22-05-2025
Facing extreme health disparities, native voices must be added to Spokane's Board of Health under new state law
May 21—A seat meant to represent tribal communities has remained vacant on the Spokane Regional Health District board for the past three years. A new state law will require multiple tribal voices to be seated on the board overseeing Spokane's public health.
The new law is set to remake the local board and potentially double its size. Local health boards must now seat a board member appointed by a local tribe or an urban Indian organization recognized by the Indian Health Service. According to the law's author, that could mean three tribal representatives on the SRHD board, if not more.
"This speaks to how representation matters. When we have folks representing directly from their community and having a say in the policy, it is always more effective," said Spokane Rep. Natasha Hill, the Democrat who sponsored and led the bill's passage through the Legislature earlier this year.
Because of differing interpretations of a state law passed in 2022, a seat for a tribal representative has been vacant for the past several years. The new law clarifies that the intent is to seat multiple tribal representatives on local health boards.
While there is no reservation land in Spokane County, both the Spokane and Kalispel tribes have trust land in Airway Heights where Northern Quest Casino and Spokane Tribe Casino are located. Those lands would call for each tribe to appoint a member to the board.
The Native Project provides health services to native peoples in Spokane and is recognized by the Indian Health Service. It would also receive a seat on the SRHD board.
Current members of the board said they would discuss how to best implement the new law at their next meeting.
"I welcome new voices and experiences on the board. I'm always ready to have new people to help us tackle the hard issues," board president and Spokane County Commissioner Amber Waldref said.
Board member and fellow County Commissioner Josh Kerns said the board may make decisions more slowly because of its growing size. Local health boards are required to have a mix of elected officials and community members. As tribal representatives are appointed, more county commissioners or Spokane City Council members may be added too, as state regulations require health boards be evenly divided between elected officials and members of the public.
Right now, there are seven members on Spokane's Board of Health, including four elected officials. Under the new law, the body's size could easily double.
"This is great for diversity of thought. But things will take longer almost certainly," Kerns said.
He said that adding more politicians to the typically nonpartisan health board may make their debates "more political."
While ensuring the board would "abide by the law," Spokane County Commissioner Mary Kuney said the new board's composition would be interesting because it will have "the interest of one group more heavily weighted than any other groups in our community."
The elected officials on the board have often been predominately made up of the Republican-majority Spokane County Commission. Because of the need to appoint more elected officials alongside Indigenous appointees, progressively aligned members on the Spokane City Council may find themselves on the board.
According to Hill, creating large health boards is the intent of her legislation.
"We don't need fewer people making decisions. Sometimes that means that things are getting missed. There are blind spots," Hill said.
According to the 2020 census, those who identify themselves as American Indian and Alaska Native make up 1.9% of the population in Spokane County.
Hill said she was not concerned that the appointment of multiple tribal representatives could be disproportionate to their population.
"God forbid we're ruled by a group of natives and Indigenous people whose land we stole. Am I worried about that? Not for a second. Are white folks worried about that? If they believe in a white supremacist system, for sure they are," Hill said.
Native health disparities
Local health districts inform the public about communicable disease spreading in their community and how to remain healthy. Some, like SRHD, provide direct services such as Spokane's opioid treatment services.
Native communities face large health disparities and local health districts sometimes struggle to reach them, according to Native Project's clinic director Dylan Dressler.
"We have so many co-morbidities with chronic disease like hypertension, cardiovascular diabetes and mental health like depression and anxiety," she said. "And much of it can go untreated, especially for those who chose to live off the reservation in the cities away from community."
American Indian or Alaska Native persons are the only racial group in Washington state whose life expectancy has gone down in this century. According to a 2023 report from the Governor's Indian Health Advisory Council, native life expectancy in the state has fallen from an average of 73.2 years in 2000 to 71.6 years in 2020.
Native people had the highest drug overdose death rates across the United States in 2020 and 2022. According to the CDC, 56.6 per 100,000 American Indians died of a drug overdose in 2021, compared to 30.6 per 100,000 for the population as a whole.
Dressler applied to be on the board of health in 2020 and 2022. That representation never materialized in Spokane over disagreements whether the law required a single or multiple native representatives.
Dressler does not plan to seek appointment to the board as the Native Project representative, but she hopes more tribal and native representation can improve the health of native people in Spokane County.
"In the past decade, we were happy if our elders would reach 60 years old. Now, we're seeing their lives extending five to 10 years longer. We're still not at the life expectancy of others, but we are keeping our culture and keeping our elders to tell stories and show us the land and the water important to us," she said.
