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Reviewed by:
  • Plagues, Politics, and Policy: A Chronicle of the Indian Health Service, 1955-2008
  • Monika Bilka (bio)
Plagues, Politics, and Policy: A Chronicle of the Indian Health Service, 1955-2008. by David H. DeJong. Rowman and Littlefield Publishers, Lexington Books, 2011

In his broadly sweeping study Plagues, Politics, and Policy: A Chronicle of the Indian Health Service, 1955-2008, David H. DeJong analyzes the level of health care the Indian Health Service (IHS) provided American Indians and Alaska Natives. He argues that between 1955 and 2008 the IHS improved American Indians' and Alaska Natives' health statuses by combating their long-standing diseases. However, the agency's focus remained crisis-oriented rather than preventative, constraining [End Page 137] its ability to mediate new health issues, such as diabetes and mental illness, which continue to afflict American Indians and Alaska Natives.

This book is part of a one-hundred-year national study of the federally implemented health care for American Indians and Alaska Natives. DeJong's preceding volume, "If You Knew the Conditions": A Chronicle of the Indian Medical Service and American Indian Health Care, 1908-1955 (2011), assesses the health care challenges American Indians and Alaska Natives faced while the Indian Service, and later the Bureau of Indian Affairs (BIA), operated the IHS during the first half of the twentieth century.

Prior to 1955, when the BIA administered the IHS, inadequate congressional appropriations, the lack of facilities and infrastructure, and poor institutional organization hindered the service's ability to provide satisfactory health care to Native communities. By the 1960s, the Public Health Service already had proven that with its professional staff, direct connections to the medical field, and strong relationship with Congress for appropriations, it had the means to improve the IHS. The Public Health Service expanded the IHS's infrastructure, increased its efficiency, and worked at directly integrating its services with Native communities.

During the 1970s the IHS underwent further reorganization due in large part to the Indian Self-Determination and Education Assistance Act of 1975, which encouraged Native communities to manage programs administered by the federal government. While IHS traditionally focused on reservation Indians, in 1976 the service received appropriations to extend its services to urban Natives through federal contracts with the organizations Indian leaders had already established there.

In 1982 Everett Rhoades, a Kiowa physician, took the reins of the service as its first American Indian director. Under his leadership, Natives increasingly brokered contracts with IHS to manage health care in their communities and the service began adopting preventive care strategies. Rhoades also recognized the importance of cultural sensitivity and encouraged Indian communities to hire medicine men to treat Native patients for mental health and other medical issues.

The 1990s and 2000s reflected the earlier trends of IHS. The service strove to involve Native communities in their own health services and attempted to integrate culturally acceptable health care into its programs, but it struggled to meet the health care needs of its clientele. Mental illness and alcohol-related diseases and deaths eclipsed the health issues that threatened Indian communities in the 1950s (largely infectious diseases). While IHS made progress during this period, socioeconomic issues continued to exacerbate the service's success. Many Native communities lived in poverty-stricken conditions, including substandard housing beset with poor sanitation and water infrastructures.

In his last chapter, titled "Into the Twenty-First Century," DeJong concludes by answering the question, Has the federal government adequately [End Page 138] upheld its moral and legal promise to maintain a reasonable standard of health among Native peoples? He answers no. The Public Health Service improved the IHS and reduced the risk of illnesses that had plagued Native communities for decades prior to the 1950s. Despite these successes, the services IHS administered have failed to elevate the health statuses of American Indians and Alaska Natives to a level equivalent with the rest of the nation.

Rather than simply make that conclusion, DeJong provides a prescriptive analysis. To improve health in Indian Country, the IHS must adapt its services to meet the cultural needs and socioeconomic situations of Native communities. This includes practicing prevention-focused, rather than crisis-oriented, medicine. The programs must emphasize changing behavioral habits...

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