Equity in health care is a basic human right, yet disparities in health and wellness exist across racial lines. Despite the fact that disparities in Indigenous People’s health are particularly dramatic, they are less well understood. This volume focuses on the American Indian, in whom disparities in health are particularly severe. In a disease-specific format, health disparities in the American Indian are identified and discussed, with an emphasis on causes and solutions. Edited by experts in healthcare disparities, one of whom is a member of the Oglala Lakota Tribe, this book focuses attention on the historically overlooked and underappreciated problem of inadequate healthcare for the American Indian and has relevance for Indigenous People’s health around the world. Of interest to all concerned with equity and inclusiveness in healthcare, it will be essential reading for physicians, public health workers, academics, and Indigenous People worldwide.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Ever since their arrival in North America, European colonists and their descendants have struggled to explain the epidemics that decimated native populations. Century after century, they tried to understand the causes of epidemics, the vulnerability of American Indians, and the persistence of health disparities. They confronted their own responsibility for the epidemics, accepted the obligation to intervene, and imposed social and medical reforms to improve conditions. In Rationalizing Epidemics, David Jones examines crucial episodes in this history: Puritan responses to Indian depopulation in the seventeenth century; attempts to spread or prevent smallpox on the Western frontier in the eighteenth and nineteenth centuries; tuberculosis campaigns on the Sioux reservations from 1870 until 1910; and programs to test new antibiotics and implement modern medicine on the Navajo reservation in the 1950s. These encounters were always complex. Colonists, traders, physicians, and bureaucrats often saw epidemics as markers of social injustice and worked to improve Indians' health. At the same time, they exploited epidemics to obtain land, fur, and research subjects, and used health disparities as grounds for "civilizing" American Indians. Revealing the economic and political patterns that link these cases, Jones provides insight into the dilemmas of modern health policy in which desire and action stand alongside indifference and inaction. Table of Contents: List of Figures Acknowledgments Introduction 1. Expecting Providence 2. Meanings of Depopulation 3. Frontiers of Smallpox 4. Using Smallpox 5. Race to Extinction 6. Impossible Responsibilities 7. Pursuit of Efficacy 8. Experiments at Many Farms Epilogue and Conclusions Notes Index Rationalizing Epidemics is a superb work of scholarship. By contextualizing his deep and thorough research in original documents within the larger literature on the history and nature of epidemics, Jones has produced a profound account of how epidemics are social and cultural phenomena, not just biological. This book will be of great interest to scholars of American Indian history and the history of medicine, and with its engaging and accessible writing style, it promises to be a book that students and the general public will appreciate as well. --Nancy Shoemaker, University of Connecticut An imaginative and insightful approach to health and disease among American Indians, Rationalizing Epidemics represents a remarkable accomplishment. The breadth of reading and depth of research, the subtlety used in explaining each case, and the original approach to the material are altogether impressive. Jones's book undoubtedly will be a major contribution to American history. --Daniel H. Usner, Jr., Vanderbilt University

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

The reported population of American Indians and Alaska Natives has grown rapidly over the past 20 years. These changes raise questions for the Indian Health Service and other agencies responsible for serving the American Indian population. How big is the population? What are its health care and insurance needs? This volume presents an up-to-date summary of what is known about the demography of American Indian and Alaska Native populationâ€"their age and geographic distributions, household structure, employment, and disability and disease patterns. This information is critical for health care planners who must determine the eligible population for Indian health services and the costs of providing them. The volume will also be of interest to researchers and policymakers concerned about the future characteristics and needs of the American Indian population.

The report reveals that the Native American health care system created by the federal government has used only limited and incremental responses to the health care challenges faced by Native Americans.