Whenever the health needs of the Indians can be better met thereby, the Secretary вЂ¦ is authorized in his discretion to enter into contracts with any вЂ¦ institution providing for the transfer of Indian hospitals or health facilities That all functions, responsibilities, authorities, and dutiesвЂ¦relating to the maintenance and operation of hospital and health facilities for Indians, and the conservation of Indian health вЂ¦ shall be administered by the Surgeon General of the United States Public Health Service. The Indian health program became a responsibility of the Public Health Service under the Transfer Act of 1954.

These 4 laws encompass only a small portion of the exhaustive list of laws and policies affecting how AI/AN individuals receive health services. Several of them, including the Snyder Act, Transfer Act, Indian Self-Determination and Education Assistance Act, and the Indian Health Care Improvement Act, are described here. However, numerous laws passed in the 20th century have had a significant impact on the way health services are provided to AI/AN persons. Moorehead, a commissioner for the Bureau of Indian Affairs, stated that вЂњIt is incomprehensible to me that appropriations for combating disease are so meager.вЂќ 5 Unfortunately, underfunding of the IHS continues to this day ( Figure 1). For example, according to the 1890 Annual Report of the Commissioner of Indian Affairs, physicians working with Indian populations were paid an average annual salary of $1028 compared with $2823 and $2622 for Army and Navy physicians, respectively. This article provides a brief overview, history, and evolution of AI/AN health policy as well as recent trends and contemporary issues.ДЄ deficiency of resources has plagued the provision of health services to AI/AN persons since the last treaties were signed in 1871. However, a long-standing history of underfunding of the Indian Health Service (IHS) and its predecessor agencies has led to significant challenges in providing proper care and protection. 3 Trust responsibility is also a legally administrated financial obligation on the part of the US government to defend tribal treaty rights, lands, assets, and resources, as well as a duty to provide health services. 2 This obligation was initially described by Chief Justice John Marshall in 1831 in reference to the Supreme Court case Cherokee Nation v Georgia. The federal Indian trust responsibility is a legal obligation under which the government вЂњhas charged itself with moral obligations of the highest responsibility and trustвЂќ toward Indian tribes. The result is that there is a trust responsibility on behalf of the federal government to provide services to AI/AN persons. 1 The Supremacy Clause of the US Constitution establishes the Constitution, federal statutes, and treaties as вЂњthe supreme law of the land.вЂќ Typical language in many of the treaties signed between the United States and tribal nations included phrases like вЂњpromise of all proper care and protectionвЂќ in exchange for tribal land and natural resources. For example, between 17, at least 367 treaties were ratified by the federal government. Services provided to AI/AN persons (e.g., housing, education, health care) have been guaranteed through treaties, executive orders, and other legal bases. This history has resulted in a complex web of federal Indian policy, treaties, and intergovernmental relationships. American Indian and Alaska Native (AI/AN) tribes have had a unique history with the United States that is mixed with conflict, warfare, cooperation, and partnership.

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