{"title":"Utilizing the Indian Self-Determination Act to enhance and improve health outcomes in Tribal communities in the United States.","authors":"Adriann Ricker, Shawnda Schroeder","doi":"10.1057/s41271-026-00623-y","DOIUrl":null,"url":null,"abstract":"<p><p>The Indian Self-Determination and Education Assistance Act (PL 93-638) serves as a critical policy mechanism enabling Tribes to exercise sovereignty and self-determination in health care delivery in the United States. American Indian and Alaska Native communities face significant disparities in oral health outcomes, driven by systemic and structural racism, geographic isolation, and inadequate access to health care professionals. This policy paper examines the historical context and implementation of PL 93-638 and explores how the law empowers Tribes to address health inequities on their own terms. Drawing on case studies and insights from the Fort Peck Assiniboine and Sioux Tribes, this paper highlights how the community leveraged PL 93-638 to assume control of oral health services from Indian Health Services. The discussion underscores how the policy improves oral health outcomes and offers critical lessons and recommendations for future applications of tribal self-determination in oral health care.</p>","PeriodicalId":50070,"journal":{"name":"Journal of Public Health Policy","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Public Health Policy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1057/s41271-026-00623-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
The Indian Self-Determination and Education Assistance Act (PL 93-638) serves as a critical policy mechanism enabling Tribes to exercise sovereignty and self-determination in health care delivery in the United States. American Indian and Alaska Native communities face significant disparities in oral health outcomes, driven by systemic and structural racism, geographic isolation, and inadequate access to health care professionals. This policy paper examines the historical context and implementation of PL 93-638 and explores how the law empowers Tribes to address health inequities on their own terms. Drawing on case studies and insights from the Fort Peck Assiniboine and Sioux Tribes, this paper highlights how the community leveraged PL 93-638 to assume control of oral health services from Indian Health Services. The discussion underscores how the policy improves oral health outcomes and offers critical lessons and recommendations for future applications of tribal self-determination in oral health care.
期刊介绍：
The Journal of Public Health Policy (JPHP) will continue its 35 year tradition: an accessible source of scholarly articles on the epidemiologic and social foundations of public health policy, rigorously edited, and progressive.
JPHP aims to create a more inclusive public health policy dialogue, within nations and among them. It broadens public health policy debates beyond the ''health system'' to examine all forces and environments that impinge on the health of populations. It provides an exciting platform for airing controversy and framing policy debates - honing policies to solve new problems and unresolved old ones.
JPHP welcomes unsolicited original scientific and policy contributions on all public health topics. New authors are particularly encouraged to enter debates about how to improve the health of populations and reduce health disparities.
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