The Indian Health Service, part of the U.S. Department of Health and Human Services, provides health services to federally recognized American Indian and Alaska Native tribes. The agency focuses on school nutrition and exercise programs, education about diabetes and obesity, injury prevention, and treatment for mental health issues and substance abuse. With about 15,000 employees, IHS is the largest employer in Indian Country; its 2016 budget was about $6 billion.

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Anna V. Smith is an associate editor of High Country News. She writes and edits stories on tribal sovereignty and environmental justice for the Indigenous Affairs desk from Oregon.