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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: The National Congress of American Indians, Washington, D.C. DATE: February 25, 2000
I was here last year. And of course leaders throughout our Department - especially Deputy Secretary Kevin Thurm - have been meeting and listening to the concerns of American Indians for seven years.
Nevertheless, I have to admit I'm a little nostalgic today. . . even a little wistful. This is my last year to speak with you as Secretary. But I want you to know - I am very proud of what we've accomplished together. We've traveled a long way, and our journey is not over.
Perhaps you saw the movie, Smoke Signals. It tells the story of Thomas Builds-the-Fire and Victor Joseph - two young men from the Nez Perce reservation in Idaho who travel to Phoenix.
At first, the two young men seem like a poorly matched pair to make this difficult journey. However, by the end of their trip, Thomas and Victor prove that with cooperation, perseverance and some fry bread they can go anywhere - and do anything.
Like Thomas and Victor, we have traveled very far - on a trail that has not always been flat and smooth. Like Thomas and Victor, we've learned the benefits of cooperation and perseverance. And Like Thomas and Victor, we've proved that if we walk together under the sheltering sky we can reach any horizon.
I come to you today at the start of a new century. As we start this new age, lets continue to walk and work together to make this an era of great progress and even greater promise. Not for some Americans - but for every American. The opportunity is certainly here. In the last seven years, we've created 20 million new jobs -- but as everyone here knows, opportunity knocks softer on the doors of our Reservations. The President understands that. And I do too.
Too many American Indians - both on and off the reservation - live in the shadow of poverty, poor health and an uncertain future. They also live in a world of tradition, oral history and hope.
In Smoke Signals, Thomas knew that sometimes we need to write new endings for old stories. That courage and determination bring change. Like Thomas, together, we're rewriting an old story and making a new one.
In our new story, despair becomes promise. Poverty becomes opportunity. Poor health becomes strength. And uncertainty becomes security. That is the story - and the future - we want to pass down to our children.
In his State of the Union address, President Clinton said this: "Never before have we had such a blessed opportunity - and, therefore, such a profound obligation - to build the more perfect union of our dreams."
That union must include the dreams of American Indians and Alaska Natives and it must be forged through a partnership of equals. That means the federal government is not the senior partner. Or the majority partner. Or the partner with the most votes.
We must be nothing more - and nothing less - than collaborating partners whose first obligation is to listen. I don't have to tell you that this has not always been the case. In the past, the federal government's relationship with American Indians and Alaska Natives has been unequal, not to mention long on promises made and short on promises kept.
But from the first day of this Administration, we were determined to do things differently. We knew that effective solutions would only come by strengthening the bridges of understanding and cooperation with American Indians and Alaska Natives. I'm not talking about circulating a memo or adding a program or two. I'm talking about a top-to-bottom change - where tribal consultation is the first, last and only way we do business.
Joy Harjo, a poet from the Muskogee tribe, once wrote: "The world begins at a kitchen table." With this wise thought in mind, I want to mention two people who knew something about the transforming effect of sitting down and talking.
Dr. Phil Lee was my first Assistant Secretary of Health. And Dr. Jo Boufford was his deputy. Both have since left the Department - but not before putting into practice the first listening councils and establishing this Department's commitment to our government-to-government consultation process.
In 1994, the President met with tribal leaders at the White House and put into place a directive on consultation with Indian nations. To continue that policy, in 1998, the President signed an Executive Order requiring the federal Government to consult with American Indians on policies and matters that significantly affect their communities.
The order recognizes the right of each sovereign nation to self-government, and commits all federal departments to open their doors to Tribal governments so you have the opportunity to help shape and strengthen our plans.
My department took this to heart. We designed our own department-wide Tribal Consultation and Participation Policy, and we're making sure other agencies within HHS - including our Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration and the National Institutes of Health - consult with tribal governments.
In 1998 and 1999, the Deputy Secretary literally traveled the country to listen to and consult with tribes. Kevin Thurm hosted five listening councils - in Phoenix, Bismarck, Seattle, Oklahoma City and Syracuse. And, I'm pleased to say that we're planning a National Tribal Listening Council for later this year.
These listening councils have taught us what you have long known. American Indians are not a monolithic group. Tribes differ and face unique priorities and challenges.
In Phoenix, we learned that diabetes and pneumonia topped the list of health concerns. In Bismarck, we heard worries about increasing tobacco use, particularly among women. In Seattle, we learned just how important access to quality health care is for American Indians living in remote locations. And, believe me, we're going to keep learning.
In part because of Dr. Michael Trujillo, our Director of the Indian Health Service. Dr. Trujillo is one of the brightest lights at HHS. He leads by example and never lets us forget: First listen. Then learn. Then act.
I started my remarks today by noting that this will be my last year with you as Secretary. But I want you to know that while I may be leaving, I'm going to do everything in my power to make sure that the process of consultation stays - and grows.
That's why we remain committed to working with Congress to elevate the position of the IHS Director to the level of "Assistant Secretary" in the Department. I'm optimistic Congress will pass this vital measure this year.
But elevating the role of the Director of the Indian Health Service is only part of our American Indian and Alaska Native agenda. We have also presented Congress with a budget that includes the largest requested increase in funds for the Indian Health Service in two decades.
But I'm getting a little ahead of myself. I want to be clear: Our budget proposals grew out of the same philosophy of consultation that has governed all of our work with tribal nations and urban Indian leadership.
Last May, we joined each other at the table to discuss the needs and priorities of American Indian communities. HHS became the first federal department to hold a department-wide budget consultation with American Indian and Alaska Native leaders and representatives - before the submission of the Department's budget request. And we're not finished yet.
In April, we will host another budget consultation - a cooperative effort that will help us plan our budget for Fiscal Year 2002.
If consultation is the first principle by which HHS and the Indian Health Service lives, then the deep belief that actions speak louder than words is the second. In Smoke Signals, Thomas taught Victor that sometimes you have no choice but to take action to overcome great challenges.
For seven years, we've been letting our actions do the talking. For example, the Indian Health Service budget has grown by over 40 percent just since 1995. We're continuing our work to raise Medicare and Medicaid reimbursements to the IHS hospitals and clinics. Thanks to the hard work of an inter-agency working group -- we're making progress at ensuring the hospitals and clinics you rely on receive reimbursements that better meet the costs of providing care.
Indian visits to health care services have been steadily increasing over the last five years. Indian child immunization rates are nearly 90 percent. And, infant mortality rates in tribal communities continue to decline.
Still, I want to repeat something I said when we announced our 2001 budget proposals earlier this month: closing the gap in health outcomes between minority populations and the majority population is our greatest moral imperative. These gaps are unworthy of a great nation - and they must end.
That's why in 1998, President Clinton announced his goal of eliminating racial and ethnic health disparities in six critical areas by 2010. Those six areas are: childhood immunizations, cancer screening, cardiovascular disease, HIV/AIDS, infant mortality - and of particular concern to American Indians, diabetes. Today, almost every operating division at HHS is making a contribution toward ending these disparities.
While we knew before we sat down at the table together that these gaps in health outcomes existed, we didn't always know the best way to close them. Now, by working together, we're refining our programs so that they meet the special needs of tribal populations.
We're also putting our money where our commitment is. This year we're proposing to invest 35 million dollars at the Centers for Disease Control and Prevention for community based research and demonstration projects to reduce disparities. And the Indian Health Service, whose proposed budget is 3.1 billion dollars - a full 230 million dollars more than last year - will similarly focus on health disparities and the health problems of many of our First American: American Indians and Alaska Natives.
I know that one area of special concern is the high rate of diabetes among American Indians. That's why in partnership with Senator Domenici, Tribes and Urban Indian Health Centers - we're waging a five-year, 150 million-dollar, battle against diabetes.
Scott Momaday, an American Indian who grew up in poverty on several reservations across the southwest, wrote the Pulitzer Prize winning novel, House of Dawn. If you're familiar with the book you know that Abel is a young Indian caught between the traditional world of his father and the contemporary world of industrial America.
The story tells a tale many American Indians know all too well: the story of being unable to feel completely at home in either the old world or the new. I am not an American Indian. So it would be wrong of me to assume I have the answers to the unique cultural pressures felt by some American Indians. But I am a proud Lebanese American - whose grandfather came to this country from Lebanon. That experience has taught me the importance of family. The importance of holding on to traditions. And the importance of recognizing that America's future is in the hands of our children all of our children.
Which brings me to the third and last principle I want to talk about today: the future is in our hands. All we have to do is roll up our sleeves and build it. The place to start is on a piece of paper every family in America will receive. I'm talking about the Census form.
Words cannot adequately explain the importance of participating in the Census. First of all, the Census is the number one factor in determining how hundreds of billions of federal dollars for health, child care, education, job training, drug and alcohol treatment and many other human services are allocated.
That means every form counts. But the Census also helps us learn about communities. What are your needs and priorities? How are your families changing? Where are you moving - and why? So I urge you to take the lead - by talking to your friends, colleagues and communities about the importance of participating in the Census.
This is truly the first step toward building a better future for every generation of American Indian and Alaska Native.
So I repeat: Every form counts. Fill them out.
Let me talk some more about the next generation of American Indians.
We're working to make sure more kids who are living without health insurance get the coverage they need. Today, all fifty states now have a State Children's Health Insurance Program. The goal now is to get eligible children enrolled - either in a state SCHIP plan or in Medicaid. That means outreach. At schools. At Indian Health Service clinics. At Head Start and child care centers. We want to sign up every eligible child in every corner of this country.
The President is also proposing that parents of eligible children be covered -- provided the state's plan enrolls children up to 200 percent of poverty. To assure a promising future for American Indian children, we're also expanding Head Start, child care, and foster care services -- and we're taking on substance abuse, mental health, teen suicide, and violence in the home and at school.
Let me say a word about Girl Power! This campaign is helping girls 9 to 14, both on the reservation and off, strengthen the skills they need to say "no" to dangerous behaviors like drinking and smoking. We're helping them build the skills they need for a bright, healthy future.
To complete our ladder to a better future for young American Indians - we're expanding our efforts on behalf of the Tribal Colleges and Universities. We want to help today's dreamers become tomorrow's leaders.
And what about today's leaders?
My goal is simple: To lock arms with all of you - and help you do what you do best: give strength, character and vitality to the Indian nations.
That's why in 1996, when President Clinton signed the new welfare law, he wrote a new chapter in the government to government relationship between Washington and American Indian and Alaska Native sovereign nations.
Just last week, we announced the publication of a final provision of the Tribal Temporary Assistance to Needy Families, TANF. This rule will help American Indians and Alaska Natives move toward increased economic self-sufficiency - and offers greater flexibility to develop innovative programs that meet the needs of tribal families.
We're also proposing a significant increase in funding for the Administration for Native Americans - an organization promoting local strategies in economic and social development.
Finally - and let me be clear about this - we support the reauthorization of the Indian Health Care Improvement Act and the Tribal Self-Governance legislation.
We want this done on our watch. And we're going to work very hard to make sure it happens. With the guiding principles of cooperation and consultation, hard work and investing in the future, we're strengthening and securing the health of American Indians and Alaska Natives.
But, together, we have an even bigger challenge ahead of us. That is to make sure that the journey we've started continues. There must be no going back to the old days of decisions made behind closed doors of too much talk and not enough action of turning a blind eye to the unique health problems of American Indians and Alaska Natives and of saying one thing and doing something else.
The Tribal Consultation and Participation Policy is an important step toward making our partnership strong and permanent. So is elevating the Director of the Indian Health Service to the level of Assistant Secretary for Indian Health.
But as you know, the most important change is what happens in the human heart. For example, when two young men - like Thomas and Victor in Smoke Signals - travel together and come to a better understanding of themselves and each other.
Or when a nation wakes up to a long history of injustice - and makes right what was once wrong. Our nation is taking that journey with you. We still haven't reached our destination. But we can look back with honor and pride - to see how far we've come and to know that we will never - never - be turned around.
Thank you.