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Saturday, October 18, 2025

University of Oklahoma researchers propose novel solution to American Indian Health Service underfunding

University of Oklahoma

image:
Junying Zhao of the University of Oklahoma is the lead author of an article in *Health Affairs* titled "The Indian Health Service Is Chronically Underfunded. Here Is How To Close The Gap."
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Credit: University of Oklahoma

OKLAHOMA CITY – For many years, the Indian Health Service (IHS) has been underfunded, leading to health and life expectancy disparities among Indigenous people, according to University of Oklahoma researchers. In a newly published article in Health Affairs, OU researchers propose a novel trust fund solution to increase and sustain the funding level, with the ultimate goal of improving health care access and outcomes.

“IHS underfunding has been a challenge for tribal nations and the United States, and it is highly relevant to Oklahoma, which was partly founded on Indian Territory. The health of Indigenous populations in the U.S. has suffered greatly because of chronic underfunding of IHS. Indigenous people have a life expectancy of 67.9 years – a decade less than the average U.S. life expectancy,” said lead author Junying (June) Zhao, Ph.D., Ph.D., MPH, an assistant professor at the OU Hudson College of Public Health.

“The difference in federal health care investment compared to other health programs is stark,” she added. “In fiscal year 2021, per capita federal spending for the IHS was $4,140. In comparison, the Bureau of Prisons spent $8,302; Medicaid, $8,908; the VA, $12,223; and Medicare, $15,094. For the IHS, this has meant staff shortages, outdated facilities and care that is declined or deferred.”

To raise funding, Zhao and her research team propose the creation of an IHS Trust Fund, modeled after the federal Vaccine Injury Compensation Trust Fund. In the late 1980s, Congress made a one-time appropriation to the Vaccine Injury Compensation Fund, which has since collected excise taxes on vaccine sales and invested its balances. As of January 2023, the fund held over $4 billion, which is used to pay for injury claims. An IHS Trust Fund would operate similarly to generate ongoing financial resources for unmet Indigenous health care needs.

From fiscal years 2009 to 2020, the IHS was underfunded by about $60 million annually, Zhao said. To generate a $60 million annual return, about $600 million would be needed for the baseline principal, assuming a modest 10% return rate on investments. Accounting for inflation, that number would be close to $1 billion today, she said.

In addition to a one-time congressional appropriation to launch an IHS Trust Fund, Zhao and her team suggest that Congress should grant IHS the ability to accept gifts. Although government programs typically cannot accept gifts, Zhao believes that some entities and individuals have shown the ability and desire to contribute. There is a precedent for IHS accepting gifts: About 20 years ago, the IHS manual included a policy for donations.

“This approach is similar to endowments created by major universities for their capital projects,” said Pallab Ghosh, Ph.D., an associate professor in OU’s Department of Economics and co-author of the paper. “We believe it would be good to apply this solution to the IHS budget problem as well.”

The IHS health care system is comprised of IHS facilities, tribal-administered services and urban Indian facilities. Together, they serve approximately 2.6 million Indigenous people. Past efforts to address the underfunding problem have fallen short. Members of Congress have twice proposed transforming IHS funding from discretionary to mandatory. Other ideas, such as creating a unique Medicaid program for individual tribes, have also failed to gain support.

“Since the late 18th century, the United States has had a trust responsibility to provide care in exchange for tribal lands,” said study co-author Rashmi Jaggad, MPH, MDS, research project coordinator in the OU Hudson College of Public Health. “But when funding is low, health care access decreases. If people cannot afford services in private care, they often must go without. That is the problem we are seeking to solve.”

Zhao and her team have a long history of conducting research involving underserved populations. Their work is at the heart of public health, said Dale Bratzler, D.O., MPH, dean of the OU Hudson College of Public Health.

“At the OU Hudson College of Public Health, we are committed to research that addresses real-world inequities and improves the health of all communities,” Bratzler said. “This work reflects that mission by offering a creative, evidence-based solution to a longstanding issue that has impacted Indigenous people for generations.”

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About the project

Research support was provided by the Presbyterian Health Foundation in Oklahoma City and a National Institutes of Health grant for the Strong Heart Study. Additional authors of the article are James R. Kennedye, M.D., MPH, of the Chickasaw Nation and Creek Nation Medical Centers; Kylie Stewart, a clinical fellow at OU Health; and Janis E. Campbell, Ph.D., MSc, a professor in the Department of Biostatistics and Epidemiology in the OU Hudson College of Public Health.

About the University of Oklahoma

Founded in 1890, the University of Oklahoma is a public research university with campuses in Norman, Oklahoma City and Tulsa. As the state’s flagship university, OU serves the educational, cultural, economic and health care needs of the state, region and nation. In Oklahoma City, the OU Health Campus is one of the nation’s few academic health centers with seven health profession colleges located on the same campus. The OU Health Campus serves approximately 4,000 students in more than 70 undergraduate and graduate degree programs spanning Oklahoma City and Tulsa and is the leading research institution in Oklahoma. For more information about the OU Health Campus, visit www.ouhsc.edu.

Journal

Health Affairs

DOI

10.1377/forefront.20250827.319208

Method of Research

Commentary/editorial

Subject of Research

Not applicable

Article Title

The Indian Health Service Is Chronically Underfunded. Here Is How To Close The Gap

Wednesday, October 15, 2025

New study finds that ALS and MS likely share an environmental cause

Research finds a phenomenon that may have been previously masked by the data

New York University

Figure 1: Geographic patterns of MS and ALS in the US — image:
Heat maps showing the geographic patterns of ALS and MS in the US.
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Credit: Melissa Schilling. Figure based on data from the US CDC Wonder database.

A new study published in Nature’s Scientific Reports indicates that amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) have an extremely high geographic association, even after controlling for race, gender, wealth, latitude, and access to neurological healthcare.

“The results of the study are surprising because previous studies have typically concluded there was no evidence for a mechanistic or genetic link between the two diseases,” explains study author Melissa Schilling, a professor at New York University’s Stern School of Business who specializes in analyzing large-scale datasets using econometrics.

Heat maps in accompanying Figure 1 show the geographic patterns of the diseases in the US.

The study also shows that the relationship between the two diseases has likely been overlooked until now because of a “Simpson’s Paradox”—a statistical phenomenon whereby a trend appears in different groups of data but disappears or reverses when the groups are combined.

In this case, the groups are based on gender: As shown in accompanying Figure 2, both women and men show a strong positive correlation (greater than 70 percent) in the geographic distribution of ALS and MS, but when the data are pooled across gender, these relationships are obscured because, on average, ALS is more common in men and MS is more common in women

For several decades researchers have noted a north-south gradient in the distribution of MS. This led to speculation that UV light or vitamin D might play a role in the disease, but studies that supplemented MS patients with UV light or vitamin D had minimal or inconsistent results.

The findings in the new Scientific Reports study indicate that MS and ALS have a much stronger geographic relationship with each other than with latitude, suggesting that both diseases may share a connection to a factor that varies imperfectly with latitude.

“I started gathering and analyzing every dataset I could find relevant to ALS about nine years ago when a friend with ALS asked me if I would take a look at the data,” says Schilling. “I was very surprised to find such a strong geographic pattern as most of the research on ALS does not emphasize the role of geography. I was even more surprised to find that ALS has a very strong association with the geography of MS.

“This finding is important because it suggests that an environmental factor likely plays a significant role in both diseases, and that could provide clues that help us determine what causes them and how they might be avoided or treated.”

Elements of the environment that vary imperfectly with the north-south gradient include natural things like viruses, parasites, algae, and molds, as well as human-made elements or practices like the use of heating oil, agricultural practices, industrial practices, mining, and chemical contamination of fisheries.

“The list of suspects is long, but comparing across geographies and, in particular, across outlier locations, such as the Faroe Islands, where MS increased strikingly after military troops arrived there in the 1940s, could significantly narrow the hunt,” observes Schilling.

The study combined mortality and demographic data obtained from the US Centers for Disease Control and Prevention WONDER database (in the US, the collection of mortality data is mandatory and standardized) with latitude data, economic data, and data on access to neurological healthcare. The primary results are based on US crude mortality rates at the state level. The analysis was then replicated at the global level using mortality data from the World Health Organization and obtained nearly identical results.

About New York University
Founded in 1831, NYU is one of the world’s foremost research universities (with more than $1 billion per year in research expenditures, it is ranked seventh among private research universities) and is a member of the selective Association of American Universities. NYU has degree-granting university campuses in New York, Abu Dhabi, and Shanghai; has 13 other global academic sites, including London, Paris, Florence, Tel Aviv, Buenos Aires, and Accra, and US sites in Washington, DC, Los Angeles, CA, and Tulsa, OK; and both sends more students to study abroad and educates more international students than any other U.S. college or university. Through its numerous schools and colleges, NYU is a leader in conducting research and providing education in the arts and sciences, law, medicine, business, dentistry, engineering, education, nursing, the cinematic and performing arts, music and studio arts, public service, social work, public health, and professional studies, among other areas.

The blue line shows the trend line for men, the pink line shows the trend line for women, and the black line shows the trend line obtained for the pooled data.
Credit
Melissa Schilling. Figure based on data from the US CDC Wonder database.