Indian Health Care Page: iii
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American Indians and Alaska Natives have a unique historical and legal relation-
ship with the Federal Government. Through treaties and statutes, the Federal Govern-
ment acts as a trustee for Indian tribes. In this "government-to-government" relation-
ship, Federal programs for Indians are administered principally by the Bureau of Indian
Affairs in the Department of the Interior, except for medical and health-related serv-
ices, which are provided through the Indian Health Service, a component of the Public
Health Service in the Department of Health and Human Services.
The health of Indian people still lags behind the health status of the general U.S.
population, and there are substantial differences in health status and causes of illness
among the nearly 300 Indian tribes and more than 200 Alaska Native villages in the
United States. Continuing concerns over the health of Indian people led the House Energy
and Commerce Committee and its Subcommittee on Health and the Environment to
request that OTA examine the health status of Indians and the services and technol-
ogies that are provided to them through Federal Indian health programs, The request
was also supported by the Senate Select Committee on Indian Affairs and by the Chair-
man and Vice-Chairman of OTA's Congressional Board, one of whom was also acting
in his capacity as Chairman of the House Committee on Interior and Insular Affairs.
An advisory panel, chaired by Rashi Fein, Professor of the Economics of Medi-
cine, Harvard Medical School, provided guidance and assistance during the assessment.
Also, four public meetings were held (in Portland, Oregon; Phoenix, Arizona; Rapid
City, South Dakota; and Tulsa, Oklahoma) to provide tribes and their representatives
the opportunity to comment on assessment activities and to confirm the information
that OTA had collected. Site visits to nearby reservations and health facilities were also
conducted as part of these activities. A large number of individuals from Indian tribes
and organizations, the Federal Government, academia, the private sector, and the pub-
lic provided information and reviewed drafts of the report.
OTA gratefully acknowledges the contribution of each of these individuals, As with
all OTA reports, the content of the assessment is the sole responsibility of OTA and
does not necessarily constitute the consensus or endorsement of the advisory panel or
the Technology Assessment Board. Key staff responsible for the assessment were
Lawrence Miike, Ellen M. Smith, Denise Dougherty, Ramona M. Montoya, and Brad
JOHN H. GIBBONS
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United States. Congress. Office of Technology Assessment. Indian Health Care, report, April 1986; [Washington D.C.]. (digital.library.unt.edu/ark:/67531/metadc39610/m1/3/: accessed September 21, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.