Indian Health Service & the Trust Responsibility

Established in numerous Treaties and the Constitution, the Trust Responsibility forms a unique government-to-government relationship between the federal government and American Indian and Alaska Native (AI/AN) people, and has been reaffirmed and given substance through 200 years case law, executive action and congressional statute. These actions form the legal basis by which the United States has committed to protecting the health and well-being of America’s first citizens in perpetuity.

While the Indian Health Service is primarily charged with carrying out the Trust Responsibility in the Lower 48, Alaska Tribes have taken over these programs and services through a contracting and compacting process and now carry out nearly all of the functions previously administered by the Indian Health Service. Collectively, The Alaska Tribal Health System forms an integrated statewide health network, providing health care services at village clinics, regional hubs and the Alaska Native Medical Center.

In taking on this responsibility, Alaska Tribes operate on the principles of self-determination and intertribal cooperation, and in doing so have achieved remarkable advances in strengthening the health and well-being of our people.