Disability and its prevention in Indian populations: is it someone else's responsibility?

American Rehabilitation, Autumn, 1989 by Jamil I. Toubbeh

4. Current databases on chronic illness and disability in IHS area offices are severely limited in scope and purpose. As a major provider of comprehensive services to Indian populations, IHS is in the unique position to track health conditions in Indian populations, to compile state-of-the-art information and to focus attention on the provision of medical, habilitative and rehabilitative services.

5. The purpose of this action is to create a coordinative role for the Office on Chronic Illness and Disability. Through examination of program components of the IHS at the headquarters and area levels, administrators can assess and direct contributions of each group to the goals, financial structure and creative force behind the OCID.

Activities under this step would be guided by the IHS Director or his designate, in coordination with the associate directors of the Offices of Health Programs; Planning, Evaluation and Legislation; Health Program Development; Tribal Activities; and Environmental Health and Engineering.

6. The establishment of liaison and dialogue with the National Council on Disability is based on the mandate of the council and its recent focus on Indian disability issues. The council is the only federal agency with responsibility to address, analyze and make recommendations to the President and Congress on issues of public policy which affect people with disabilities. Hence, it is important for IHS to keep the council apprised of the needs of the chronically ill and disabled Indian.

The representative selected for the position of liaison should have access to the IHS Director or his designate, understand disability, have knowledge about habilitation and rehabilitation, and be experienced in federal and state programs that serve disabled citizens.

Conclusion

Policy coordination at federal and state levels creates jurisdictional barriers that impede service delivery to Indian citizens. Although these policies have not adversely affected the provision of medical care, their impact on services to the disabled Indian has been significant. As a federal advocate, IHS has the responsibility to ensure that this underserved population receives its share of this resource. The proposed IHS involvement is in disability and its prevention. To carry out its responsibility, six steps are recommended and discussed. In summary, these are: the establishment of an interagency task force on disability; an Office on Chronic Illness and Disability; an IHS-wide policy on disability; an areawide database and information system on disability; a liaison with the National Council on Disability; and the development of an agency management plan to ensure that the prevention initiative is carried out in a coordinated manner within the various components of the agency.

Opinions expressed in this article are those of the author and do not necessarily reflect the views of the Indian Health Service, the Department of Health and Human Services or the Department of Education.

Note

Within the context of this article, disability is defined as either a health condition which imposes limitations on an individual's normal development and activities or one which prevents or limits an individual's ability to lead a productive life; the latter is most often associated with work. Prevention is the elimination or reduction of those factors which either result in or contribute to disability. It is intervention before disability to ensure against further complications. Prevention may be primary, secondary or tertiary.