The factors contributing to lower life expectancy, higher maternal mortality, and overall poorer health outcomes for Native people in the U.S. are vast and troubling. Rooted in centuries of discrimination, disinvestment and injustice, they persist today with limited access to care, bias within our health system, and a host of social determinants of health, including civic engagement, water rights, job and housing instability, and the pervasive burden of poverty.
And so the solutions needed to reverse these alarming health trends must be equally multifaceted, and advanced in collaboration with American Indian and Alaska Native (AI/AN) communities. These solutions include:
- Strengthening our physician workforce with tailored educational opportunities to better serve rural and historically and structurally marginalized communities;
- Advocating for greater funding and support for the federal Indian Health Service (HIS) and urban Indian health organizations; and
- Developing a broad pathway to allow more young people of AI/AN descent to pursue careers in medicine, which is perhaps most important.
The AMA is working in all three areas, and many others, to help improve health outcomes for Native populations and follow through on our commitment to building a more diverse physician workforce to care for our increasingly diverse nation.
The AMA House of Delegates adopted several policies at our Annual Meeting in June to prioritize this work. The policies include urging the federal government to expand funding and support specifically focusing on AI/AN through education opportunities, IHS Treatment Centers, language revitalization and language-concordant care, measures that address food insecurity and promote greater access to care, and inclusive research to better understand and identify solutions to the health care needs of AI/AN communities.
For example, the AMA is advocating to expand the number of tribally and federally funded IHS Youth Regional Treatment Centers across the U.S. These culturally rooted, evidence-based behavioral health centers help AI/AN adolescents and their families who are struggling with a substance-use disorder or other mental health issues. Currently, there are only 12 such centers in the U.S., providing an array of treatment programs to thousands of Native youths—often at no cost. But we can and we must do better.
Additionally, the AMA supports a fully refundable, expanded child tax credit, as well as extending eligibility for federal nutrition programs to enrolled members of recognized AI/AN tribes and villages, and actions by the federal government to create alternative pathways for AI/AN patients to access the full spectrum of health care outside the IHS.
Fighting for Native health, well-being
Aligned with AMA’s strategic plan to advance health equity, ongoing state and federal advocacy efforts are also focusing on health inequities for Indigenous peoples. These efforts include calling for significant budget increases to improve delivery of care for AI/AN patients and working with the U.S. Department of Agriculture to make equity-minded changes to the Women, Infants and Children program, the National School Lunch and Breakfast program and Dietary Guidelines for Americans.
The AMA joined a sign-on letter (PDF) to the U.S. House and Senate this year asking for more funding to address clinical staff shortages across Native communities through graduate medical education (GME) programming.
The AMA has fought for the health and well-being of AI/AN families in the courts. We joined the American Academy of Pediatrics in 2022 in an amicus brief that successfully urged the U.S. Supreme Court to uphold the Indian Child Welfare Act of 1978. That is a landmark law enacted to protect Native foster children from being removed from Native family or tribal members. In successfully defending the law, we argued that it was an important tool to redress centuries of harmful federal and state policies that systemically separating AI/AN children from their families and Native nations.
Our AMA supports consultation with tribes to facilitate the development of best practices, including culturally sensitive data collection, safety monitoring, the development of payment methodologies, healer credentialing and tracking of traditional healing services utilization at IHS, tribal and Urban Indian Health Programs. We also recommend that AI/AN religious and cultural beliefs be recognized and respected by those providing services through Native health programs.
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And we continue to push for greater inclusion of AI/AN students in medical education and representation of AI/AN physicians in health care, recognizing that physicians from historically excluded racial and ethnic groups are shown to provide better and more culturally sensitive care to patients from similar cultures, and by building pathways for more aspiring students from Indigenous families to pursue careers in medicine.
This includes advocating for wider education opportunities in IHS, tribal-administered, and urban Indian health organizations and facilities by establishing partnerships with accredited medical schools and teaching hospitals. The AMA also is committed to work toward establishing dedicated GME funding and programs that benefit tribal communities, increase physician training sites, and reduce physician shortages, particularly among historically marginalized populations.
Driven by AMA policy
AMA policy also supports loan forgiveness for physicians who practice in an IHS, tribal or Urban Indian Health Program, increasing compensation for IHS physicians to a level competitive with other federal agencies. We also back reforming IHS Loan Repayment Program eligibility to remove the high cost of pursuing a medical degree from the list of barriers that medical students face.
AMA policy has long supported loan forgiveness for physicians practicing in a Veterans Administration facility through the public service loan-forgiveness program. These more recently adopted policies support extending loan-forgiveness opportunities to young physicians practicing in the IHS, recognizing the vital role they play in caring for Native families and communities.
Reliable data is central to support this work, set goals and measure our progress. That is why AMA policy clearly supports robust data-sharing by public authorities as well as consultation with, and funding to, AI/AN tribes and villages around research, grounded in Indigenous data sovereignty.
Our nation can never truly erase the centuries of injustice—and continuing injustices— directed at Native communities that have led to ever-widening health inequities.
But we can take steps today to right past wrongs, to join other physician leaders in calling for greater funding and support to improve health care access and delivery for Indigenous populations, and to work in partnership to increase the AI/AN workforce in medicine.
Organized medicine, working as one collective body to advance equity, gives us our best chance to create a healthier tomorrow for Native children and families—a future we must deliver.
