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Health Inequities May 11, 2023

Q&A with NCUIH: Supporting Culturally Competent Health Care for Urban Indians

A pervasive myth about American Indians and Alaska Natives (AI/ANs) is that most of them live on or near designated tribal lands. In fact, more than two-thirds of AI/ANs reside in cities. Here, they’re subject to the same health care challenges as other rural indigenous population—behavioral health concerns, alcoholism, suicide, racial prejudice, high unemployment—and yet, as noted by the National Council of Urban Indian Health (NCUIH), they are further disadvantaged because the Indian Health Service (an agency within the U.S. Department of Health and Human Services) spends only one percent of its budget on urban Indian programs.

American Indian woman wearing face mask with bandage on arm covering vaccination site

NCUIH is one of the AMA Ed Hub’s newly added content providers and offers much-needed support to this overlooked population. Headquartered in Washington, D.C., the membership-based nonprofit advocates for health equity among urban AI/AN by increasing access to quality, accessible and culturally sensitive health care services, including providing tangible assistance to Urban Indian Organizations (UIOs).  

UIOs were created in 1972 to fulfill the federal government’s health care–related trust responsibilities for Indians who live off the reservations. “They provide primary care, behavioral health care and support for the social needs of the population,” explains Evelina Maho, who was NCUIH’s Public Health Program Manager and is now Director of Technical Assistance. “Fundamentally, they were established to create a sense of home far from home.” All of the 41 UIOs in the U.S. are represented by NCUIH. 

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Physicians should be aware of the specific challenges faced by AI/ANs. The AMA Ed Hub spoke with Maho about NCUIH’s efforts to address these challenges. Read the following interview, which has been edited for length and clarity, then be sure to check out NCUIH’s educational resources on the AMA Ed Hub. 

  1. AMA Ed Hub: In what ways does NCUIH, and the UIOs it supports, work to uphold the cultural traditions of American Indians and Alaska Natives?

    Maho: Our tribal nations have their own form of traditional health care delivery and practice, and they’re centuries old. However, you take that framework and place it in our current American Indian health care system and it’s not billable. So how do we create this opportunity now, in today’s age, to translate that and be able to bill for some of these services? There’s a lot of work to be done, including changing legislation, and that has been part of the focus of our policy team here at NCUIH. 

    We also have to keep in mind that each of these 41 UIOs serve multiple tribal members from different tribes, and so they’re all unique. What we try to do is home in on common themes that may evoke a sense of healing and infuse them into best practices or promising practices in health care. We want to make our patients feel safe and secure and, as providers, deliver health care in a way that makes sense to them. 

  2. AMA Ed Hub: What is an urgent concern NCUIH is focused on addressing?

    Maho: One is vaccine equity. There’s this common theme of our population not trusting health care systems—for many reasons. At NCUIH, the vaccine equity group really concentrated on how providers at UIOs can become trusted. It’s about relationships, communication and establishing kinship. A perfect example is our campaign that was titled “Be a Good Relative” that encouraged folks to get their vaccines. There’s an opportunity to take that same campaign and use it with our providers to say, “Look, we have to be the good relative as well in order to be successful in the communities we serve.” 

  3. AMA Ed Hub: Why did you decide to create the Native Healthcast in partnership with the CDC’s Project Firstline and what’s your goal in sharing this resource?

    Maho: The podcast was designed to target providers, clinicians and nurses who could listen to topics on break—during lunch hour or on the weekend. We know that they’re so busy providing care at these Urban Indian Health Centers. The podcast allows folks to listen to different discussions around infection prevention and control and how to [apply] key learnings. In the coming months, we’re hoping that NCUIH takes on Healthcast to open it up to other topics. It might involve policy briefs, health care change approaches, C-suite leadership or public health awareness. [By sharing resources on] the AMA Ed Hub, we really want to increase engagement among our clinicians and nursing staff and bring value to them. We know their time is critical. 

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