Fifty-two years ago, I graduated from the University of Maine. I also finished my part-time volunteer work directing the tutorial program for elementary students on Indian Island. In some ways, that latter experience was more meaningful to me than the former. In those two years I got to know a bit about the “island” and tutor young students, some of whom I would learn later became distinctive voices of the Wabanaki Nations’ efforts for self-determination. I also saw how social determinants of health affected the everyday lives of those children and their parents, as well as the feeble efforts at the state level to address those needs. Indeed, two experiences further shaped my perspectives.

First, I was volunteering on Indian Island when news came that documents from the state of Massachusetts relating to the tribal rights of the Wabanaki Nations were discovered. That remarkable finding drove a level of excitement and energy that propelled Maine tribal communities to seek further independence from the state and a federal identity. Second, I spent time in Augusta in the early 1970s with Ed Hinckley, the then-administrator of Maine Indian Affairs. I witnessed his frustration with the lack of support at the legislative level for Indian health, and the scanty resources that the state committed overall to Indian affairs. Fast-forward 50 years and really not much has changed.

The Maine Indian Claims Settlement Act implemented in 1980 provided for state recognition of three tribal nations, and a fourth was added in 1989. Ultimate authority for Indian affairs, however, remained in the hands of the state, and there was no promise of federal support for the four tribes. The settlement has subsequently been amended by the Legislature several times but still leaves the state in control over Indian affairs.

The state commitment remains woefully short. Economic growth for the Wabanaki Nations lags far behind the 560 tribes with federal recognition. The recent failure of the Legislature to override the governor’s veto of legislation for self-determination of the tribes in Maine reneges on promises made in the 1790s and harks back to pre-settlement times in the 1970s.

Why would this veto be of interest to a health care provider? My current professional role is as principal investigator for the National Institutes of Health-sponsored Northern New England Clinical and Translational Research Network. Its commitment is to improve the health status of all Mainers through health care research and implementation. Social determinants have now been recognized as major factors in overall health status. Between 1980 and 2019, 151 major federal Indian laws have been passed related to housing, education and welfare, all major factors in overall social determinants of health. Maine tribes are excluded from full beneficiaries of these laws because of the Settlement Act.

By contrast, our research network has worked with Native American Centers in Alaska, the Dakotas and Oklahoma, active recipients of those laws. Their initiatives include cutting-edge federal grant programs designed to blunt the high rates of drug dependency, suicide, diabetes and alcohol abuse among tribal members. In addition, there are novel programs in telehealth, hospice care and environmental sustainability. Although it is possible these programs could happen in our state, sustained federal-tribal partnerships through self-determination bring with it the best opportunity to leverage these innovations and best practices back to Maine tribes.

The Maine Indian Claims Settlement Act is a living document, amended more than 40 times since its passage. For many reasons, not the least being the promise of better health care opportunities for Native Americans in Maine, new legislation in the next session, L.D. 2007, must be passed and any vetoes overridden.