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MessageFrom theDirectorIn 1955, the Transfer Act established the Indian HealthService (IHS) as part of the United States Public HealthService (USPHS) in the former Department of Health,Education, and Welfare, currently known as the Department of Health and Human Services. One of the initialorders of business for the first Director of the IHS was todescribe the health status of American Indians and AlaskaNatives (AI/AN). A report entitled “Health Services forAmerican Indians” was prepared by the Surgeon General ofthe USPHS and submitted to Congress on February 11,1957. This report became known as the “1957 IHS GoldBook.” The Gold Book is recognized as a foundinghistorical marker outlining the challenges that faced thenewly formed IHS.I am proud of the accomplishments made by the IHS since1955. As we commemorate our 50th anniversary, I am pleased to present to you this progressupdate. Such progress would not have been possible without the vision of great leaders and thededication of the IHS staff and Tribal partners.Our goal at the IHS is to ensure that comprehensive, culturally acceptable personal and publichealth services are available and accessible to AI/AN people. Since 1955, the IHS, in consultation with Tribes, Urban Indian programs, and Indian organizations, has been working diligentlyand effectively towards this goal.This Executive Summary is a preview of the updated version of the IHS Gold Bookthat describes the health status of AI/ANs after the first 50 years of the IHS.3
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Table ofContentsMessage From the Director . 1The Birth of the Indian Health Service . 7Federal Indian Policy . 13Indian People . 17Health of American Indians and Alaska Natives . 19The Indian Health Service Program . 23The Future . 285
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The Birthof theIndian HealthServiceHistorical Summary of Indian Health:The Story of a Public Health MissionAmerican Indians and Alaska Natives (AI/AN) share acomplex, sometimes turbulent, history with the Europeansettlers and other immigrants who came to this country.Many AI/AN ancestors lost their lives to achieve Tribalrecognition and Indian rights. Through their struggle, theoften-embittered relationship between the settlers/immigrantsand AI/ANs has evolved into one of structure, substance, anddirection. The initial treaties of 1784,in which the Federal Governmentacknowledged certain responsibilitiestoward the indigenous people, beganthe formalization ofAI/AN rights. The Government’sobligations were subsequently reconfirmed and defined by Supreme Courtdecisions, congressional legislation,Executive Orders, and other Federalpolicies. The relationship betweenTribal Governments and the FederalGovernment is founded in the U.S.Constitution, which recognizes thatfederally recognized Indian Tribes aresovereign nations with certain inherentrights. This distinguishes AI/ANsfrom all other ethnic groups in theUnited States.During the late 1700s, European immigrants broughtsmallpox, plague, tuberculosis, and other infectious diseases tothe continent. Lacking immunity from foreign contagions,American Indians were vulnerable to these maladies. Thus,illness spread rapidly and decimated many Tribal groups.Federal health care for Indian people began with tentative stepsand gradually evolved throughout the 19th and first half of the20th centuries. In the early 1800s, while the administrationof Indian affairs was based in the Department of War, Indiansliving near military forts were provided such episodic care asmilitary physicians might offer. Thefact that the vaccination of Indians wasan important public health measureprovided an added incentive to renderthis care to Indians. In 1832, Congress directed 12,000 for small poximmunizations for Indians. Four yearslater, the Federal Government began aprogram that provided health servicesand physicians to the Ottawa andChippewa Tribes. In subsequentdecades, the Government graduallyassumed an increasing obligation toprovide health care, which usuallyconsisted of sending a physician andmedications to Tribes. The responsibil7
ity for Indian medical services was transferred from military tocivilian control when the Bureau of Indian Affairs (BIA) wastransferred from the War Department to the Department of theInterior in 1849. The first separate funding for Indian health( 40,000) was identified in an appropriation act in 1911.The cession of most of the lands in the United Statesby the Indians, codified in hundreds of treaties,forms the basis for the Government’s provision ofhealth care to Indians. Many treaties identifiedhealth services as part of the Government’spayment for Indian land. Indian treaties werecontracts between the Federal and Tribal Governments. Indian Tribes gave up their land in returnfor payments and/or services from the U.S.Government.Pre-Indian Health Service,1921-1955In 1921, the Snyder Act (42 Stat.208), was passed by Congress to provide continuing authority for Federal Indian programs. The Snyder Act isthe basic authorization for Federal healthservices to U.S. Indian Tribes. It identifiedthe “relief of distress and conservation ofhealth of Indians” as one of the Federalfunctions.The health status of Indians remained poorduring the following three decades. Severalstudies of Indian health, including those by theInstitute for Government Research (1928), theHoover Commission (1948), and the American MedicalAssociation found high infant mortality and excessive deathsfrom infectious disease. Based on these studies, efforts weremade to transfer the Indian health program from the BIA tothe United States Public Health Service (USPHS) in theDepartment of Health, Education, and Welfare. It was alsoduring this time period that public health advisors were firstassigned to the BIA from the PHS, thus beginning participation by the USPHS Commissioned Corps in Indian healthprograms.The 1950sIn 1954, all functions of the Secretary of the Interior relatingto the conservation of the health of Indians were transferred tothe Surgeon General of the USPHS. On July 1, 1955, about2,500 health program personnel of the BIA, along with48 hospitals, 18 health centers, 62 stations, 13 schoolinfirmaries, and other locations, came under the jurisdictionof the newly created Indian Health Service (IHS).At the time of the transfer, conditions in Indian healthfacilities were marginal at best. Around 1956, theCommittee on Appropriations of the House ofRepresentatives, 84th Congress, directed theUSPHS to make a comprehensive survey ofIndian health. The USPHS established a survey team,and over the next year this team conducted an extensivesurvey of Indian health, including in-depth studies of ninereservations. The results were transmitted toCongress in 1957 as “Health Services forAmerican Indians.” This report had agold cover and became commonlyknown as the “1957 IHS GoldBook.” The conclusions: 1) Asubstantial Federal Indian healthprogram will be required; 2) allcommunity health resources should bedeveloped in cooperation with Indiancommunities and done on a reservationby-reservation basis; 3) Federal Indian healthprograms should be planned in each community and servicesmade available to Indians under State and local programs; and4) efforts should be made to recognize the obligations andresponsibilities to Indian residents on a nondiscriminatorybasis from the State and local communities.8
community health resources should be developed in cooperation with Indian communities and done on a reservation-by-reservation basis; 3) Federal Indian health programs should be planned in each community and services made available to Indians under State and local programs; and 4
