According to Census Bureau statistics from 2000, American Indians make up 2.8 percent of the U.S. population. However, only 0.3 percent of students in medical schools and 0.5 percent of students enrolled in schools of pharmacy are American Indians.
“We’ve been working hard to get these numbers up,” says Lori Morin, an assistant dean for student affairs at the University of Montana, who regularly works with Indian pharmacology students. “We’d like to be doing a lot better.”
"There are very few positive Indian health professional role models on Indian reservations," adds Polly Olsen, who directs the Native American Center of Excellence at the University of Washington. "I grew up on a reservation, I know."
The educators say one program in particular -- the “Centers of Excellence,” mandated by Congress in 1988 -- has been instrumental in their efforts to reverse the numbers. Directed by the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, the program is meant to help universities and health professions institutions bolster training and support for minority students in a range of health fields. To date, 30 programs, including ones for African Americans, Hispanics and Native Americans, have been supported. Until this year, the competitive grants had been awarded by the federal government in three-year cycles. But recent federal budget cuts have put this and other health professions training programs at risk. A new round of budget battles starts today, when a House of Representatives appropriations panel will draft a bill to fund this and other federal education and health programs.
Some of the programs' most significant assistance has gone to Centers of Excellence at the Universities of Minnesota, Montana, Oklahoma and Washington, which have traditionally enrolled a significant number of Native Americans. The centers have offered a range of services, from academic counseling to apprenticeships with Native American health professionals.
In recent years, many Native Americans served by the program have gone on to earn health professions degrees. At the University of Montana, for instance, 100 percent of the 17 Indian students who have taken part in its pharmacology programs have graduated since the institution started receiving funding through the program. Ten more are expected to graduate soon. Students there receive specialized teaching support and assistance adjusting to a large campus. Many have come from small reservations in Montana and retention has been a key goal, Morin says. Non-Indian students have also been able to take classes to help them understand the culture and health concerns of their Indian peers.
Many health experts are concerned that recent federal budget cuts will impede such progress. The Centers of Excellence received $33 million in federal funding in the 2005 fiscal year. Almost five percent of the funds in 2005 supported Native American training and retention efforts. But this year, Congress appropriated less than $12 million for the program, all of which will go to historically black colleges.
"We are the most underserved population in the nation," says Olsen, who is a member of the Yakama Nation. "I think they should have split the pot among all centers."
As a result of the cuts, the University of Montana’s Center of Excellence program will end in six months. Other Native-focused centers will continue operating, but at dramatically reduced levels. The Center for American Indian and Minority Health at the University of Minnesota, for example, will lose 83 percent of its budget. It was among the first Native American-focused Centers of Excellence, receiving its first funds in 1991. Educators there are concerned that the program may not be able continue operating, despite a small financial commitment from University of Minnesota administrators.
“It’s a significant reduction in funds,” says David Bowman, a spokesman for the Health Resources and Services Administration. While the program isn’t aimed specifically at Native Americans, he said that some of the most compelling success stories have come out of Native-focused centers.
“The grant allows us to create an atmosphere of success, which is the basis for retention,” says Morin. “Nearly all the Native pharmacists in Montana have graduated from our program and many have returned to their reservations to provide care. The impact of the loss of this funding will be tremendous.”
Since there is already a lack of federal funding for Native American health professions training, several health experts have argued that overall cutbacks in the federal government’s health professions programs will disproportionately affect American Indian students and their ability to make headway in medical fields.
“These Title VII programs are so unique because they strive to improve and diversify the health workforce,” says Erica Froyd, a senior legislative analyst for the Association of American Medical Colleges. She says that many Native Americans will face increased challenged without the institutional support the program has been able to provide. “This program has really ensured that they make it through and get the experience they need. Certainly, this is going to be of detriment to Native Americans.”
Other support is available for Native Americans interested in the health fields, through individual direct scholarships with the Indian Health Service. But Morin says that from her experience, institutional support from the Centers of Excellence program has helped colleges strategically aid more students. She adds that some individual students have not been able to succeed once they are in a new college environment -- even with scholarships.
“The Centers of Excellence money doesn’t go directly to students,” explains Froyd. “It goes to institutions and tends to have more staying power.”
Morin says she is pessimistic that funds for the program will be restored in the current budgetary climate. “I don’t know how they decided where the money would go,” she says. “We feel like the powers that be really just don’t understand the importance of these programs.”