Introduction

American Indians have had government- supplied health care since tribes ceded ancestral land to the United States in exchange for certain promised benefits. Why, then, are American Indians as a population sicker than other Americans and dying at much younger ages?

The American government's delivery on the promise of health care has had a rocky history. Responsibility over the centuries has shifted from the War Department to the Bureau of Indian Affairs to the Indian Health Service. Tribes themselves have shared oversight for health care since the Self-Determination and Education Assistance Act of 1975. Yet still the disparity in the health status of Americans remains.

Indians are 500 percent more likely to contract tuberculosis, 519 percent more likely to become alcoholics, and 195 percent more likely to develop diabetes. They also have a 149 percent higher rate of accidental injury, and are 72 percent more likely to commit suicide than the general population.

The reasons are both social and economic. Poverty, access to care, social problems and a lack of funding to meet more than basic needs have compounded the health issues of this nation’s first peoples.

The University of Montana School of Journalism's Native News Honors class examined some issues that affect the health of Indians on the state's seven reservations and those enrolled tribal members who live away from the reservations. In this issue you'll find stories that shed light on the cultural and physical distances that many Indians encounter when seeking health care, and others that examine the problems of youth suicide, alcoholism and water sanitation. Other stories show the progress Montana tribes are making to heal their communities, such as implementing cultural advocacy groups and alcoholism treatment programs.

The stories are as varied as each Montana reservation and tribe. But, underneath them all is hope for a better future, and hope that, in time, the state’s Indian tribes will regain the health and vigor that for centuries made them a resilient people.