A recent report on health care access revealed Oklahoma’s Native American population faces significant barriers to receiving health care. However, Citizen Potawatomi Nation Health Services is working on plans to address some of those challenges.

Oklahoma ranked above only West Virginia and Mississippi in the Commonwealth Fund’s 2024 state health disparities report. (cpn.news/healthdisparities) The report ranks each state’s health care system based on how well it provides high-quality, accessible and equitable health care. The Commonwealth Fund is a New York-based foundation that supports health care equity.

The Oklahoma health care system score for American Indians and Alaska Natives was 11 out of 100. Oklahoma ranked fourth among the 10 states with a large enough AI/AN population to measure.

“The Commonwealth Fund’s findings are on par with what we’re seeing reported for Native American populations in the state of Oklahoma. I sit on several boards with the University of Oklahoma, one of which is specifically focused on health equity for Native Americans due to the identified gaps in equitable health for our population,” said Lauren Bristow, CPN clinic operations administrator.

Barriers to care

High poverty rates and large numbers of uninsured individuals are just two of the factors that contribute to health care inequities. According to the U.S. Census Bureau, Oklahoma has the sixth highest poverty rate and the third highest uninsured rate in the country.

Nearly 20% of Native Americans in Oklahoma live below the poverty threshold.

“People who are experiencing poverty are understandably in survival mode,” Bristow said. “Adding lack of insurance to this equation increases the likelihood that health care will be put off.”

Once an appointment has been scheduled, the ability to get there could also prevent someone from receiving care.

“Transportation also seems to be a large barrier,” she said. “While we are only 40 minutes from a large, academic health care center, sometimes traveling this distance is simply not an option. Transportation concerns can present both physical and emotional barriers, when considering the dynamics of driving in a metropolitan area.”

Bristow has voiced these concerns to the many boards and organizations she participates in, one of which is the Tribal Advisory Board of the Stephenson Cancer Center at the University of Oklahoma. Stephenson is the state’s only National Cancer Institute-designated cancer center and has been named Oklahoma’s top facility for cancer care by U.S. News & World Report.

Oklahoma’s Native American population has a notably high rate of cancer diagnoses, some of which are easily treatable if detected early. However, when patients do not receive regular screenings or preventive care, many cancers can go undetected, sometimes leading to premature deaths.

Some cancers and infant and maternal mortality rates figured into the Commonwealth Fund report. The report said premature deaths from treatable causes among Native Americans in Oklahoma were 697.6 deaths per 100,000 population. The lowest rate was 234.8 deaths per 100,000 population among Asian American, Native Hawaiian and Pacific Islanders in Oklahoma.

The health care access report did contain some hopeful news. The Native American population in Oklahoma does have better health care access than their peers in the northern and southwestern regions of the U.S.

Bristow said it is possible that the number of Oklahoma tribal clinics available may account for the data, as well as the fact that Oklahoma tribes are located in closer proximity than in states like North Dakota, Arizona and Utah, where patients may have to drive for hours to reach a provider.

Increasing access

The U.S. Indian Health Service is responsible for most of the funding for tribal health clinics, however the agency has been chronically underfunded for decades. Bristow urges Tribal members to advocate for additional IHS funding.

Bristow said CPN works diligently to make the budget stretch to serve growing tribal populations without additional funding. It is a point she makes each Tuesday when she participates in new hire orientation and explains how CPN Health Services is funded.

“We’re trying to break the misconceptions of what tribal health is and how we’re funded. It’s not just a blank check for us, and it’s certainly not ‘Indian insurance,’” she said.

CPNHS, with the assistance of the CPN Office of Self Governance, also seeks out any available grants from the National Institutes of Health and other sources. NIH has offered grant opportunities to specifically address health disparities in Native American communities.

“The University of Oklahoma recently applied for a nation-wide grant which seeks to reduce inequity in cancer care among Native American populations, and also provide additional funds to support preventative screenings. I am honored to sit on the Tribal Research Advisory board, along with several other representatives from tribal nations here in Oklahoma. The Tribal Research Advisory board and numerous health professionals from Stephenson Cancer Center and the University of Oklahoma, collaborated on the grant submission for this opportunity,” Bristow said. “I do think if we continue to advocate in every available avenue that we can push towards change.”

Other ways CPNHS is working to serve a growing patient population is the new CPN clinic site currently in the planning stages, which will be located in Choctaw, Oklahoma, as well as maximizing existing resources.

“In addition to expanding physical locations, we work to ensure that we are operating at the highest efficiency, with the highest quality of care possible. That means reviewing processes frequently and implementing creative solutions where possible. I think that’s the best way that we can serve our people with the resources we have today,” she said.

Bristow added that it is important for Tribal members to use CPNHS because that influences IHS funding.

“The number of patients attributed to our health care facility makes up our user population. And that user population number goes into a calculation with IHS to determine our funding,” she said.

She urges patients to sign up for care early instead of waiting until they have a health problem.

“Establishing care with a primary care provider before you have an urgent need makes the process more seamless and expedites our ability to provide care when or if you do have an urgent need. New patient appointments tend to schedule out further than established patient appointments, so waiting to establish care until an urgent health care need exists, could potentially delay care,” Bristow said. “Being proactive is certainly very beneficial.”

For more information about the CPNHS facilities, visit cpn.news/health or @potawatomihealth on Facebook and Instagram.