Health Equity in Indian Country: Rethinking How CMS Approaches Health Equity for American Indians and Alaska Natives

Over the past year, the National Indian Health Board (NIHB), supported by the Centers for Medicare & Medicaid Services (CMS) and the CMS Tribal Technical Advisory Group (TTAG), convened Native health leaders from across the country to answer one critical question: “What does health equity mean from a Tribal perspective?”

In this report, we hope to faithfully portray the perspectives on Tribal health equity we have heard from Indian Country. For AI/ANs, discussions around health equity will always revolve around Tribal sovereignty, the federal trust responsibility, and how colonization and U.S. government policies have driven the severe health inequities we are now facing. This report focuses on how the Centers for Medicare and Medicaid Services (CMS), under the U.S. Department of Health and Human Services, can more effectively advance health equity for American Indians and Alaska Natives. The core principles around Tribal health equity remain relevant to anyone working towards health equity in Indian Country, and the lessons here are easily applicable to other federal agencies. As the Biden-Harris Administration raises health equity to a high government-wide priority, moving forward will require both a nuanced understanding of the unique context of Tribal health equity and a commitment to action.

• 2023 CMS Health Equity Report
• Executive Summary
• VIDEO: Overview of the Health Equity Report – Presentation to the CMS Tribal Technical Advisory Group, March 2023
• Overview Slides

Tribal Health Equity Resources

• The Hope + Healing Podcast: Health Equity
• Foundations of Health Equity in Indian Country
• Key Drivers of Health Inequities: How colonization has led to inequities in health outcomes for American Indians and Alaska Natives
• Summary of recommendations for Federal agencies to advance health equity for American Indians and Alaska Natives
• Health Equity at NIHB – 2022 Recap
• Overview of NIHB’s Tribal Health Equity Project
• Urban Indian Health Institute: Indigenous Health Equity
• All my relations -- a traditional Lakota approach to health equity | Dr. Donald Warne | TEDxFargo
• Indigenous Determinants of Health Report by the United Nations Permanent Forum on Indigenous Issues
  • Read the full report
  • VIDEOS: See statements made by Geoffrey Roth (North America Representative and Vice Chair for the Permanent Forum) and Stacy Bohlen (CEO of the National Indian Health Board) during the 22nd Session of the UNPFII

2023 National Tribal Health Conference

• Tribal Perspectives on Health Equity – Plenary presentation by AC Locklear and Carrie Field
• Workshop: Towards an Indigenous Model of Health Equity
  • Session Description: In this interactive session, presenters shared existing and proposed models of health equity and social/structural determinants of health. Attendees participated in facilitated small group discussions to provide feedback about the strengths and shortcomings of each model and insight into how best to understand and visualize an Indigenous perspective of health equity.
  • Results Summary – Coming Soon!
  • Presenter Slides
  • Four Proposed and Existing Models of Health Equity
  • Learn more about the Indigenous Determinants of Health report developed for the United Nations Permanent Forum on Indigenous Issues
  • Learn more about the original “Web of Causation” model developed by ROOTT
  • Learn more about the “Public Health Framework for Reducing Health Inequities” developed by Bay Area Regional Health Inequities Initiative
  • See the full “American Indian and Alaska Native Health & Wellness Equity Model” developed by Frizzell & Ischcomer (2016)

September 2022 Listening Session on the CMS Framework for Health Equity

• Results Summary – CMS Health Equity Listening Session
• Agenda – CMS Health Equity Listening Session