title: Health ownership in American indigenous communities.
abstract: BACKGROUND
  Although the Indian Health Service (IHS) has adequately stifled acute infectious diseases that once devastated American Indian and Alaska Native (AIAN) communities, this system of health provision has become obsolete in the face of chronically debilitating illnesses. Presently, AIAN communities suffer disproportionally from chronic diseases that demand adequate, long-term health maintenance such as hepatitis, renal failure, and diabetes to name a few. A number of research endeavors have sought to define this problem in the literature, but few have proposed adequate mechanisms to alleviate the disparity. The objective of this study was to examine the efficacy of both the Indian Health Service (IHS) and the relative few tribal healthcare systems (PL 93-638) respectively in their sociopolitical contexts, to determine their utility among a financially lame IHS.
  
  
  METHODS
  Domestic and international indigenous health systems were compared through analysis of the current literature on community and indigenous health. Informal interviews were carried out with indigenous practitioners, community members, and political figures to determine how AIAN communities were receiving PL 93-638 programs.
  
  
  RESULTS
  Although the IHS has adequately stifled the acute infectious diseases that once devastated AIAN communities, this system of health provision has become obsolete in the face of chronically debilitating illnesses. A number of research endeavors have sought to define this problem in the literature, but few have proposed adequate mechanisms to alleviate the disparity. International indigenous health systems are noted to have a greater component of community involvement in the successful administration of health services.
  
  
  CONCLUSIONS
  Reinstating notions of ownership in multiple paradigms, along with novel approaches to empowerment is requisite to creating viable solutions to the unique health circumstances in Native America. This article demonstrates the importance and need of more qualitative data to better characterize how PL 93-638 healthcare delivery is actually experienced by AIAN patients.
authors.affiliation: School of Osteopathic Medicine in Arizona, AT Still University, Mesa, Arizona, USA.
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D000413:Alaska / Q000208:ethnology; D002908:Chronic Disease / Q000517:prevention & control; D017281:Cost of Illness; D054625:Healthcare Disparities / Q000191:economics / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D007407:Interviews as Topic; D009313:National Health Programs; D010067:Ownership; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D044382:Population Groups / Q000331:legislation & jurisprudence*; D015397:Program Evaluation; D014481:United States; D016549:United States Indian Health Service / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data