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Social determinants of health, such as access to health care
services, contribute significantly to disparities, especially in Indian
Country.
Efforts to expand access to care are more likely to be
successful when we address common administrative hurdles. For example,
sometimes people are denied health care benefits because language or literacy
issues prevent them from telling their story in a way that adequately
substantiates their eligibility.
In other cases, access to care is directly influenced by one or
more legal issues. For instance, American Indians and Alaska Natives (AI/ANs)
are significantly more likely than White people to have administrative
disqualifications from employment (ADEs), which can hurt people's ability to
support their families or meet medical needs. The problem is compounded when
someone with ADEs survives a crime, such as sexual assault, and is unable to
obtain medical or behavioral health services in a timely fashion.
"Health care access is so closely correlated with resource
access," says Cina Littlebird (Laguna Pueblo), a staff attorney in
Northwest Justice Project's (NJP's) Native American Unit. "And often
people have a whole host of legal problems that impede access to medical
care."
Organizations like NJP play a significant role in efforts to
address social determinants of health. A nonprofit with 18 offices throughout
Washington state, NJP provides free legal services to low-income people.
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"We
look at what will help folks gain more stability when experiencing poverty,
and access to care is a main piece of that."
— Cina Littlebird, Staff Attorney, NJP's
Native American Unit
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NJP's staff
handles a variety of civil (non-criminal) cases, including those involving
denial, termination, and reduction of benefits or health care services. The
Native American Unit focuses on areas of critical and unique importance to
AI/AN clients. Examples include Indian Child Welfare Act cases,
discrimination in schools, and issues arising from a client's survival of
domestic violence, sexual assault, wage theft, or other crimes.
Counseling and other health services can go a long way toward
helping crime survivors recover, but people often require financial
assistance to access such services. To that end, the Native American Unit
helps clients access resources available through the nonprofit Victim Support
Services, the Washington State Labor and Industries' Crime Victims
Compensation Fund, and restitution in collaboration with prosecutors. This
work is in addition to other general civil legal support the unit offers
crime survivors.
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