American Indian Culture and Research Journal

Over the last twenty-five years, there has been a significant migration of American Indian people from reservations and rural areas to cities. The 1980 census reported that almost two-thirds of the 1.5 million persons identifying themselves as Indians live off reservations, tribal trust lands, or other Indian lands. Fifty-four percent of the total United States American Indian population lived in metropolitan areas. In 1976, the United States Congress passed Public Law 94-437, the Indian Health Care Improvement Act, in part due to their recognition that urban American Indians were a population group that continued to lag behind others in access to primary health care. Access, Congress found, was severely curtailed by a lack of knowledge or understanding of available medical services in most urban areas, and a lack of income or health insurance to pay for medical care. Thirty-seven urban Indian primary medical and dental clinics have been established as a result of this legislation. These programs offer a variety of social services, and may appropriately be characterized as "human services organizations." However, only 32 percent of the reported urban program encounters (approximately 55,000 encounters) in 1984 were medical, while 27 percent were health related (health education, nutrition, etc.), and 31 percent represented other community service contacts.