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Teens and Indian Health Service: Saving Both

by Resa Crane Bizzaro

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Over the years, much of my writing has been in response to news articles. Among stories about Native Americans that have spurred me to write essays is an Associated Press story of another sort: disturbing statistics indicating the attitudes of teenagers about their future lives.

After I saw the story in the Raleigh (NC) News and Observer reporting general research that suggests the hopelessness of young people, I obtained the article the story was based upon from the July 2009 issue of Pediatrics. Iris Wagman Borowsky and her colleagues at the University of Minnesota were interested in why 13-18 year olds across genders and ethnicities engage in risky behaviors, including using illicit drugs, being arrested, sustaining fight-related injuries or practicing unsafe sexual activity. What their research shows is pretty surprising and grim, particularly for minorities.

The article says that for the previous 40 years, therapists believed that young people, in general, had a diminished sense of vulnerability -- best summed up in David Elkind's discussion of "the personal fable" (or the "it-can't-happen-to-me" story). But more recent work in this area shows teen perceptions are based upon more complex factors. Generally, teens engage in risky behaviors because they sense their own mortality -- that is, they're going to die young, anyway. In 1997, 19 percent of all 15- and 16-year-olds surveyed thought they would die within a year; just over 20 percent believed they would not live to be twenty. More recently, Borowsky's 2009 study indicates that nearly 15 percent of all respondents expect to die before the age of 35.

The data reported by racial/ethnic group is more upsetting. Just over 10 percent of teens of European descent say they will not live into middle age. They are followed by Asian Americans (14.9 percent), Latinos/Latinas (21.2 percent), and African Americans (25.7 percent). My own group—Native Americans—came in last at slightly over 29 percent. Of course, those teens whose families receive welfare and who live with people other than their biological parents have higher perceptions of their own mortality. By gender, 15.3 percent of young men believe they will die early; 12.9 percent of young women think they will not live to be 35 years old. (There are no statistics according to race among the gender data.)

I was astonished. If our children believe they won't be here, then of course they won't bother to behave cautiously in a world that will snuff them out before they can even reach middle age. I believe teens' despairing attitudes are due to social neglect they've felt; for indigenous peoples, this neglect might be traced to the federal government and its insufficient provision of health care, particularly in mental health arenas.

For me, Borowsky's numbers are alarming, but not very surprising. Fear of early death may be reasonable for indigenous teens, as life on and off reservations continues in appalling circumstances. Among other things, Native Americans suffer higher rates of poverty, obesity, diabetes and suicide. Currently, overall health care is provided by the Indian Health Service (IHS), which is dreadfully underfunded and understaffed. The IHS estimates it receives only 55 percent of the federal funding it requires. At the present rates, the U.S. government provides half as much of the per capita funding for Native Americans as it does for incarcerated Americans; however, President Obama has requested a 13 percent increase in funding for the IHS in 2010—the largest boost in twenty years. But will this increased funding change the attitudes about longevity of young Native teens?

Among others, Tim Giago has asked how the proposed health care plan will affect the IHS and its ability to provide health care services for Native Americans, especially since providing health care for all Americans will cost the country an estimated 1.5 trillion dollars.

Kimberly Teehee, President Obama's Senior Policy Advisor for Native American Affairs, says the U.S. provides health care services -- including counseling -- to Native peoples as part of its federal trust responsibilities. She insists the IHS will not be dismantled in the process of implementing a health insurance system for all Americans, rightly pointing out that likening "the IHS to health insurance ... is an inaccurate comparison." Teehee maintains the IHS will not be supplanted, and Native peoples will "continue to have access to their Indian Health Care facilities."

While I want to be optimistic, I must be realistic, too. If we take on $1.5 trillion in debt, as Giago speculates, will Congress allocate more funds to the IHS? It's a difficult situation, but I must continue to hope so. Whatever we are currently doing to address these problems is obviously not enough to give hope to Native American teenagers.

January 12, 2010

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Resa Crane Bizzaro, of Cherokee and Meherrin descent, lives in western Pennsylvania with her husband, Patrick, and son, Antonio, and teaches at Indiana University of Pennsylvania. Resa is a co-founder of Blankets for the Elders, a non-profit organization that provides blankets and warm clothing to indigenous peoples living on reservations in the U.S.

Also see "The First of All Liberties: Making Health Care Meet All Women's Needs" by Eesha Pandit in this edition of On The Issues Magazine.

See "The Next Seven Generations: Reclaiming Healthy Sexuality for Native Youth" by Jessica Yee in this edition of On The Issues Magazine.

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