HOW DOES IHS RELATE ADMINISTRATIVELY TO THE HIGH ALCOHOLISM MORTALITY-RATE

From 1969 to 1990 the alcoholism mortality rate for American Indians/A laska Natives (AI/AN) has been steadily decreasing. Compared to the U. S. All Races overall rate decrease of 7.8% in that time period, the AI /AN rate has decreased 33.6%, a remarkable fourfold decrease in the mo rtality rate due to alcoholism. In the decade from 1978 to 1988 the ra te decreased from 64.5/100,000 in 1978 to 37.3/100,000 in 1988 a decre ase of 42.2%. The comparable figures for U.S. AN Races were 8.1/100,00 0 in 1978 and 7.0/100,000 in 1988, a decrease of 13.6%. During this de cade (1978 to 1988) the Indian Health Service (IHS) embarked upon a ma jor effort to assimilate and to expand alcoholism programs then transf erred from the National Institute on Alcohol Abuse and Alcoholism (NIA AA) by incorporating those programs into the IHS health delivery syste m. The number of programs has more than doubled (158/400) since the tr ansfer was completed in 1983. Funds, moreover, have quadrupled ($20/$8 2.3 million in 1993). The actual funds expended by IHS from Fiscal Yea r (FY) 1981 through FY 1993 were $559,916,000. Despite the dramatic in crease in numbers of programs and total funds applied to the reduction of alcoholism mortality, available data reveal an increase in alcohol ism mortality of 40.3% from 1986 to 1990. This article reviews and que stions the relationship of allocations, per capita expenditures, and s ervice components available to reduce alcoholism mortality by IHS Area s in light of the increase in the mortality rate and the fourfold incr ease in the budget. The data appear to show little relationship of mor tality rate with allocations, the number of service components availab le, or per capita expenditures.