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359 made available to carry out this Act) make grants under this section on behalf of Indian tribes to carry out affordable housing activities. Under such a grant on behalf of an Indian tribe, the Secretary shall provide the grant amounts for the tribe directly to the recipient for the tribe. . . . TITLE II—AFFORDABLE HOUSING ACTIVITIES sec. 201. national objectives and eligible families. (a) Primary Objective.—The national objectives of this Act are— (1) to assist and promote affordable housing activities to develop, maintain, and operate affordable housing in safe and healthy environments on Indian reservations and in other Indian areas for occupancy by low-income Indian families; (2) to ensure better access to private mortgage markets for Indian tribes and their members and to promote selfsuf ficiency of Indian tribes and their members; (3) to coordinate activities to provide housing for Indian tribes and their members with Federal, State, and local activities to further economic and community development for Indian tribes and their members; (4) to plan for and integrate infrastructure resources for Indian tribes with housing development for tribes; and (5) to promote the development of private capital markets in Indian country and to allow such markets to operate and grow, thereby benefiting Indian communities. (b) Eligible Families.— (1) In General.—Except as provided under paragraph (2), assistance under eligible housing activities under this Act shall be limited to low-income Indian families on Indian reservations and other Indian areas. . . . TITLE VI—FEDERAL GUARANTEES FOR FINANCING FOR TRIBAL HOUSING ACTIVITIES sec. 601. authority and requirements. (a)Authority.—Tosuchextentorinsuch amounts as provided in appropriations Acts, the Secretary may, subject to the limitations of this title (including limitations designed to protect and maintain the viability of rental housing units owned or operated by the recipient that were developed under a contract between the Secretary and an Indian housing authority pursuant to the United States Housing Act of 1937), and upon such terms and conditions as the Secretary may prescribe, guarantee and make commitments to guarantee, the note or other obligations issued by Indian tribes or tribally designated housing entities with tribal approval, for the purposes of financing affordable housing activities described in section 202. (b) Lack of Financing Elsewhere.—A guarantee under this title may be used to assist an Indian tribe or housing entity in obtaining financing only if the Indian tribe or housing entity has made efforts to obtain such financing without the use of such guarantee and cannot complete such financing consistent with the timely execution of the program plans without such guarantee. . . . [U.S. Statutes at Large, 110:4016–18, 4022, 4031, 4046.] 233. The Future of the Indian Health Service A Message from the Director December 1996 The director of the Indian Health Service, Dr. Michael H. Trujillo, a member of Laguna Pueblo, issued this statement of his views about the status of Indian health and his visions for the future. He points to health challenges facing the Indian communities but also notes the encouraging progress that has been made. Since I was confirmed and sworn in as Director of the Indian Health Service in April 1994, my work has been rewarding and challenging. It has been challenging because of the pressures on the Agency that require us to change how we conduct business and 360 deliver health care. It has been professionally rewarding because the guiding principle of putting patient care, prevention, and community health care first has been strengthened , and this principle continues to serve as the focus for decision-making in all aspects of the Indian Health Service. I have noticed a dramatic change in discussions with our partners in Indian health that reflects this guiding principle. From finance to facilities, from paperwork to personnel, the effect on primary and preventive health care is considered in decisions we make. . . . Employees of Indian health programs have helped to raise the health status of American Indians and Alaska Natives signi ficantly. Since 1973, infant mortality has decreased 60% and is nearing the rate of the general population; mortality rates have also dropped for tuberculosis (80%), gastrointestinal diseases (76%), and deaths due to unintentional injury (56%). Life expectancy at birth for American Indians and Alaska Natives has increased 12.2 years since 1973 and is now just 2.6 years below that of the general population. These are examples of the achievements made in the last 20 years. It is the collaboration of Indian Health Service, tribal, and urban Indian health programs...


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