Abstract
The provision of health and medical care to American Indians and Alaska Natives has undergone major changes in the 150 years during which the federal govern ment has assumed responsibility for these services. Signifi cant legislation leading to present programs and directions is reviewed to place current programs in the perspective of historic evolution. The changing patterns of disease indicate that Indian health status is rapidly approaching that of the Western world, with a reduction in infectious diseases and an increase in psychosocial problems and chronic conditions. In order to provide quality health care under isolated, rural conditions, the Indian Health Service is exploring innovative uses of paraprofessionals and the application of modern space technology to primary care settings.
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