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Transferring BIA's Health Division to PHS dramatically improved prospects for the health status of indigenous peoples. But the transfer legislation also split public health from BIA's economic development mission, despite widespread recognition that health measures would "be largely wasted unless the basic economy of the Indian groups makes provision of a sanitary environment economically possible" (in Burnet Davis's words). Would PHS be more successful than BIA in meeting Federal obligations? And what would the result be? An ongoing or permanent commitment to achieving social justice through public health measures, a stopgap measure supporting Federal termination policies, or both?

What PHS Inherited

BIA's Indian Service grew out of 19th century treaty obligations. High morbidity and mortality rates from communicable disease and the shortened life spans of indigenous peoples compelled Federal officials to continue health programs into the 20th century, after most treaties had expired. Federal efforts were stymied by insufficient funds; by the difficulties of managing programs in isolated, remote areas, often with harsh environmental conditions; and by the sovereignty of reservation and village communities, which lay outside the jurisdiction of health departments. Until 1931, when authority was transferred to BIA, the United States Bureau of Education provided health care to Alaskan Natives, outfitting itinerant school teachers with first aid kits and instruction manuals.

Foundations for transferring BINs Health Division to PHS were laid between the two World Wars. PHS's distinguished performance during World War I spurred initial discussions about a transfer. Starting in the 1920s, a handful of PHS medical officers were assigned to duty with BIA's Indian Service. Administrative mechanisms were set in place with the Snyder Act of 1921 (which authorized BIA to pay contractors), the Indian Reorganization Act of 1934 (which permitted Federal recognition of tribal governments), and the Johnson-O'Malley Act of 1934 (which allowed BIA to contract with the states). Mobilization for World War 11 boosted support for the transfer; as BIA lost health officers and funds reallocated to the military and as American Indians and Alaska Natives moved to urban areas for industrial jobs or service in the Armed Forces, breaching the relative isolation that previously had confined much communicable disease to reservations and villages.

Washington, DC, lobbyists and Congressmen alarmed by reports of high incidence rates for tuberculosis among indigenous communities campaigned vigorously and successfully for the transfer. U.S. Representative Judd of Minnesota and the National Tuberculosis Association attracted supporters across the political spectrum, including the American Medical Association. The proposed transfer was controversial. Opposition on technical grounds was tangled up with broader debate about Federal termination policies. The Eisenhower Administration advocated transfer as a means to improve health status before devolving Indian Service duties to the states, while BIA and the Bureau of the Budget opposed the transfer in favor of giving such obligations directly to the states. Neither was there agreement among the tribes. Factions within the Navajo Nation and among Oklahoma tribes, for example, expressed fears that existing services would deteriorate, resulting in the loss of benefits. After initial skepticism PHS leadership came to support the transfer, which advocates like medical officers Fred Foard and Joseph Mountin described as a natural complement to PHSs role working with the World Health Organization to bring Western-style public health abroad.

The transfer legislation (PL83-568), enacted in August 1954 and effective the following July, infused millions in new appropriations and fresh public health-oriented strategies into Federal Indian programs. PHS organized a new Division of Indian Health within the Bureau of Medical Services and split administration among a group of regional or Area offices, to which sub-area or District officers reported. PHS ran a more centralized operation in the Alaskan Territory, managing the Alaska Native Health Service, operating the Arctic Health Research Center (opened in 1948), and staffing key positions in the Territorial Health Department. The Alaska Native Health Service, in turn, split duties between a headquarters at its Anchorage hospital and a southeastern Alaskan field group at the hospital in Mount Edgecombe, the base for the old Bureau of Education's school health programs.

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