Bergman A B, Grossman D C, Erdrich A M, Todd J G, Forquera R
Harborview Medical Center, Seattle, WA 98104, USA.
Milbank Q. 1999;77(4):571-604, iv. doi: 10.1111/1468-0009.00152.
One of the few bright spots to emerge from the history of relations between American Indians and the federal government is the remarkable record of the Indian Health Service (IHS). The IHS has raised the health status of Indians to approximate that of most other Americans, a striking achievement in the light of the poverty and stark living conditions experienced by this population. The gains occurred in spite of chronically low funding and can be attributed to the combination of vision, stubbornness, and political savvy of the agency's physician directors and the support of a handful of tribal leaders and powerful allies in the Congress and the White House. Despite the agency's imperfections and the sizeable health problems that still exist among American Indians and Alaskan Natives, the IHS is an example of one federal program that has worked.
美国印第安人与联邦政府关系史上为数不多的亮点之一，是印第安卫生服务局（IHS）的卓越成就。印第安卫生服务局已将印第安人的健康状况提升至与大多数其他美国人相近的水平，鉴于这一群体所经历的贫困和恶劣生活条件，这是一项惊人的成就。尽管资金长期不足，但这些成果依然实现了，这要归功于该机构内科主任们的远见卓识、坚韧不拔以及政治智慧，还有少数部落领袖以及国会和白宫一些有影响力盟友的支持。尽管该机构存在不足之处，且美国印第安人和阿拉斯加原住民中仍存在大量健康问题，但印第安卫生服务局是一个运作成功的联邦项目典范。
