Access, utilization and distribution of health care services to Native Americans in Northern California: A rural versus urban comparison

Objectives. (1) To determine what geographic, cultural, economic and physical barriers exist preventing Native Americans in Northern California from obtaining adequate health and nutritional care. (2) To identify and discuss possible approaches to improvement of access to and participation in health care and nutritional programs.; Methods. Interviews of Native American community members and Indian health center staff in Sacramento and at Round Valley Indian Reservation using standardized questionnaires. The samples consisted of 40 Native American community members from each study. The staff of the local Indian Health clinics were also surveyed for a total of 21 respondents at Round Valley and 34 respondents at Sacramento. Data was analyzed using the Statistical Package for the Social Sciences (SPSS).; Results. Access to primary health care was greater for residents of the rural study site of Round Valley. Despite the geographic isolation of the valley and fewer health care resources being available as compared to Sacramento, the close proximity of the health center and its free services for Indian community members made it very accessible. However, distance and transportation proved to be barriers to obtaining care outside of Round Valley, particularly for prenatal and obstetrical care. While the urban study site had a greater variety of health care services and facilities, including an urban Indian health clinic, inability to afford care (which is not free at urban Indian clinics), lack of transportation, and lack of culturally appropriate care all presented barriers to obtaining health care.; Supplemental feeding programs at both study sites were determined likely to increase health problems, specifically diabetes, obesity and heart disease because they provided foods high in fat, sodium and sucrose.; Native American community members and health clinic staff at Round Valley and Sacramento believed the most pressing problems within their communities were substance abuse and diabetes.; Despite governmental treaty obligations to provide free health care to all eligible Native Americans, funding was clearly insufficient at both study sites. The underfunding of Indian health care remains a problem that must be addressed, particularly in urban areas where the majority of Native Americans now reside.