Whether tribal health services are provided in a direct-service arrangement, through contracting with tribes, or through a self-governance model, this is a partnership between your governments and the federal government.
Good afternoon everyone, and thank you for coming here today.
We want to thank you Ben [Keel] for helping put together this gathering.
Holding this event is a testament to President Trump and his administration’s commitment to tribal issues, and to maintaining a strong, positive government-to-government relationship.
Many of you have come from very far to get here, and your presence here is a wonderful reciprocal commitment to this partnership, so thank you for that.
The White House has held several tribal meetings like this so far, but today’s meeting is a special opportunity to discuss our government-to-government relationship because we’re focusing on the very health and well-being of tribal communities, and the cooperative work we do to enhance and protect it. In fact, I’m told that the White House found this was the topic most requested to discuss by tribal leadership.
This is a vital responsibility to this administration, and our team at HHS is proud to be a leading part of this effort.
As some of you have heard me say at previous meetings, we are committed to building a culture of greater cooperation and collaboration through IHS and with Indian Country.
When I was sworn in, I directed our entire team to adhere to the principles of people, patients, and partnerships — the three P’s. These priorities are well-reflected when it comes to the federal government’s relationship with tribal communities.
I recently visited Alaska, and had a great opportunity to learn more about the work of the Indian Health Service and tribal communities.
What we saw there was remarkable: The Alaska Native Health Consortium has built a system that truly puts the patient at the center of everything. It meets patient’s needs holistically by integrating physical and mental healthcare, and incorporates Alaska Native traditions and spirituality. As I said on several occasions, I think there’s something the rest of America could learn from what Alaska Natives have built.
Next week, we will continue our on-the-ground experiences with IHS facilities, by traveling to Pawnee and Cherokee Nations.
We’ll be visiting a range of facilities, but we’ll also be going there for a special occasion: the first-ever meeting of the Secretary’s Tribal Advisory Council in Indian country.
I greatly enjoyed my first STAC meeting earlier this year—we have at least a couple familiar faces from that meeting here today, Aaron Payment of the Sault Ste Marie Tribe of the Chippewa Indians, and Russell Begaye of the Navajo Nation.
Partnering to run tribal health systems is a solemn responsibility on the part of HHS, and it’s one that I take very seriously as Secretary and as a physician.
But if we’re being honest with ourselves, we must acknowledge the fact that, as a Government, we have not always performed as effectively as we should.
So let me be very clear: Under this administration, we will have no patience for substandard care for American Indians and Alaska Natives at IHS facilities.
We are very optimistic about the opportunity to move forward and take positive steps in improving IHS.
This summer’s appointment of Admiral Weahkee as Acting IHS director was just one step in that direction. We’ve already seen some pieces of good news: Just this month, Rosebud Hospital in South Dakota completed its Systems Improvement Agreement with CMS, returning it to normal status within the Medicare program. We look forward to more such positive steps to come.
There’s another good reason for us to be particularly focused on tribal health. We’ve identified three clinical priorities for the department as a whole—the opioid crisis, serious mental illness, and childhood obesity—and the work of tribal communities will be essential to making meaningful progress on them.
On each one of them, tribal leadership has taken the initiative, and we’re looking forward to working together.
The opioid crisis, as you know, is a scourge of epidemic proportions: 52,000 drug overdoses in 2015, looking like more than 60,000 in 2016. That’s more Americans lost each year than in the entire Vietnam War, and it has certainly not spared Indian country.
But tribal leaders, like state and county leaders across the country, have responded to this challenge. It has been a particular tragedy among young Indians, and your unique Indian youth treatment facilities have helped meet that need.
HHS unveiled a comprehensive five-point strategy for tackling the epidemic in April, which encompasses:
- Improving access to prevention, treatment, and recovery services, including the full range of medication-assisted treatments;
- Targeting availability and distribution of overdose-reversing drugs;
- Strengthening our understanding of the crisis through better public health data and reporting;
- Providing support for cutting edge research on pain and addiction; and
- Advancing better practices for pain management.
On that last point, for instance, in May, IHS established a national committee on Heroin, Opioid, and Pain Efforts—HOPE—to consider issues like how pain is treated in IHS facilities. Admiral Weahkee will provide a more comprehensive update on this issue in a few minutes.
When it comes to serious mental illness, our healthcare system and our policies have failed Americans living with these diseases—most prominently, schizophrenia and bipolar disorder.
This problem can be summed up in three numbers: 10 million, 10 years, 10 times.
Ten million of our fellow Americans live with these diseases, and their lives end, by one estimate, 10 years sooner than other Americans. Approximately ten times as many of these fellow Americans living with these illnesses are in prison as in inpatient psychiatric treatment.
Over the past several decades, we replaced an often cruel and inadequate system of institutionalization with a system that can be even more cruel and inadequate, because we have failed to give communities and families the tools they need to treat those with serious mental illness.
The other day, HHS kicked off the first meeting of the Inter-Departmental Serious Mental Illness Coordinating Committee, which is charged with reviewing how the federal government is addressing this issue, and how we can better focus in on getting treatment for Americans living with these diseases.
This challenge, perhaps more than most health challenges, really requires the kind of culturally competent care in which tribal facilities specialize. In this effort, we also want to take a hard look at suicide, and what really works in preventing it in our communities.
Our third clinical priority, childhood obesity, is one where we’re also in a pretty bad spot: almost one in five American kids is obese.
We know this is a tremendous challenge in Indian country. Everywhere, it’s a complex challenge: There are not just nutritional but economic, genetic, emotional factors at play here.
Obesity is not just lowering quality of life for kids and adults today; it also means they are going to see health challenges, and the attendant costs, at 30 or 40 years of age that we expect to see at 60 or 70 years old.
At HHS, we’ve convened a task force to look at what the department is doing on this issue and how we can better tackle it.
One wonderful example of a success on this issue is IHS’s diabetes program, which has held obesity and diabetes rates steady among American Indians, while driving down the rates of kidney failure significantly. That is an achievement of which tribal communities should be proud.
So those are some of the priorities we have identified—and like I said, achieving success on them is going to require active cooperation from you and your communities.
When it comes to the three P’s, really, the system of tribal healthcare in this country is the ultimate recognition of how important partnership is.
Whether tribal health services are provided in a direct-service arrangement, through contracting with tribes, or through a self-governance model, this is a partnership between your governments and the federal government.
Under this administration, we’re committed to making that as successful a partnership as possible.
Thank you for coming here today, and I ask you to stay in touch with us, share your ideas and your concerns. If we maintain a close, positive partnership, we can accomplish great things for the health and well-being of American Indians and Alaska Natives together.
