§ 1602 TITLE 25—INDIANS Page 420

dence of preventable illnesses among, and unnecessary and premature deaths of, Indians.

(d) Despite such services, the unmet health

needs of the American Indian people are severe

and the health status of the Indians is far below

that of the general population of the United

States.

(Pub. L. 94–437, §2, Sept. 30, 1976, 90 Stat. 1400;

Pub. L. 102–573, §3(a), Oct. 29, 1992, 106 Stat.

4526.)

AMENDMENTS

1992—Pub. L. 102–573 substituted ‘‘finds the following:’’ for ‘‘finds that—’’ in introductory provisions and

struck out last sentence of subsec. (d) which compared

death rates of Indians to those of all Americans for tuberculosis, influenza and pneumonia, and compared

death rates for infants, subsec. (e) which related to

threat to fulfillment of Federal responsibility to Indians posed by low health status of American Indian people, subsec. (f) which enumerated causes imperiling improvements in Indian health, and subsec. (g) which related to confidence of Indian people in Federal Indian

health services.

SHORT TITLE OF 1996 AMENDMENT

Pub. L. 104–313, §1(a), Oct. 19, 1996, 110 Stat. 3820, provided that: ‘‘This Act [amending sections 1603, 1613a,

1621j, 1645, 1665e, 1665j, and 1680k of this title] may be

cited as the ‘Indian Health Care Improvement Technical Corrections Act of 1996’.’’

SHORT TITLE OF 1992 AMENDMENT

Section 1 of Pub. L. 102–573 provided that: ‘‘This Act

[see Tables for classification] may be cited as the ‘Indian Health Amendments of 1992’.’’

SHORT TITLE OF 1990 AMENDMENT

Pub. L. 101–630, title V, §501, Nov. 28, 1990, 104 Stat.

4556, provided that: ‘‘This title [enacting sections 1621h,

1637, 1659, and 1660 of this title, amending sections 1653,

1657, and 2474 of this title, and enacting provisions set

out as notes under sections 1621h, 1653, and 2415 of this

title] may be cited as the ‘Indian Health Care Amendments of 1990’.’’

SHORT TITLE OF 1988 AMENDMENT

Pub. L. 100–713, §1, Nov. 23, 1988, 102 Stat. 4784, provided that: ‘‘This Act [enacting sections 1616 to 1616j,

1621a to 1621g, 1636, 1651 to 1658, 1661, 1662, and 1680a to

1680j of this title and sections 254s and 295j of Title 42,

The Public Health and Welfare, amending sections 1603,

1612 to 1613a, 1614, 1615, 1621, 1631, 1632, 1634, 1674, 1676,

and 1678 to 1680 of this title and section 5316 of Title 5,

Government Organization and Employees, repealing

section 1635 of this title and section 254r of Title 42, enacting provisions set out as notes under this section

and sections 1611, 1621b, 1661, and 1677 of this title and

sections 254r, 1395qq, and 1396j of Title 42, amending

provisions set out as a note under section 1396j of Title

42, and repealing provisions set out as a note under section 1396j of Title 42] may be cited as the ‘Indian Health

Care Amendments of 1988’.’’

SHORT TITLE OF 1980 AMENDMENT

Pub. L. 96–537, §1(a), Dec. 17, 1980, 94 Stat. 3173, provided that: ‘‘this Act [enacting sections 1622, 1634, and

1676 to 1680 of this title, amending sections 1603, 1612 to

1614, 1621, 1651 to 1657, and 1674 of this title and section

294y–1 of Title 42, The Public Health and Welfare, and

repealing section 1658 of this title] may be cited as the

‘Indian Health Care Amendments of 1980’.’’

SHORT TITLE

Section 1 of Pub. L. 94–437 provided: ‘‘That this Act

[enacting this chapter and sections 1395qq and 1396j of

Title 42, The Public Health and Welfare, amending sections 234, 1395f, 1395n, and 1396d of Title 42, and enacting

provisions set out as notes under section 1671 of this

title and sections 1395qq and 1396j of Title 42] may be

cited as the ‘Indian Health Care Improvement Act’.’’

SEPARABILITY

Pub. L. 100–713, title VIII, §801, Nov. 23, 1988, 102 Stat.

4839, provided that: ‘‘If any provision of this Act, any

amendment made by this Act [see Short Title of 1988

Amendment note above], or the application of such provision or amendment to any person or circumstances is

held to be invalid, the remainder of this Act, the remaining amendments made by this Act, and the application of such provision or amendment to persons or

circumstances other than those to which it is held invalid, shall not be affected thereby.’’

AVAILABILITY OF APPROPRIATIONS

Pub. L. 100–713, §4, Nov. 23, 1988, 102 Stat. 4785, provided that: ‘‘Any new spending authority (described in

subsection (c)(2)(A) or (B) of section 401 of the Congressional Budget Act of 1974 [2 U.S.C. 651(c)(2)(A), (B)])

which is provided under this Act [see Short Title of 1988

Amendment note above] shall be effective for any fiscal

year only to such extent or in such amounts as are provided in appropriation Acts.’’

§ 1602. Declaration of health objectives

(a) The Congress hereby declares that it is the

policy of this Nation, in fulfillment of its special

responsibilities and legal obligation to the

American Indian people, to assure the highest

possible health status for Indians and urban Indians and to provide all resources necessary to

effect that policy.

(b) It is the intent of the Congress that the Nation meet the following health status objectives

with respect to Indians and urban Indians by the

year 2000:

(1) Reduce coronary heart disease deaths to

a level of no more than 100 per 100,000.

(2) Reduce the prevalence of overweight individuals to no more than 30 percent.

(3) Reduce the prevalence of anemia to less

than 10 percent among children aged 1 through

5.

(4) Reduce the level of cancer deaths to a

rate of no more than 130 per 100,000.

(5) Reduce the level of lung cancer deaths to

a rate of no more than 42 per 100,000.

(6) Reduce the level of chronic obstructive

pulmonary disease related deaths to a rate of

no more than 25 per 100,000.

(7) Reduce deaths among men caused by alcohol-related motor vehicle crashes to no

more than 44.8 per 100,000.

(8) Reduce cirrhosis deaths to no more than

13 per 100,000.

(9) Reduce drug-related deaths to no more

than 3 per 100,000.

(10) Reduce pregnancies among girls aged 17

and younger to no more than 50 per 1,000 adolescents.

(11) Reduce suicide among men to no more

than 12.8 per 100,000.

(12) Reduce by 15 percent the incidence of injurious suicide attempts among adolescents

aged 14 through 17.

(13) Reduce to less than 10 percent the prevalence of mental disorders among children and

adolescents.

(14) Reduce the incidence of child abuse or

neglect to less than 25.2 per 1,000 children

under age 18.
Page 421 TITLE 25—INDIANS § 1602

(15) Reduce physical abuse directed at

women by male partners to no more than 27

per 1,000 couples.

(16) Increase years of healthy life to at least

65 years.

(17) Reduce deaths caused by unintentional

injuries to no more than 66.1 per 100,000.

(18) Reduce deaths caused by motor vehicle

crashes to no more than 39.2 per 100,000.

(19) Among children aged 6 months through

5 years, reduce the prevalence of blood lead

levels exceeding 15 ug/dl and reduce to zero the

prevalence of blood lead levels exceeding 25 ug/

dl.

(20) Reduce dental caries (cavities) so that

the proportion of children with one or more

caries (in permanent or primary teeth) is no

more than 45 percent among children aged 6

through 8 and no more than 60 percent among

adolescents aged 15.

(21) Reduce untreated dental caries so that

the proportion of children with untreated caries (in permanent or primary teeth) is no more

than 20 percent among children aged 6 through

8 and no more than 40 percent among adolescents aged 15.

(22) Reduce to no more than 20 percent the

proportion of individuals aged 65 and older

who have lost all of their natural teeth.

(23) Increase to at least 45 percent the proportion of individuals aged 35 to 44 who have

never lost a permanent tooth due to dental

caries or periodontal disease.

(24) Reduce destructive periodontal disease

to a prevalence of no more than 15 percent

among individuals aged 35 to 44.

(25) Increase to at least 50 percent the proportion of children who have received protective sealants on the occlusal (chewing) surfaces of permanent molar teeth.

(26) Reduce the prevalence of gingivitis

among individuals aged 35 to 44 to no more

than 50 percent.

(27) Reduce the infant mortality rate to no

more than 8.5 per 1,000 live births.

(28) Reduce the fetal death rate (20 or more

weeks of gestation) to no more than 4 per 1,000

live births plus fetal deaths.

(29) Reduce the maternal mortality rate to

no more than 3.3 per 100,000 live births.

(30) Reduce the incidence of fetal alcohol

syndrome to no more than 2 per 1,000 live

births.

(31) Reduce stroke deaths to no more than 20

per 100,000.

(32) Reverse the increase in end-stage renal

disease (requiring maintenance dialysis or

transplantation) to attain an incidence of no

more than 13 per 100,000.

(33) Reduce breast cancer deaths to no more

than 20.6 per 100,000 women.

(34) Reduce deaths from cancer of the uterine cervix to no more than 1.3 per 100,000

women.

(35) Reduce colorectal cancer deaths to no

more than 13.2 per 100,000.

(36) Reduce to no more than 11 percent the

proportion of individuals who experience a

limitation in major activity due to chronic

conditions.

(37) Reduce significant hearing impairment

to a prevalence of no more than 82 per 1,000.

(38) Reduce significant visual impairment to

a prevalence of no more than 30 per 1,000.

(39) Reduce diabetes-related deaths to no

more than 48 per 100,000.

(40) Reduce diabetes to an incidence of no

more than 2.5 per 1,000 and a prevalence of no

more than 62 per 1,000.

(41) Reduce the most severe complications of

diabetes as follows:

(A) End-stage renal disease, 1.9 per 1,000.

(B) Blindness, 1.4 per 1,000.

(C) Lower extremity amputation, 4.9 per

1,000.

(D) Perinatal mortality, 2 percent.

(E) Major congenital malformations, 4 percent.

(42) Confine annual incidence of diagnosed

AIDS cases to no more than 1,000 cases.

(43) Confine the prevalence of HIV infection

to no more than 100 per 100,000.

(44) Reduce gonorrhea to an incidence of no

more than 225 cases per 100,000.

(45) Reduce chlamydia trachomatis infections, as measured by a decrease in the incidence of nongonococcal urethritis to no more

than 170 cases per 100,000.

(46) Reduce primary and secondary syphilis

to an incidence of no more than 10 cases per

100,000.

(47) Reduce the incidence of pelvic inflammatory disease, as measured by a reduction in

hospitalization for pelvic inflammatory disease to no more than 250 per 100,000 women

aged 15 through 44.

(48) Reduce viral hepatitis B infection to no

more than 40 per 100,000 cases.

(49) Reduce indigenous cases of vaccine-preventable diseases as follows:

(A) Diphtheria among individuals aged 25

and younger, 0.

(B) Tetanus among individuals aged 25 and

younger, 0.

(C) Polio (wild-type virus), 0.

(D) Measles, 0.

(E) Rubella, 0.

(F) Congenital Rubella Syndrome, 0.

(G) Mumps, 500.

(H) Pertussis, 1,000.

(50) Reduce epidemic-related pneumonia and

influenza deaths among individuals aged 65

and older to no more than 7.3 per 100,000.

(51) Reduce the number of new carriers of

viral hepatitis B among Alaska Natives to no

more than 1 case.

(52) Reduce tuberculosis to an incidence of

no more than 5 cases per 100,000.

(53) Reduce bacterial meningitis to no more

than 8 cases per 100,000.

(54) Reduce infectious diarrhea by at least 25

percent among children.

(55) Reduce acute middle ear infections

among children aged 4 and younger, as measured by days of restricted activity or school

absenteeism, to no more than 105 days per 100

children.

(56) Reduce cigarette smoking to a prevalence of no more than 20 percent.

(57) Reduce smokeless tobacco use by youth

to a prevalence of no more than 10 percent.

(58) Increase to at least 65 percent the proportion of parents and caregivers who use
§ 1603 TITLE 25—INDIANS Page 422

feeding practices that prevent baby bottle

tooth decay.

(59) Increase to at least 75 percent the proportion of mothers who breast feed their babies in the early postpartum period, and to at

least 50 percent the proportion who continue

breast feeding until their babies are 5 to 6

months old.

(60) Increase to at least 90 percent the proportion of pregnant women who receive prenatal care in the first trimester of pregnancy.

(61) Increase to at least 70 percent the proportion of individuals who have received, as a

minimum within the appropriate interval, all

of the screening and immunization services

and at least one of the counseling services appropriate for their age and gender as recommended by the United States Preventive

Services Task Force.

(c) It is the intent of the Congress that the Nation increase the proportion of all degrees in the

health professions and allied and associated

health profession fields awarded to Indians to 0.6

percent.

(d) The Secretary shall submit to the President, for inclusion in each report required to be

transmitted to the Congress under section 1671

of this title, a report on the progress made in

each area of the Service toward meeting each of

the objectives described in subsection (b) of this

section.

(Pub. L. 94–437, §3, Sept. 30, 1976, 90 Stat. 1401;

Pub. L. 102–573, §3(b), Oct. 29, 1992, 106 Stat.

4526.)

AMENDMENTS

1992—Pub. L. 102–573 amended section generally. Prior

to amendment, section read as follows: ‘‘The Congress

hereby declares that it is the policy of this Nation, in

fulfillment of its special responsibilities and legal obligation to the American Indian people, to meet the national goal of providing the highest possible health

status to Indians and to provide existing Indian health

services with all resources necessary to effect that policy.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1616l, 1621,

1621b, 1621m, 1665g, 1671 of this title.

§ 1603. Definitions

For purposes of this chapter—

(a) ‘‘Secretary’’, unless otherwise designated,

means the Secretary of Health and Human Services.

(b) ‘‘Service’’ means the Indian Health Service.

(c) ‘‘Indians’’ or ‘‘Indian’’, unless otherwise

designated, means any person who is a member

of an Indian tribe, as defined in subsection (d) of

this section, except that, for the purpose of sections 1612 and 1613 of this title, such terms shall

mean any individual who (1), irrespective of

whether he or she lives on or near a reservation,

is a member of a tribe, band, or other organized

group of Indians, including those tribes, bands,

or groups terminated since 1940 and those recognized now or in the future by the State in which

they reside, or who is a descendant, in the first

or second degree, of any such member, or (2) is

an Eskimo or Aleut or other Alaska Native, or

(3) is considered by the Secretary of the Interior

to be an Indian for any purpose, or (4) is determined to be an Indian under regulations promulgated by the Secretary.

(d) ‘‘Indian tribe’’ means any Indian tribe,

band, nation, or other organized group or community, including any Alaska Native village or

group or regional or village corporation as defined in or established pursuant to the Alaska

Native Claims Settlement Act (85 Stat. 688) [43

U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of

their status as Indians.

(e) ‘‘Tribal organization’’ means the elected

governing body of any Indian tribe or any legally established organization of Indians which

is controlled by one or more such bodies or by a

board of directors elected or selected by one or

more such bodies (or elected by the Indian population to be served by such organization) and

which includes the maximum participation of

Indians in all phases of its activities.

(f) ‘‘Urban Indian’’ means any individual who

resides in an urban center, as defined in subsection (g) of this section, and who meets one or

more of the four criteria in subsection (c)(1)

through (4) of this section.

(g) ‘‘Urban center’’ means any community

which has a sufficient urban Indian population

with unmet health needs to warrant assistance

under subchapter IV of this chapter, as determined by the Secretary.

(h) ‘‘Urban Indian organization’’ means a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled

board of directors, and providing for the maximum participation of all interested Indian

groups and individuals, which body is capable of

legally cooperating with other public and private entities for the purpose of performing the

activities described in section 1653(a) of this

title.

(i) ‘‘Area office’’ means an administrative entity including a program office, within the Indian Health Service through which services and

funds are provided to the service units within a

defined geographic area.

(j) ‘‘Service unit’’ means—

(1) an administrative entity within the Indian Health Service, or

(2) a tribe or tribal organization operating

health care programs or facilities with funds

from the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.],

through which services are provided, directly or

by contract, to the eligible Indian population

within a defined geographic area.

(k) ‘‘Health promotion’’ includes—

(1) cessation of tobacco smoking,

(2) reduction in the misuse of alcohol and

drugs,

(3) improvement of nutrition,

(4) improvement in physical fitness,

(5) family planning,

(6) control of stress, and

(7) pregnancy and infant care (including prevention of fetal alcohol syndrome).

(l) ‘‘Disease prevention’’ includes—

(1) immunizations,