & the IHS
History of Assimila6on Health Predictors & Outcomes What Must Change?
21.6
16.4
9.2
5.9
0
10
20
30
Chronic Liver
Disease &
Cirrhosis
Alcohol-Induced
Death Deaths per 100,000
Alcohol-Related Mortality Rate per
100,000; AI/AN Compared to All Races
Urban
AI/AN
All Races
AI/AN experience staggering
rates of historical trauma-
related condi0ons, such as:
• Substance Abuse
• Domes0c Violence
• Depression
• Suicidal Idea0on/
Behaviors