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Mr. YATES. What did you study at the University of Munich, Mr. Williams?

Mr. WILLIAMS. I was an English major in college and I continued my English studies there, plus history and German.

Mr. YATES. Your English studies were in Germany?

Mr. WILLIAMS. No, my English studies at the University were in English. They also have an English program there, but since I was an English major I took the opportunity to use it.

Mr. YATES. And you were also at John Hopkins. What is "SAIS?” Mr. WILLIAMS. School of Advanced International Studies.

Mr. YATES. How did you wind up with Indian Health?

Mr. WILLIAMS. I don't actually work for Indian Health, I work at the Department in the Budget Office.

Mr. YATES. Yes, but you're a specialist in international affairs, aren't you?

Mr. WILLIAMS. That's right, I am. In a previous incarnation.

Mr. YATES. I see. Someday you'll come back as an international specialist.

STATUS OF INDIAN HEALTH

All right. Your statement is in the record, Dr. Rhoades. Tell us about all the great things that the Indian Health Service is doing and about its deficiencies, if any.

Dr. RHOADES. Thank you very much, Mr. Yates.

Let me just sort of summarize. There are good things going on. Progress continues to be made as reflected in increased longevity for Indian people.

Mr. YATES. From what to what?

Dr. RHOADES. I can actually give you some numbers here in relationship to life expectancy.

Mr. YATES. Their longevity will have to be held up temporarily. Dr. RHOADES. If it's all right with you, perhaps we could come to that. Let me just point out-you have the chart series in front of you-if you could look at page 16, it is sort of the standard index of adequacy of care.

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Mr. YATES. What you're saying then is the life expectancy of Indian people has been increased because you have improved infant mortality.

Dr. RHOADES. That's very nearly totally correct. It is not quite that simple, but that is certainly the largest contributor to the increased life expectancy. And it continues down to a level equal to or less than that for "U.S. All races".

Mr. YATES. Well now, does that mean that the Indian people have enjoyed an improvement in their all-around health?

Dr. RHOADES. I believe it does mean that. Yes, sir. We'll come to some other information that reflects that.

Mr. YATES. All right. You may proceed. [The information follows:]

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Dr. RHOADES. It certainly does not mean that everything is fine, but the improvement is very, very clear. The chart on page 17 is a little too complicated to go over but it does reflect-if you look at the black bar graph showing infant mortality rates for Indians dying at less than one day of age, from one to six days of age, and then seven to twenty-seven days-you can see that just looking at Indians in the black bar compared with U.S. All Races in the bar with vertical lines on it-that, in fact, the infant mortality rate under one day of age is less for Indians than for the rest of the population. It continues to decline up to twenty-seven days of age. After the Indian baby goes home-in the tall bar graph-then accidents and other kinds of acute infectious etiologies cause this great increased proportion of Indian deaths during the first year of life after the first month. That's one of the places we continue to target our efforts, to try to bring that mortality rate down.

Mr. YATES. How do you target your efforts? Do you have centers? Dr. RHOADES. We don't actually have centers for this. We have a Maternal and Child Health Special Emphasis Program.

Mr. YATES. Are the Indian women giving birth in hospitals now rather than on the reservation?

Dr. RHOADES. Yes. It is unusual for birth to take place outside the hospital.

Mr. YATES. It is now?

Dr. RHOADES. Yes, sir. We believe the prenatal care that Indian women get is more extensive than that which is available to the other lower socio-economic classes across the country.

I believe that the greatest contributor to this, however, is the operation of what we call Comprehensive Community-Oriented Primary Care, giving attention to what's going on in that community, taking into account safe water, sanitation, sewage and so forth. It clearly has had the most pronounced effect at this age.

SANITATION FACILITIES

Mr. YATES. I'll agree with that. How many communities are there now that do not have safe water and sanitation?

Dr. RHOADES. We don't express it necessarily in terms of communities, but Mr. Pearson can provide us some information that can give you an idea about what we call the unmet need in relationship to sanitation.

Mr. YATES. Mr. Pearson?

Mr. PEARSON. Approximately 80 percent of all Indian people now have safe water and sanitation facilities. This means that there are approximately twenty percent of the Indian people who presently do not have such facilities. That translates into homes in the order of magnitude of about 22,000 Indian homes that we have yet to serve for the first time.

Mr. YATES. Okay.

Go ahead, Dr. Rhoades.

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