ACP lists recommendations to mitigate health disparities for Indigenous people

In a new position paper, published on Indigenous Peoples' Day, ACP stated that policymakers must provide financial resources to support equitable health care for Indigenous populations.

Indigenous people face poorer health outcomes, higher rates of poverty and incarceration and disparities in access to health care compared with other populations. They also face socioeconomic factors that further contribute to health disparities, according to ACP, many resulting from “decades of societal discrimination, removal and forced assimilation, and historical trauma.”

“The forcible relocation of Indigenous peoples to reservations severed connections to ancestral lands and subsistence lifestyles, which degraded access to traditional foods and methods of food production and worsened well-being,” Josh Serchen, a health policy associate with ACP, and colleagues wrote. “This destruction of Indigenous tradition, culture, and societal fabric brought with it heightened rates of poverty, mental and behavioral health issues, diet related illness, and alcohol and substance use.”

In the position paper published in Annals of Internal Medicine, Serchen and colleagues wrote that the significant disparities and barriers in health care that Indigenous populations face are at least partly because the federal government fails to provide adequate services and health support in these communities.

“Although the federal government has assumed a trust responsibility to provide health care to Indigenous peoples, programs and facilities serving these communities are insufficient and underfunded, which inhibits access to care,” they wrote.

They added that policymakers must provide equitable health care and financial resources to support the endeavor to Indigenous populations.

“Inadequate investment in Indigenous health care infrastructure has resulted in denials and delays in referred care, high medical professional turnover and vacancies that negatively impact access to care, outdated technology and facilities, and diminished access to traditional medicine,” the authors wrote. “ACP believes that policymakers have a duty to fulfill the federal trust responsibility to provide and fund equitable health care and other services to U.S. Indigenous populations. In fulfilling this duty, policymakers must acknowledge the historical and contemporary circumstances that have produced these distinct health and social challenges and recognize that Indigenous communities know their own needs best.”

ACP provided multiple recommendations for federal-level public policymakers to “strengthen the health and well-being of Indigenous populations in a manner that reflects the need for self-determination and collaboration while ensuring federal obligations are met,” such as:

• community-driven public policy that is developed with Indigenous leaders to “remedy the injustices, disparities and inequities experienced by Indigenous individuals and communities;”
• a multidisciplinary approach that is developed by Indigenous populations, along with other experts, to “implement culturally appropriate interventions to address the underlying drivers that exacerbate physical, mental, and behavioral health issues and contribute to catastrophic rates of suicide in Indigenous communities;”
• adequate investments in the health infrastructure that serves Indigenous individuals to ensure equitable access to high-quality, modern, and state-of-the-art health care;”
• increased funding for Indigenous people’s health services — “particularly given the identified disparities and inequities in federal funding;”
• increased Indigenous representation in the medical workforce and medical school;
• community-driven collaboration between Indigenous leaders, relevant governments and agencies to create plans that will help reduce the high rates of violence that Indigenous populations experience;
• more support for public health interventions that address morbidities with high incidence in Indigenous communities; and
• collaborations between policymakers and Indigenous leaders “to address the full range of underlying social drivers of health associated with disproportionately high rates of poverty experienced by Indigenous communities.”

“As a leading physician organization with patients of diverse backgrounds, ACP strongly believes there is a moral imperative to understand the social and historical context surrounding Indigenous patients, to provide equitable access to culturally accepted and appropriate care, and, in collaboration with Indigenous communities, to focus resources toward developing solutions to improve the well-being and address the health disparity gap facing Indigenous people.”