Selected health policy issues among Native Americans.

Abstract

This dissertation's central theme is the importance of developing more systematic approaches to policy development within Native American communities. An intractable problem of Native Americans remains poor health status; a major challenge is to develop effective methods for improving conditions within available resources. The dissertation provides three examples of how the Cherokee Nation of Oklahoma (CNO) has achieved noteworthy success, though heretofore undocumented and not fully verified emperically, in attempting to improve health status. The examples were selected for their mix of governance and management issues; each paper constitutes an analysis of a policy problem, description of how it was handled and a conceptual framework for seeing it in a broader perspective. The first paper discusses the governance issue of changing eligibility criteria for Indian Health Service benefits. It discusses fundamental constitutional, moral and existential issues pertaining to Federal-Indian relationships and offers an emperical analysis of the likely effects of proposed changes on the health and well-being of Native Americans. The second paper--a mixture of governance and management issues--describes self-help efforts being employed to encourage self-reliance and communal participation in health care programming. A central issue is how Native Americans can assume more control without allowing the Federal government to avoid its responsibilities. The third paper describes the use of the Negotiated Investment Strategy as a method of coordinating/integrating resources as a means of maximizing those resources that are available to Native Americans. The papers are intended to provoke discussion and, possibly, spark some debate with the ultimate goal of affecting the approaches to policy development within Native American communities.