Semin Neurol 2024; 44(02): 205-216
DOI: 10.1055/s-0044-1782517
Review Article

Neurological Care within the Indian Health Service

Karen Parko
1   Department of Neurology, University of California at San Francisco, San Francisco, California
Michael Stitzer
2   Winslow Indian Health Care Center, Navajo Area Indian Health Service, Winslow, Arizona
5   Department of Neurology, Mayo Clinic, Phoenix, Arizoana
Brian Trimble
3   Division of Neurology, Department of Internal Medicine, Alaska Native Tribal Health Consortium, Anchorage, Alaska
Loretta Christensen
4   Indian Health Service, Washington, DC
› Author Affiliations


American Indians and Alaska Natives (AI/AN) are the Indigenous peoples of the United States. According to the U.S. Census Bureau, approximately 9.7 million people self-identified as AI/AN (alone or in combination with other races), representing 2.9% of the total U.S. population. These people represent diverse groups of discrete Tribes, each with their language, culture, and geographic home. As part of the conquest and settlement of North America, some Indigenous peoples signed treaties with the U.S. government, surrendering their lands in return for various government commitments, including health care. The Indian Health Service (IHS) was born out of these agreements. The IHS is an agency in the U.S. Department of Health and Human Services under the U.S. Public Health Service. The IHS provides a comprehensive health service delivery system for approximately 2.7 million AI/AN who belong to 574 federally recognized Tribes/nations in 37 states. The aim of this paper is to make recommendations regarding the initiation of sustainable neurology care in marginalized or underserved populations by reviewing 40 years of neurology care provision within the IHS. We will discuss (1) the IHS, (2) neurological care provided within the IHS, including midlevel provider extension of neurology care and traditional medical care, and (3) select neurological diagnoses within AI/AN populations. Marginalized populations, including those in the United States that are rural, remote, or low socioeconomic status, lack access to specialty neurology care. This includes many AI/AN. The IHS has developed novel solutions to promote specialty care, including neurology. Notably, initial IHS investments in full-time neurology providers have led to more robust neurology care, often receiving attention from university programs. This suggests that an initial investment in stable on-site full-time neurology services provides a path to potential sustainable care for marginalized populations.


In alignment with the Consolidated Criteria for Strengthening the Reporting of Health Research involving Indigenous Peoples (CONSIDER) Statement[38] disclosure, the writing team for this paper has expertise in Indigenous health research and care. All four of the authors of this paper have worked within the Indian Health Service and we have specified this in our affiliations and within the manuscript our involvement. This publication directly involves, as authors, Indigenous stakeholders from the following Tribes: Estom Yumeka Maidu of the Enterprise Rancheria (M.S.), Navajo (L.C.).

Publication History

Article published online:
18 March 2024

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