In his current roles as executive director of both the Montana-Wyoming Tribal Leaders Council and Area Indian Health Board, Mr. Belcourt coordinates advocacy and information flow among tribal health departments, tribal councils, and federal and state agencies. As the key staff person on all issues pertaining to public health for 100,000 tribal members, ten tribal governments and eight large land-based reservations, Mr. Belcourt endeavors to strengthen tribal self-determination and foster effective government-to-government relationships.
Throughout his career Mr. Belcourt has been involved with groups that have focused on the critical allocation of scarce health-care resources, the restructuring of the Indian Health Service, and the development of a national budget to provide better care to an underserved population struggling with disproportionately high rates of alcoholism, diabetes, tuberculosis, and bodily injury associated with cultural dislocation, poverty, and limited access to health care.
In the 1970s, Mr. Belcourt became nationally recognized as an expert in the field of American Indian alcoholism. As National Field Director for the American Indian Commission on Alcoholism and Drug Abuse, Mr. Belcourt visited every American Indian reservation, community and enclave to assist local communities in developing alcoholism and substance abuse prevention programs. He ultimately established 235 such programs in 36 states, which continue to help countless people regain sobriety and reclaim their lives.Mr. Belcourt has a lifetime appointment as an Appellate Justice of the Blackfeet Nation; is active on the boards of organizations advocating for public health, higher education, civil liberties and the environment; and is extensively involved in traditional Native American and spiritual gatherings essential to public health at the tribal level.
Award Presenter
Leonard Duhl, M.D., Professor of Health Policy and Administration, at the UC Berkeley School of Public Health, is noted for his pioneering work related to healthy cities and healthy communities. His research focus has been on the planning and policy of cities to improve the quality of life and health status of individuals, families, and groups in diverse heterogeneous communities in the United States, Canada, Europe, and the developing world. Since 1968, thousands of Dr. Duhl's students have carried on the enthusiasm and energy he transmits as professor of public health and city planning and professor of psychiatry.
The Challenge: Reducing Health Disparities
As compared to estimates for all Americans, stunningly high numbers of American Indians and Alaskan Natives succumb to preventable or controllable health problems. According to the National Indian Health Service, the rate of death from alcoholism among this population is 740 percent higher than the national average. Tuberculosis-related mortalities are 500 percent greater; diabetes is 390 percent more prevalent; and injuries and accidents account for 340 percent more deaths than in the nation taken as a whole. The figures for lives lost to suicide and homicide are well above the national average, as well.
These disease patterns are associated with several factors that contribute to unhealthy lifestyles and limit American Indian access to quality, affordable health care. Thirty-two percent of the American Indian population falls below the poverty standard. The rate of unemployment is 2.5 times greater than the national average. Left without employer-subsidized health insurance or the resources to purchase independent health coverage, it is estimated that 1.4 million of an estimated 2.5 million American Indians and Alaskan Natives rely solely on the national Indian Health Service and tribal programs for health care.
Tribal leaders are concerned that Indian health resources are not adequate to deal with the enormous needs—a concern consistent with a recent actuarial study that found IHS funding for personal health services at 60 percent compared to mainstream employer-provided plans. While the IHS has seen many improvements since the 1970s, the most serious health problems are long-term, intractable issues that will be greatly affected by social and economic conditions in Indian communities and the resources available to respond to them.
A sense of dislocation—geographic and cultural—also contributes to health disparities in American Indian health care. Much of the American Indian population lives in rural settings, far from hospitals, clinics and sources of mental health counseling and health education. When available, health care is often provided in a manner that does not incorporate American Indian cultural and spiritual traditions. As recent research confirms, social status—as measured by wealth, but also education and other markers of status—correlates highly with health. For great segments of the American Indian community, the many obstacles to self-determination and self-esteem lead to emotional isolation and lifestyle choices that become health problems in and of themselves.
The School of Public Health Responds
The UC Berkeley School of Public Health has a long-established commitment to American Indian health that began in the 1950s and has grown into a graduate program designed to encourage American Indian people to become empowered by education, research, and training and to shape public health policy and practice at tribal, regional, and national levels.
Officially designated the American Indian Graduate Program (AIGP) in 1971, the program identifies American Indians and Alaskan Natives with an interest in professional health education or training at the master's level. While initially a response to the need for Indian professionals in public health fields, AIGP has expanded into social welfare and graduate programs throughout the university.
During the past three decades, more than 200 American Indian and Alaskan Natives have earned master's or doctoral degrees at the School of Public Health. Many have returned to their communities and established careers in public health service, often working with the Indian Health Service. Other AIGP-affiliated alumni have gone on to contribute their culturally sensitive expertise as doctors, nurses, social workers, teachers, health officers, educators, and community leaders.
