TRAHANT REPORTS—In the news business, this would be a man bites dog story. That’s the idea that a narrative framework is the opposite of what’s supposed to be. The usual story is that Indian health programs are a disaster and only getting worse. But in the real world if you want to find innovation, efficiency, and ideas that must be borrowed by state governments, then explore some of the many successes found in the Indian health system.
Of course that’s not what we are reading about lately. Most of the news stories about Native health focus on the serious problems in the Great Plains. That indeed is a crisis — and one worth fixing.
But at the same time there are other parts of the Indian health system that are unbelievable success stories.
Consider the data: Just before the Indian Health Care Improvement Act was signed into law in 1976 the average age at death for American Indians and Alaska Natives was 48.3 years. The age at death for White people was 72.3 years. And today? That 20-plus-year difference has been reduced to a gap of less than five years. Today the life expectancy at birth for American Indians and Alaska Natives is 72.3 years, compared to 76.9 for all races.
And that steady progress, imperfect as it is, has been made without the same resources as the general population. Doing more with less is part of the operating framework at tribal health facilities, nonprofits that operate health clinics for a Native community, and, even for the federal Indian Health Service.
The story that still needs to be told is that the U.S. medical system could learn a lot from the Indian health system. The U.S. system is the most expensive in the world, by far, while the Indian health system operates at levels comparable to what other nations spend on health care. Could Indian health use more resources? Absolutely. That’s the frustrating part of the narrative; it’s the option that Congress never seems to consider. (Previous: Paul Ryan’s call for Indian health ‘choices’ would be a disaster.)
So with that context let’s celebrate a success story with roots from the Alaska Native medical experience.
Last week Vermont Gov. Peter Shumlin signed into law a bill that licenses dental therapy in Vermont. Therapists are midlevel providers who will provide dental procedures such as fillings and simple extractions. “This is important because there’s a direct connection between oral health and overall health,” the governor said. “Having dental therapists available to work with dentists and hygienists will make it easier for Vermonters to get the care they need, closer to home and no matter what type of insurance they have.”
More than a decade ago the Alaska Native Tribal Health Consortium experimented with a program to train midlevel oral health providers. It was a community-based program to serve a need because too few dentists were practicing in remote Alaska Native villages.
Almost immediately this was an “aha!” moment as other communities saw this as a smart way to expand dental access. Dental therapy students were hired and trained right out of high school and then were put right to work.
But the innovation was followed by a fight. The American Dental Association sued trying to stop this program, saying that the midlevel providers were practicing dentistry without a license. The Alaska Native Tribal Health Consortium fought back and won, using the Indian Self-Determination Act and the Indian Health Care Improvement Act to trump the state’s licensing regulations.
The data today is clear. The program has been spectacularly successful providing routine dental care to some 40,000 patients every year. As the Pew Charitable Trusts wrote: “Evidence is growing that expanding the dental team to include midlevel providers, often called dental therapists, helps dentists build their businesses while increasing access to high-quality, cost-effective care. A 2014 report from the Minnesota Board of Dentistry and Department of Health evaluated the impact of these providers and found that they expand access to care for vulnerable populations and improve the efficiency of clinics and dental offices.”
Across the country, both in Indian country, and now in states, the idea of a midlevel dental practice is expanding.
Last summer at the National Congress of American Indians, Brian Cladoosby, Chairman of the Swinomish Indian Tribal Community, and president of NCAI, said the tribe would expand dental health therapy using its own sovereign regulatory structure. In recent months tribes in Oregon began their own pilot program to train dental therapists.
This innovation is the future. It expands dental care as well as opportunity for young people who want a career in dental health. It’s important to tell the story and its roots with the Alaska Native Tribal Health Consortium.
Supreme Court Justice Louis Brandeis once called states “the laboratories of democracy.” Tribes, and intertribal organizations, then, might be first test labs.
Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports.