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Credit Stephen Melkisethian

The federal appropriations process is complicated and confusing. And it might be at its worst.

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NCAI President Brian Cladoosby announcing a new dental health initiative for his community, the Swinomish Tribe.

The idea of “tribal sovereignty” is not static. It’s always a test, a back and forth contest between those who believe in indigenous self-government versus those who like the idea of Someone Official dictating rules.

Alaska, like much of Indian Country, was facing an oral health epidemic with tooth decay (and pain) being the norm for nearly every child. A number of studies reached the same conclusion: “Lack of access to professional dental care is a significant contributor to the disparities in Indian health that exist in the American Indian / Alaska Native population.”

So more than a decade ago the Alaska Native Tribal Health Consortium experimented with mid-level oral health providers, dental health therapists. The design of the program was to train and hire community-based providers right out of high school who would serve patients at the village level. The program has been fabulously successful.

This is where the next chapter in this story starts. At the National Congress of American Indians mid-year conference last week, President Brian Cladoosby, Chairman of the Swinomish Tribe in Washington state, announced that his tribe will enroll a student in a two-year training program to become a dental health therapist.

“We as Indians have long faced an oral health crisis, and the crisis is only growing,” Cladoosby said. “There just aren’t enough dentists in Indian Country to address this crisis. The Swinosmish dental clinic sees more than twice the number of patients per provider as the national average. That’s why we are expanding the Swinomish dental team through the proven solution of training and employing dental health aide therapists.”

This is tribal sovereignty in action.

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President Obama hugs Kristie Canegallo and Vice President Biden hugs Denis McDonough President Barack Obama hugs Kristie Canegallo, Deputy Chief of Staff, and Vice President Joe Biden hugs Chief of Staff Denis McDonough as they celebrate the Supreme Court ruling on Affordable Care Act subsidies in the Oval Office, June 25, 2015. (Official White House Photo by Pete Souza)

The Supreme Court once again affirmed the legality of the Affordable Care Act. This time the court’s answer is unambiguous.  As Chief Justice John Roberts wrote: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

There is an interesting twist on this case for American Indian and Alaska Native consumers. Early on both supporters in Congress and in the Obama administration decided to play up the portion of the law that exempted Native Americans from the mandatory insurance requirements. The idea was that delivery of health care is seen as a treaty right, so it was impossible to force Native Americans to buy insurance. But the problem is the Indian health system does not have adequate funding — and the best course for improving that revenue stream is to sign up more Native Americans for some kind of insurance through a job, Medicaid, Medicare, Childrens’ Health Insurance Program, or these health insurance exchanges.

So expect a new emphasis on insurance. There are a variety of Obamacare programs that cost little or nothing — call them the pre-paid, Treaty Insurance Plans.

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Canada’s National Aboriginal Day showcases the Native community’s extraordinary talent. It’s also an opportunity for that nation to change its conversation and bring about true reconciliation. It’s also an idea worth emulating in the United States. It would be fantastic if for a moment, even for a single day, we were defined by what we can be — and not just our challenges.

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Do you sleep with your smart phone? Or first thing the next morning, even during the night, do you peek to see what’s new? If you are a Millennial — between 15 and 35 years old — the answers are likely, yes.

Every year author and digital analyst Mary Meeker presents her view of Internet trends. Turns out Millennials look at the world differently, starting with the way they see smart phones. Nearly nine-in-ten (87 percent) say their phone never leaves their side and 80 percent say it’s the first thing they look at after waking.

I don’t have numbers for Indian Country but given the lack of universal Internet or even cell phone service, I am sure that the numbers are lower. That said: Just by looking at Facebook, Instagram, Snapchat, Twitter, and other social media, it’s clear Indian Country Millennials are similar in their use of social media. (Remember Indian Country’s population skews younger than the general population.)

 The three digital trends I think most important:  The demand for more (and better) data; a need to rethink governance; and, the end of geography as a barrier.

First, let’s explore data.

Indian Country already has a data gap. Many of our statistics, ranging from unemployment to health metrics, are unreliable and out of date.  A few years ago a BIA official had to testify with a series of “I don’t knows” about unemployment because his report was unreliable.  That’s too often the case. 

Second, we need to rethink governance.

So many of our laws, tribal, state and federal, are written for an era that no longer exists. One of the trends that Meeker identified is the growth of people working in flexible or supplemental jobs. More than a third of the workforce (some 53 million people) is now made up of independent contractors. Nearly 70 percent of those surveyed say that “social networking has drastically changed the dynamics of networking. So what will it take to get tribal laws in sync, and further encourage these trends? Meeker’s report says too many laws are written in a world where business is business, and “so what happens when a person becomes a business?”

The third trend is the lifting of geography as a barrier.

In the digital world location does not matter. A business can operate successfully anywhere there’s a good connection to the Internet. The retail site Etsy is a good example. According to Meeker’s research, 35 percent of Etsy sellers started a business without much capital. It’s the perfect space for authentic Indian art. Stephanie Pinkham,  a Nez Perce, sells  high quality Northwest beaded vests and other crafts. Or rent a Navajo hogan in Chinle or near Shiprock on AirBnB.  One day I hope, you can text Uber and get a ride into a border town. 

The important thing is that we are at the beginning of the digital transformation. Then, American Indians and Alaska Natives have a long history of adapting to new technology. This is just a new and exciting chapter — especially if you’re reading this on your phone in bed.

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Fort Peck Tribal Health Department is a success story showing how a community can reduce diabetes rates. From left: Janene Padilla, Diabetes Coordinator Tessie LaMere. Cheryl Bighorn-Savior (RN), and Laurel Cheek.

Across America diabetes rates are exploding. Recent data show diabetes rates increasing in nearly all of the 2,992 counties in the U.S. And ten of those counties showed a decrease.

Here is the thing: Two of the ten counties showing a decrease in rates are found on Indian reservations, Fort Peck, Montana, and Rosebud, South Dakota.

Indian Health Service data also shows a slowing of the diabetes epidemic. From 2001-2005, there was a relative increase in age-adjusted diabetes prevalence in American Indian and Alaska Native adults of 2.2% per year on average. Contrast that with 2006-2013 numbers that show diabetes prevalence increased at a rate of 0.8% per year on average.

We hear all the time about how bad things are in Indian Country. But when you look at the spike in rates of diabetes across the country — it’s clear that Indian Country is showing what can be done to reverse a dangerous trend.

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Williams family photo
Mike Williams and his granddaughter Megan at a hunting and fishing rights rally last year in Anchorage.

Alaska’s tribes are setting up a new system to give them a say over salmon.

On May 8, Twenty-eight tribes created the Kuskokwim River Inter-Tribal Fish Commission.  “The people of the Kuskokwim River are no longer satisfied with serving in an advisory role to state and fishery managers,”  says a news release from the new commission. “The message, Kuskokwim River tribes and rural residents desire a “meaningful role” in the management of fish and wildlife as it is expressed by Congress in section 801 (5) of the Alaska National Interests Lands Conservation Act, a role that until now most Western Alaskans agree has been meaningless.”

I am convinced that co-management works. In Washington, Oregon and in Idaho there are salmon streams that would have gone extinct without a broader, more comprehensive management approach. Even small tribes hire people to work on habitat restoration or protecting baby salmon from predators. And it’s hard to understate the importance of creating natural resource jobs because it gives Native people a new purpose, working on the land to improve wildlife.