A Conversation with the Honorable Dr. Charles Grim

And what I would say is that urban Indians sort of share the same health problems as the general urban populations. Inasmuch as many Indian people that maybe live in the urban areas may or may not have well-paying jobs, but we know there's a large amount that are what you might term "working poor" that are just sort of out of reach of Medicaid, but may or may not have jobs that have good enough health insurance benefits, or the health insurance benefits are too expensive, so they don't take them, because they know they can go to an urban Indian health program, if we have one there. Or if they're close enough to the reservation, they can go back. But I also think the health problems in urban Indians are sort of exacerbated because a lot of them have come from reservations to try to get, perhaps, better jobs due to the poverty and lack of economic opportunities on reservations. So they have, I think, some mental and physical hardships that perhaps other urban minorities don't feel, because of the lack of family that they've left, and the traditional cultural environment that they left. There's a very strong cultural environment in Indian country, and they've left that. And so they are kind of shifting between two worlds, trying to live in a US urbanized area population, but still trying to keep touch with their cultural roots back on the reservation. So I think that they have that as an additional problem to face that some urban people don't have.

There are 34 urban Indian health organizations that operate in cities throughout the US that have significant urban populations. Then we have two demonstration programs in Oklahoma that are a little different than the general urban ones, and then we have ten alcohol programs that are located in urban areas. I think we can always do more. But, as you point out, there's been a big demographic shift over the years. When the Indian Health Care Improvement Act was authorized the first time, and those sorts of things were set up, that demographic shift you pointed out was not there. There were not over 50 percent living in urban areas. So it's something I think we are taking a look at, and we need to take a further look at, because they have the same opportunities that anyone does, living in a city. And if you live out on the reservation hours from anywhere, you don't have those options. The problem is, are we taking care of all of our urban citizens sufficiently relative to health? And so I think it's a bigger issue than just sort of with the Indian population. And that's a good thing, because the nation as a whole is taking a look at that.