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Advancing health equity for urban American Indian and Alaska Natives: Q&A with Francys Crevier


Today, most American Indian and Alaska Natives (AI/AN) in the United States live in cities, and they have unique health needs. The National Council of Urban Indian Health, a Kresge grantee partner, is the only national organization devoted to the support and development of quality, accessible, and culturally competent health services for AI/ANs living in cities.

To learn more about National Council of Urban Indian Health and how its work is critical to support the resiliency of the AI/AN community through meaningful change in the social equity of health care, Kresge recently connected with NCUIH Chief Executive Officer Francys Crevier for a conversation.

Kresge: What is the National Council of Urban Indian Health and what is the organization’s mission?

Crevier: The National Council of Urban Indian Health (NCUIH) is a 501(c)(3) nonprofit organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/AN) living in urban settings. Located in Washington, D.C., NCUIH has a national reach advocating for access to culturally competent healthcare for urban American Indian and Alaska Natives across the country.

As the only national organization advocating for the health of urban AI/AN, NCUIH provides critically-needed technical assistance, training, policy support, and other services to the 41 Urban Indian Organizations that provide health services throughout the U.S.

Kresge: What does “urban American Indian and Alaska Native” mean?

Crevier: From the 1700s and 1800s, the federal government’s policy was to strip Tribal land from American Indian and Alaska Native people. In the 19th century, federal boarding schools governed by the doctrine “Kill the Indian, save the man” were established and AI/AN children were taken from their reservations and families and inserted into foreign environments. As recent as the 1950s and 60s, the federal government’s relocation policies forced AI/AN off Tribal land. The relocation policies caused significant problems, including lack of orientation, scarce employment opportunities, serious health concerns, culture shock, and historical trauma associated with forceful assimilation.

Today, about 70 percent of the AI/AN population live in urban areas, which is about four million people. Although more than 70 percent of AI/AN people live in urban areas, they are frequently left out of national discussions on health and, as a result, don’t receive critical comprehensive healthcare resources.

The AI/AN population’s shift to urban areas has put this group at risk for a host of infectious disease issues, as many have experienced economic instability, homelessness, unemployment, poverty, and a lack of a cultural connectiveness or sense of community. Even before the onset of the novel coronavirus, Native communities across the U.S. faced a crisis in health care, including higher rates of health issues due to isolation from Tribal lands and identity, lack of adequate health care, and distressed economic conditions.

Because of consequences due to multiple traumas, having culturally competent and sensitive healthcare services available to urban AI/AN is a vital part of quality care.

Kresge: What is an Urban Indian Organization?

Crevier: Urban Indian Organizations (UIOs) are nonprofit organizations that provide local urban AI/AN with a range of healthcare and social services. UIO services are culturally tailored to combat specific health disparities associated with urban AI/AN populations, which is the key to preventing and treating serious health problems and diseases.

Through NCUIH’s active representation of UIOs’ main needs and gaps, NCUIH raises awareness about issues impacting UIOs and ensures their interests are included in key policy discussions for increased resources to better serve urban AI/AN communities.

Kresge: How has the COVID-19 pandemic impacted Indian Country?

Crevier: The COVID-19 pandemic exacerbated existing imbalances in access to culturally-competent health care for urban AI/AN.

While the pandemic’s impact has been devastating throughout the country, AI/AN are 3.5 times more likely to have serious illness. This pandemic has been deadlier for Native Americans than other groups as 1 in 475 AI/AN have died from COVID-19.

Throughout the COVID-19 pandemic, NCUIH continues to be at the forefront of advocating for Indian health to ensure the stability of UIOs that provide culturally competent healthcare services to AI/AN living in cities. Because of the catastrophic impact of this virus, most recent efforts have focused on increasing availability of and confidence in the COVID-19 vaccine.

NCUIH’s advocacy ensured UIOs had access to COVID-19 vaccines because they did not receive federal resources during the H1N1 pandemic or the recent Zika outbreak. As such, many UIOs received their vaccines through the Indian Health Service (IHS). Those providers have administered 9,000 doses so far and have another 7,000 on hand to distribute shortly. They’re hoping to eventually vaccinate more urban AI/AN across the country. However, some urban Indians will still be left out as several cities don’t have any UIO health providers due to longstanding inadequate funding for urban programs.

Due to historical trauma and mistrust caused by a long record of institutional racism, many AI/AN are less likely to be vaccinated against COVID-19.

To support vaccine confidence among AI/AN, we will be kicking off our #BeAGoodRelative campaign the week of March 15 as an effort to increase vaccine participation among urban AI/AN. NCUIH’s goal through this ongoing campaign is to encourage urban AI/AN to get vaccinated. The #BeAGoodRelative campaign utilizes a toolkit full of fun swag for urban AI/AN that includes masks, stickers, and fliers for UIOs to distribute as community members receive the COVID-19 vaccine.  To find out more and download the toolkit, follow NCUIH on Twitter, Facebook or YouTube.

For more information on NCUIH’s critical work to support the resiliency of the AI/AN community through meaningful change in the social equity of health care, visit