Vol. 14, No. 2, Winter 2000/01

Creating a Path for Urban Indian Health:
The Native Voices for Change Project

by Jacquelyn Ross

Passion. Identity. Frustration. Cultural expertise. All are attributes that Native people can contribute to increase the effectiveness of Western medicine. When the opportunity for leadership is combined with personal knowledge and professional training, projects emerge that seem useful, necessary, and obvious. The describes the birth of the Native Voices for Change Project, guided by Dr. Laura Williams (Juaneno-Acjachemem, Gabrielino–Tongva) and influenced by numerous Indian people and health professionals from Southern California. This project seeks to assess the health needs of urban Indians throughout California, with the long-term goal of improving prevention and disease control. It will affect health service, research, and policy for urban Indians statewide. The California Endowment is the major financial supporter of this project, in conjunction with the Center for Health Policy and Research at the University of California, Irvine and the Southern California American Indian Health Work Group.

The primary health care needs of urban Indians and Alaskan Natives residing in California are not known. Such information is vital to providing medical services and also mental health, dental, and social services. U.S. Census information from 1990 shows that almost sixty percent of Indian people are living in urban areas, including many federally recognized tribal members living off-reservation. Health studies of Indians have been conducted primarily in rural and reservation-based populations. Such studies indicate unusually high rates for certain diseases and abuses. If the health status for urban people resembles that of rural and reservation-based populations, then many Indian people are not getting the help they need to prevent or control major health problems such as cardiovascular disease and diabetes.

Federal health care policies and funding for urban services are based on historical precedent rather than current data. Consequently, only two percent of the total Indian health service budget is appropriated for the care of urban Indian people. Urban Indian people have not been included in studies and programs due to "statistical insignificance;" in other words, the population numbers are too small. Updated, reliable information is needed. The first part of the Native Voices for Change Project is a comprehensive study to assess the health status and health care needs of the urban Indian population. "Urban" includes local California tribes in the Los Angeles and Orange areas (Acjachemem, Tongva, and some Chumash groups) that are not federally recognized. The tribes in Orange County have not had access to Indian Health Service programs. Indian families and communities from out-of-state who were relocated to the Los Angeles area in the 1950s will also be included.

Guideline information (baseline data) needs to be gathered about health beliefs and behaviors, health status, health care needs, and access to medical care. What does it mean to be healthy and how does one achieve good health and stay healthy? How healthy are you? What are your health needs? Can you see doctors and healers, or obtain tests and medicines when you need them? Dr. Williams notes that this study will be a model for other data collection strategies nationally. The research plan is intensive. There will be thirty key interviews with local health leaders, community leaders, traditional healers, and other community members. Five focus groups will give individuals the opportunity to share their opinions in a group setting at designated urban community-based Native organizations. Finally, interviews with community members will be conducted to assess health care needs, existing services, and access to public health insurance for urban Indian people.

This coming March, a two-day conference to be held at UC Irvine will focus on the health needs of urban Indian people throughout California. Native Voices for Change Project findings will be shared, with specific discussion on research and data needs, health and human service needs, resources deficits, health manpower needs, and viewpoints from the urban Indian community. The conference will also include work groups on such topics as adolescent and child health, women’s health, elder health, and mental health and substance abuse. Innovative collaborations and model programs are to be shared, as well as strategies to educate policy makers and influence funding. Conference planners anticipate that participants will include local urban-based tribes, county, state, and federal agencies, urban Indian health programs, and researchers. This should be a revealing and productive meeting of minds.

The Southern California American Indian Health Work Group has acted as an advisory board to this project. More than 32 people, representing affiliation with over eighteen tribes both in and out of the state, have participated as part of this group and offer expertise from their personal and professional experiences. Twenty-four different organizations, government agencies, and university departments have signed on as Health Working Group Partners. The Native Voices for Change Project is an extensive endeavor with the thoughts and efforts of many good people behind it. It has the power to improve the lives of Indian people for generations to come.