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<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&#xa0;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>

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Utilizing the Indian Self-Determination Act to enhance and improve health outcomes in Tribal communities in the United States

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Adriann Ricker,
  • Shawnda Schroeder

摘要

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.