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PART B HISTORICAL EVOLVEMENT: Introduction One of the propositions offered at the beginning of this discussion is that the decision-making process is influenced by the individual beliefs and values of the IHDT members. While only seven of the twenty-eight are employees of the Indian Health Services, all of the members of the team are either Indian or have a strong affiliation with Indians. While their everyday jobs help shape values and beliefs on continual basis, a knowledge of the history of the Indians play an important part in forming a foundation for their values and beliefs.

Section 1: Forming a Basis of Understanding Treaties The nature of the relationship between the U.S. government and the Indian nations is unlike that of the federal government and the individual States. Whereas the States have powers and rights conferred to them through the Constitution, it is important to note that until 1924, not all Indians were even citizens. The basis of conferred rights to Native Americans are established in the wording and intent of treaties signed between each Tribe and the U.S. government.

Although "health" was extolled by Thomas Jefferson in his vision of a strong nation (Foley,1967), very little government involvement in health issues was realized via actual policies in the first 100 years of this country’s history. This was true for both the States and the Indian Nations. However, whereas the State to federal relationship was cemented in the Constitution in 1791, the relationship between the federal government and Indian nations "evolved" as each new treaty was signed (up until 1871). While "health" and "health care" were not part of the 19th century vernacular, there exist discernible patterns of language within those treaties which implied governmental responsibility for Indian health.

A review of Indian treaties that were entered into by the United States between 1800 and 1871 in Kappler’s Indian Affairs (1906) reveals certain patterns that serve to exemplify the extent of government involvement in Indian health. A summary of that review reveals an evolution of increasing federal government involvement in Indian health issues. From a rudimentary acknowledgment of Indian dependency, treaties in the 19th century moved from federal allotments for a "rifle, blanket, and kettle", to the building of hospitals, to the provision of medical personnel on reservations.

1800-1815: ACKNOWLEDGMENT OF FIDELITY AND DEPENDENCE. During the first few decades of American history, treaties were simple and short. Basic language included phrases where the tribe would "acknowledge themselves to be under the protection of the United States" (Kappler, p. 100). This identical language was found in treaties with the Chippewa [1808], Wyandot [1814] and Sioux of the Lakes [1815], and variations of this theme in many others during this decade and a half.

Despite the acknowledgment of dependency and fidelity, there was very little if any implication of long term responsibility by the newly formed American government. Payment and compensation for ceded lands from the tribes were expressed in terms such as "do agree to pay them, annually, for the term of twelve years [Ottawa, 1816] (Kappler, p.132), and "for this cession [of land], a further annuity of one hundred dollars, and the sum of seven hundred dollars in goods now delivered, is considered a full compensation [Kickapoos, 1809] (Kappler, p. 104). These were, in effect, closed-end transactions.

1816-1827: SOCIAL OBLIGATION AND RESPONSIBILITY. As the United States began to grow and flex after the Louisiana Purchase, interaction with Indians became more paternalistic and intrusive. It was between these years that the United States officially began removing Indians from their lands and relocating them to new western lands. These policies also engendered the first Seminole War in Florida. In attempting to maintain autonomy, the Cherokee tribe had adopted an Indian Constitution in 1827 that was modeled after the U.S. Constitution. It was nullified by the Georgia legislature. The Cherokee nation appealed to the Supreme Court where Justice John Marshall overturned Georgia's action, reaffirming tribal sovereignty as stated in treaty.

Whereas earlier treaties had only stated acknowledgment of dependency and fidelity, the treaties of the 1820s had more far-reaching language implying a more active role for government.

As the Cherokees were being relocated from their homes in 1817, a revised treaty included provision of "one rifle gun and ammunition, one blanket, and one brass kettle, or in lieu of the brass kettle, one beaver trap" (Kappler, p.143) The 1820 treaty with the Choctaws allowed for "the purpose of aiding and assisting the poor Indians...a blanket, kettle, rifle gun, bullet moulds...for one year.." and that these same poor Indians "...shall also be supplied with corn to support him and his family" (Kappler, p.192)).

After a protracted time of hostilities with the Florida tribes, the government promised that "the United States will take the Florida Indians under their care and patronage" [Florida Tribes, 1823] (Kappler, p.203). Similar treaties with the Sioune, Ogalala, and Hunkpapa Sioux in 1825 reflected a longer lasting (albeit still temporary and limited) responsibility of the government when it promised "to extend to them, from time to time, such benefits and acts of kindness as may be convenient, and seem just and proper to the President of the United States" (Kappler, p.230, 235).

1828-1860s: CONCRETE ACTIONS TOWARD RESPONSIBILITY. During this period, more social responsibility was assumed (in dollars and cents) by the federal government in assuring that the wards of their policy decisions were cared for. The policy of dependency was slowly being shifted toward a policy of self-sufficiency. Treaties signed by the Chippewa [1827], Miamis [1828] and Menominees [1831] all included a provision for government-sponsored education.

This notion of providing educational opportunities soon manifested itself in the actual government-funded building of schools, a precursor to other structural exhibits such as hospitals and sanitary housing programs. In the treaty of 1832 with the Winnebagos, it was stated that "...the United States shall erect a suitable building...and maintain therein, for the term of twenty-seven years, a school..."(Kappler, p.346). By 1838, recognizing public health problems, the treaty with the Iowas provided for the construction of "...ten Ioways may select...well sheeted and door and two windows, complete, on chimney of stone or brick..." (Kappler, p.519).

In 1855, the treaty with the Confederated Tribes of the Cayuse and Walla Walla, health and the government sponsoring of health workers on Indian reservations became part of the recognized subsistence package that defined federal responsibility. Fifty thousand dollars was allocated to the "creation of buildings...fencing, and provisions, for medicine and tools, for the payment of employees and for subsisting the Indians" (Kappler, p.695).

The 1864 treaty with the Klamaths went even farther. It provided for "one saw mill, one flour mill, suitable buildings for the use of the blacksmith, carpenter and wagon and plough maker...and such hospital buildings as may be necessary, which buildings shall be kept in repair at the expense of the United States for the term of twenty years...and to pay for the term of twenty physician, one miller and two superintendents" (Kappler, p.867).

1868-1871: THE LIMITING OF RESPONSIBILITIES. While the preceding period may appear to have given the impression of protracted and increasing government involvement, this final period of treaty making set the tone for the future. While popular culture has depicted the eternal obligation of the United States government to Indians for "as long as grass grows, river flows and the sky is blue", it should be noted that in most treaties, these were defined close-ended transactions. Even the more recent ones had terms of no more than twenty years.

In 1868, the treaty with the Brule, Ogalala, Miniconjou et al marked a turning point in treaty making and government-financed responsibilities. Wording of the document is instructive as to the limited and temporary role of government largesse.

At any time after ten years...the United States shall have the privilege of withdrawing the physician, farmer, blacksmith carpenter, engineer, and miller herein provided for (Kappler, p.1001).

Motivated by Congressional concern over the amount of foreign aid the President had been agreeing to in the Indian treaties, independent treaties with Indians were abolished in 1871. The act specifically read "No Indian nation or tribe within the territory of the United Stated shall be acknowledged or recognized as an independent nation, tribe or power within whom the United States may contract by treaty; but no obligation of any treaty lawfully made...prior to March 3, eighteen hundred and seventy-one shall be hereby invalidated or impaired (Washburn, 1971, p. 95). From this legal basis, we now move to the translation of these ideas into the area of U.S./American Indian policy.