Clinical Chats: a Podcast for Sexual and Reproductive Health Professionals · Clinical Training Center for Sexual and Reproductive Health

An Introduction to the Indian Health Service and American Indian and Alaska Native Health Disparities

February 16, 2023·27 min·1 clip

American Indian and Alaska Native people have lower life expectancy and higher deaths from diabetes, homicide, and suicide.

The episode opens with Catherine Atchison welcoming listeners to the Family Planning Files, a podcast developed by the National Clinical Training Center for Family Planning. It is part of the February 2023 Clinician Cafe on providing care to American Indian and Alaska Native clients, and it centers on the Indian Health Service and health disparities among American Indian and Alaska Native peoples. The featured guests are Tina Patar-Lau, MD, and Stacey Dawson, PhD, MSN, CNM. Dr. Patar-Lau is identified as a board-certified OBGYN and the Maternal and Child Health Consultant with the Indian Health Service Office of Clinical and Preventative Services. Dr. Dawson is a nurse midwife and serves as the Indian Health Service's Senior Women's Health Nurse Consultant within the Division of Nursing Services. Dr. Dawson first breaks down the Indian health care system. She distinguishes the Indian Health Service, Tribal Health Services, and Urban Indian Health Organizations, and explains that services are delivered through those different organizations in different ways. The discussion keeps patient education close to the center. It frames continued provision of individual patient education, health care services, public education about family planning and sexual health issues, and community-level outreach as practical ways to improve health and safety. The episode then shifts to health outcomes in American Indian and Alaska Native communities. Dr. Dawson describes lower health status, lower life expectancy, and disproportionate disease burden compared with other Americans. She ties those disparities to social determinants of health, including education, poverty, discrimination in health care services, and cultural differences. The conversation also identifies leading causes of death, including diseases of the heart, malignant cancers, unintentional injuries, and diabetes. It notes that American Indian and Alaska Native people continue to die at higher rates in several categories, including chronic liver disease, cirrhosis, diabetes, unintentional injury, homicide, intentional self-harm or suicide, and chronic lower respiratory diseases. Funding for the Indian health care delivery system comes up as one of the important issues shaping these outcomes. After Dr. Dawson's overview, Catherine Atchison turns to Dr. Patar-Lau to continue the conversation. The tone stays measured and clinical throughout, with attention to access, prevention, and respectful care. The episode works as a clear primer on how health system structure and health inequity intersect in family planning and sexual health practice.

As heard by us

A practical overview of Indian health care systems and the disparities shaping outcomes.

The episode lays out the Indian Health Service, Tribal Health Services, and Urban Indian Health Organizations, then shows how that structure can shape care differently for American Indian and Alaska Native clients.

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Get a clear map of the Indian health care system and the disparities facing American Indian and Alaska Native peoples.

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