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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		National Congress of American Indians, Washington, D.C.
DATE:		February 18, 1999

Right now, millions of our citizens are on the outside looking in - and a lot of them are the men, women, and children you represent. Simply put: the health of racial and ethnic minorities in this country still lags far behind the rest of America.

The health problems of American Indians and Alaska Natives are all too familiar. Infant mortality. Cardiovascular disease. Diabetes. Alcoholism and suicide -- all continue to plague American Indians, both on and off the reservation.

As NCAI members, you don't need to hear any statistics from me because you see the reality every single day.

That's why putting the spotlight on health disparities is so vitally important. But it's going to take more than speeches if we're going to close these gaps.

For one thing, it's going to require all of us in Washington to change the way we make decisions. That starts with understanding, once and for all, that historically, the Federal government's policies toward American Indians have been little more than a trail of broken promises.

We can't go back and change the wrong that's been done in the past, but I'm here to tell you we have a sacred responsibility to do what's right in the future.

But that's only part of the equation. It does little good for us to simply announce that we want to change the decision-making process on our own. Ultimately, what it requires is that you become part of it. That means redefining the way we work together, and all of us understanding that America will never move ahead.if it leaves American Indians behind.

That's why today I want to talk about three principles that this Department -- and this Administration - are following to map out a healthier future together.

First, we're continuing to build on the foundation of cooperation we've built over the last six years

There's an old saying about the true marker of great leadership. It's not how much gets done while you're leading.it's how much gets done after you're long gone.

From day one, President Clinton knew that "business as usual" was not the way for the Federal Government to work with this nation's First Americans. he understood that to succeed, we had to make good on the Federal government's obligation to maintain our unique government-to-government relationship with American Indian Tribes - not for just today, but far into the future.

That's why President Clinton directed the Federal departments to create far-reaching and lasting consultation plans to bring tribal governments to the table on matters that directly affect them.

I'm proud to tell you that my Department took the President's charge to heart. We recruited the brightest and most dedicated leaders to lead our efforts. First and foremost, I want to recognize the inspiring leadership of our Director of the Indian Health Service, Dr. Michael Trujillo. Dr. Trujillo -- along with his Deputy Director, Michel Lincoln -- are, without question, among the hardest working leaders within the Clinton Administration.

And since I'm talking about Dr. Trujillo, I want to say that we remain committed to working with Congress to elevate his position to the rank of Assistant Secretary of the Department. With the legislation re- introduced last month by Senator John McCain, I'm confident we will be able to bring closure to this widely supported measure.

Over the last several years, my Deputy Secretary, Kevin Thurm; former Assistant Secretary for Health, Dr. Phil Lee and his deputy Dr. Jo Boufford; and our nation's Surgeon General, Dr. David Satcher, have also stood up and stepped up on American Indian health and welfare issues.

With help and insight from these and other leaders over the years, I issued our Tribal Consultation and Participation Policy - the first of any Federal department.

This policy directs each agency - from the National Institutes of Health to the Centers for Disease Control and Prevention -- to reach out for tribal representation and improve every activity that affects American Indians.

Let me be clear with you: I'm not talking about circulating a memo to a few division directors or adding a program or two. I'm talking about a top-to-bottom change: a process of tribal consultation that becomes a routine part of the way HHS does business every single day.

Of course, if there's one thing you've taught us, it's that real change won't come without making sure the consultation is meaningful and valuable. That means talking with you, working with you, and most important, listening to you.

Which leads me to my second principle: We can't stand up for American Indians . unless we're sitting down with American Indians.

You and I both know that there is no one American Indian voice. The truth is that every American Indian Tribe and Alaska Native village has its own unique traditions, perspectives, and priorities.

That's why we're traveling to reservations and American Indian communities throughout the country to meet face to face with Tribal leaders - and learn about the problems first-hand. And that's why I assigned my own right-hand man, Deputy Secretary Kevin Thurm, to lead these efforts.

To date, he has hosted the three listening councils -- in Phoenix, Bismarck, and Seattle. Next month, he'll travel to Oklahoma City -- and still later we will begin planning for other possible councils over the remaining year.

In Phoenix, diabetes and pneumonia topped the list of health concerns. In Bismarck, we heard worries about increasing tobacco use, particularly among women. And in Seattle, we learned just how important it is that American Indians living in remote locations have access to the quality health care they need.

However, if there was one point of agreement in all of these councils, it was the vital importance of Tribal leaders having a strong voice in the Department's budget planning process. That's why we're now planning for Tribal leaders to join with us as we develop future HHS budgets. That process will start this Spring.

By joining together, I'm convinced we can ensure that every agency within he Department - not just the IHS -- opens its doors that much wider to Tribal governments and communities.

There was one other point participants made clear in our listening sessions. It was: Listen and learn, but go back and do. Sure, talk is good. But action is even better.

And that leads me to my final principle which is this: We must see to it that we invest in success today - if we want to achieve success tomorrow.

Our current HHS budget provides the Indian Health Service with 2.8 billion dollars, including 2.2 billion for clinical preventative and environmental health programs.

That's a 170 million dollar increase over last year. An increase that -- at the very start of the budget process -- I made very clear was a personal priority for me.

This budget adds up to more comprehensive clinical, preventative, and environmental health activities; stronger injury prevention programs and increased mental health services. It also means new opportunities for American Indians to visit doctors and dentists and gain access to the other vital services they need.

In addition to the budget increase, we're working to make sure that the IHS hospitals and clinics you rely on receive Medicare and Medicaid reimbursement on the same basis as other providers. Last month, we announced that Medicaid inpatient reimbursement rates will rise 40 percent for care at IHS facilities nationwide from 1997 through 1999. Medicaid outpatient reimbursement rates will also rise by 13 percent over that three-year period.

This means an additional 82 million dollars will become available to IHS facilities to increase staff, purchase additional medical equipment and supplies, and provide more services and better care to patients.

And, since we're talking about the IHS, let me also reaffirm that my Department will continue to support the transfer of IHS programs to those tribes that want to exercise this option provided by the law. In fact, that's why we're requesting an increase of 35 million dollars for contract support costs in FY 2000. We know contract support costs are important for the success of self-determination. And we are committed to working with NCAI and other tribal organizations to craft a way to distribute these funds fairly.

But, of course, our work doesn't stop there. That's only where it begins.

That's why, over the last six years, we elevated and strengthened the importance of Indian health programs throughout our entire Department.

In partnership with tribes and Urban Indian Health Centers -- we are waging a five-year, 150 million dollar battle against diabetes. And I would like to acknowledge the leadership and hard work of Senator Pete Domenici on this initiative.

We're also working to improve the health status of American Indian women by focusing not just on diabetes, but also on alcoholism, cervical cancer, and high injury rates. And we're working to the brighten the twilight years for the most respected members of your communities -- the elders -- by focusing on improving the quality of health care for older people.

But no effort would be complete if it did not include American Indian children. We all know the American Indian population in this country is very young, with 39 percent of all American Indians under the age of 20.

That's why we're working to make sure more kids who are living without health insurance get the coverage and health care they need. That's why we're giving young American Indians a healthier start in life by taking an action on substance abuse, mental health, teen suicide, and violence in the home and at school. And that's why we're making sure Tribal Colleges and Universities get the support and resources they need to help today's dreamers become tomorrow's leaders.

Now, what's behind all this work is a simple, but crucial recognition. It's that American Indian health disparities aren't "an American Indian problem," but an "American problem" that deserves our full and undivided attention.

That's exactly why we launched our Racial and Ethnic Health Initiative - a new effort targeting six key problems - infant mortality, diabetes, cancer, heart disease, AIDS/HIV, and immunizations.

With this initiative, we have signaled the end to separate - and lower - national health goals for minorities and made a commitment to health equality for all. Again, our goal is not to simply "talk about" the health disparities. We've made a commitment to begin to eliminate them - once and for all.

Of course, many of the initiatives I've discussed would not have been possible were it not for your leadership. While our work together is something to take pride in, you know all too well that we have a long way to go. And meeting the challenges ahead will require more collaboration and hard work than ever.

In preparing for today's event, I couldn't help but recall the Great Law of the Iroquois Confederacy which teaches us that every decision we make, every action we take, must take into consideration its impact on the next seven generations.

That is the wisdom that must guide us. The coming century must be a time of health and hope for American Indian peoples, and we can see to it that it is.

So let us continue to work together to build for this generation -- and the next seven generations -- a spectacular landscape for the entire world to see: the improved health of all Americans -- no matter who they are or where they live.

It is a promise we can keep. It is a promise we must keep.

Thank you.