State of Our Communities

Please click on one of the following topics:
  1. Academic Liaisons & Education
  2. Funding Sources for Urban Indian Health Programs
  3. Health Status
  4. History
  5. Human Resources (UIHPs)
  6. Leadership & Training (UIHPs)
  7. Media Development
  8. Population
  9. Poverty
  10. Relations with Non-Indian Populations
  11. Technology
  12. Tribal Relationship

Academic Liaisons & Education


 UIHI reports that AI/AN suffer disparities in educational attainment. In the UIHP's service area, 29.5% of AI/AN residents do not have a high school degree compared with 20.0% of the general population.


The Urban Indian Health Programs Survey (2008), reports that 85.7% of UIHPs have a relationship with a university on a variety of partnership activities:

68.4% of these UIHPs partner with University to offer

      • apprenticeship positions
      57.9% have research/evaluation projects
      52.6% use Universities to recruit for positions
      52.6% have projects to increase some type of health awareness
      42.1% partner on community development work
      36.8% partner on training efforts
      15.8% use Universities to assist with providing clinical and
      support services

      More...

      According to the Urban Indian Knowledge map 2007, the top three NCUIH regions with the largest amount of Academic Research are: California, Portland and Bemidji

      According to the Urban Indian Knowledge map 2007, most of the conducted academic research on Urban Indian Health is in quantitative terms


      Find Urban Indian-related research documents by clicking here

      Institutions and Research Centers with Native American Programs List

      For contact information on the Institutions/programs below click here
    • 1. Agency for Healthcare Research and Quality
      2. Auburn University Native American Association
      3. Center for Financing, Access and Cost Trends Medical Expenditure
      Panal Survey
      4. Harvard University Native American Program
      5. Haskell Indian Nations University Native American Studies
      6. Humboldt State University Native American Studies
      7. Montana State University American Indian Research Opportunities
      8. National Congress of American Indians- Policy Research Center
      9. Native American Student Alliance Aztec Center, San Diego State
      University
      10. New Mexico State University American Indian Program
      11. North Carolina State University Department of Multicultural Student
      Affairs
      12. Office of Native America Student Affairs
      13. North Arizona University Native American Students Services
      14. Oklahoma State University
      15. Penn State American Indian Leadership Program
      16. Research and Training Center Disability in Rural Communities
      17. The University of Montana Rural Institute
      18. Research Data Center
      19. South Dakota State University Office Multicultural Affairs
      20. Southeastern Oklahoma State University
      21. UCLA American Indian Studies Center
      22. University of Alaska Anchorage Native Student Services
      23. University of Alaska Fairbanks Office of Multicultural Affairs
      24. University of California
      25. University of Colorado at Boulder American Indian Student
      Services
      26.University of Kansas
      27. University of Minnesota Duluth The American Indian Learning
      Resource Center
      28. University of New Mexico American Indian Student Services
      29. University of North Carolina at Chapel Hill Native American Programs
      30. University of North Dakota American Indian Student Services
      31.University of Oklahoma Center for Student Life-Native American
      32. University of Oregon Ethnic Studies Program
      33. University of Portland
      34. University of South Dakota
      35. University of Utah Center for Ethnic Student Affairs
      36. University of Washington American Indian Studies Program
      37. Urban Indian Health Institute

      More....

      Disclaimer: the Institutions above-listed are not endorsed by NCUIH. This list is only for Informational Purposes. The list is not exhaustive. If you wish to include your educational institution in this list please contact kfowler@ncuih.org


      Funding Sources for Urban Indian Health Programs

      On average, the UIHPs reporting rely on Indian Health Services (IHS) for half of their funding, however there is incredible variability. Some UIHPs have many sources of funding revenue and are more diversified while others have very few sources and rely more heavily on IHS.Overall,Title V health programs and clinics excel at leveraging their Indian Health Service dollars to obtain additional funding from other Federal, State, and local sources. The breakdown of how Title V clinics and health programs are able to leverage funds is show below:

      While Title V programs are adept at finding other sources of funding, they are only able to do so through a solid initial investment by the Indian Health Service. When that base funding is insufficient to maintain core services the competitiveness of the Urban Indian Health Programs for other private and federal grants is badly damaged.

      When the competitiveness of the UIHP clinics and programs is damaged it is ultimately the urban Indian patients that suffer.

      • Comparison of Funding Allocation

      The fact that the Indian Health Service continues to be desperately underfunded is widely known. The FY2010 Congressional Appropriations made great strides to address this disparity, and NCUIH is relieved that the Indian Health Service was not included in the Obama Administrations FY2011 budget freeze. The Interior Appropriations Subcommittee has long recognized the need for the UIHP and consistently sought to fund the UIHP and the entire IHS at the highest possible level. NCUIH hopes that Congress will not only follow the White Houses lead, but also build upon the modest increases in the Presidents FY2011 Budget Request. Despite these modest increases in Presidents FY11 Proposed Budget, the Indian Health Service continues to be underfunded. Due to the chronic underfunding of the Indian Health Service, the Urban Indian Health Program is also desperately underfunded as the chart below demonstrates:

Human Resources


Approximately 40% of the UIHPs reporting have more than 51 full-time employees.

  • The lack of human resources emerged throughout the data as a major obstacle to operations and the top staff positions most needed to hire included doctor, nurse, case manager, and development officer. The most difficult positions to find candidates for were reported as doctor, nurse, financial staff, case managers and behavioral health staff. Further, staff training needs identified include (in order of significance) management skills, cultural competence, leadership, and communication flows.

    • Methods for Recruiting

    UIHPs also reported on their methods for recruiting staff. The top three recruitment methods identified by the UIHPs were
    1) Online
    2) Local newspapers
    3) Local Indian community. More...

    Leadership & Training

    • Accreditation

    Of the UIHPs responding the UIHP Survey 2008, 57.2% had some form of accreditation;
    of those, 25% were state or partial accreditation (i.e., accreditation for one type of service).
    For UIHPs that were not accredited, nearly sixty percent (58.3%) reported it was too expensive.

    • Current Board of Directors Training:
    UIHP Board of Directors are so critical for the direction and development of the organization. The UIHPs reported on current training that the Board of Directors received as follows:

    - 40% of the UIHP Boards had training on the role of non-profits
    - 20% had training on providing technical assistance
    - 20% had training on decision making capabilities
    - 25% had training on level of involvement
    - 35% had training on fundraising and responsibility
    - 55% had training on governance vs. management
    - 35% had training on legal/ethical issues
    - 30% had training on board self-evaluation
    - 5% had training on how to build community ownership
    - 25% had training on developing policy
    - 15% had training on managing diversity and conflict
    - 5% had training on spiritual leadership
    - 5% had training on Indian traditions and customs
    - 10% had training on strategic planning.

    • Desired Future BoD Training

    The UIHPs also had the opportunity to present the top needs with regards to board training.

    Top three needs were:
    1) Fundraising and responsibility
    2) Governance vs. Management and
    3) Level of Involvement

    Although these were the top three training needs, only 35% actually received training on fundraising and responsibility, 55% on governance vs. management, and 25% on level of involvement.
    More.

    Media Development

    Although the majority of UIHPs work with media to increase awareness of their activities in the community (85.7%), it is limited. Of those UIHPs that work with media, 88.9% do so for special events only. Fortunately, in marketing for special events, UIHPs use diverse methods of communicating to the public and 88.9% work with both native and non-native media. Of those UIHPs using native media:

    - 72.2% use native newspapers for marketing
    - 16.7% use native magazines
    - 44.4% use native internet sites
    - 27.8% use native television
    - 55.6% use flyers and other social marketing strategies within native community
    - 44.4% use native radio stations More...


    Population

    According to the Urban Indian Health Institute (UIHI) and the 2000 Census, over 1,000,000* residents reported that they are of AI/AN heritage (* This number includes AI/AN alone and in combination with another race).

    • Age-- Younger than the average
    The same study conducted by UIHI shows that the AI/AN population in the UIHO service area is younger than the population overall.

    More on the UIHI Community Profile Study--click here

    Born Unequal?
    Inequality Starts in the Womb

    Native American infants start off their lives disadvantaged. Several factors, such as smoking and alcohol use, influence the health of a Native American infant. The table (right) shows existing significant maternal and child health disparities in Indian Country. More...


    Poverty


    Native Americans: Among the Poorest People in the Wealthiest Country

    According to figures released by the U.S. Census Bureau in August 2006, Native Americans are among the poorest communities in the United States. Moreover, economic and health disparities in Indian Country are similar to those of the poorest communities in the developing world.

    • Poverty in Urban American Indian Communities

    Studies by the Urban Indian Health Institute (UIHI) show that 24% of AI/AN in urban settings are living in poverty - almost double the general population (13.3%). More...

    • The Health and Poverty Correlation
    Other studies by the UIHI show that people who live in poverty have shorter life-spans and present a higher propensity to contract or develop diseases. According to a study by the U.S. Census Bureau, the median Native American income was significantly lower [$30,784] than the national median income [$40,816]. More...

    • Had No Insurance in Past 12 Months
    UIHI studies show that over 27% of AI/AN living in urban settings reportnot having health care coverage (including federal programs) in the past year compared to 18.1% of the general population. Health service research has documented serious health and financial consequences associated with being uninsured. Those without adequate health coverage have 55% fewer interactions with health care providers. The uninsured receive less preventive care, are typically diagnosed with more advanced disease status, and have higher mortality rates compared to the insured.More...


    Relations with Non-Indian Populations


    • Self-perception about Urban Indian community activity in Mainstream Communities

      Nearly fifty percent of all UIHPs reporting in the UIHP 2008 Survey indicated that their respective American Indian/Alaska Native Community is Active in the larger mainstream community.

    Approximately 90.5% UIHPs reported having a relationship with a local government and 47.4% reported having grants and/or contracts from local agencies. Again, most partnerships were in the area of
    • Health (81%)
    • Development (14.3%)
    • Justice (38.1%)
    • Social Services (61.9%)
    • Administrative (19%)
    • Various community projects (25%; i.e. Homelessness, Cultural, etc).

    Ninety-five percent (95%) of UIHPs surveyed had multiple Non-Indian organization partnerships. These partnerships with non-Indian organizations include the following:

    • 90% have joint efforts
    • 70% have information exchange
    • 40% have sub-contracts
    • 40% have pro-bono activities
    • 25% have sub-grants
      More...

    Technology

    According to respondents of the UIHP Survey 2008:
    • Indian Community Access to Internet/e-mail
    Nearly sixty (60%) percent of urban American Indians have access to Internet and Email (59 and 57%, respectively).
    • UIHPs use the following methods for External operations:

    - 48.75% Email/PDF
    - 6.07% Fax
    - 25.31% Telephone/Cell
    - 10.93% Written letters
    - 14.47% face to face
    - .46% text

    • UIHPs with Server/Website

    100% of UIHPs reporting has their own server, with a specific email for work used by staff, and most with an organizational website (94.1%). More...

    According to the NCUIH Health Information Technology Survey 2010:


    • Fifty Eight Percent (58%) of UIHPs reported having T1 or ISDN, while 42% reported Broadband


    • Only seventeen percent (17%) of UIHPs Surveyed reported that they are connected to a Hospital or another provider's system,
      while 79% reported they were not.


    Of UIHPs Surveyed
    a) 92% reported using Email on a regular basis
    b) 79% reported Practice Management System
    c) 29% reported EHR
    d) No one endorsed E-prescribing
    e) 75% reported Document Scanning
    f) 67% reported Registries of patients with specific diseases
    g) 21% reported E-laboratory
    h) 4% reported None
    More...

  • Of UIHPs Surveyed
    83% reported using RPMS, while
    17% reported Not using RPMS at all

    Of UIHPs Surveyed
    Only 10% reported using RPMS for billing,
    while the majority of programs are not
    using RPMS for billing

    Of UIHPs Surveyed:
    79% reported that they are looking to implement EHR

    Of those programs planning to implement EHR,
    79% reported they plan to do so in 0-2 years;
    16% report 3-5 years, and
    5% reported are not Sure


    88% reported Cost as a barrier
    88% reported training staff and implement system
    29% reported lack of IT culture
    67% reported lack of technical proficiency of staff
    38% reported lack of physician champion
    13% reported lack of organizational support
    29% reported Other

    Other Responses include cost with hardware software and T-1 lines; IHS; Lack of area support for RPMS; Lack of training/process by IHS; needs for more IT input and unfamiliarity with the system; No medical services; Unable to maintain IT crew w/ proper skills. More...


    Urban Indian health Institute's Envisioning a National Health Information System for Urban Indian Health Organizations
    (Seattle IHB: Urban Indian Health Institute, 2010)

    In a round-table format, the strategic planning session participants were invited to provide input about what they envisioned as an ideal information technology system, its functionalities, and how it would be implemented. Attendees identified considerations and requirements for HIT, outlined in areas such as affordability, organizational capacity and work flow, quality improvement, surveillance, reporting and accountability, technology and security, and strategy. Although the recommendations have been grouped, it should be noted that the categories are interrelated. Through a facilitated discussion, attendees provided many recommendations about the resources, data, technology, collaboration and policy considerations required to achieve an accurate picture of urban Indian health. More....