Whereas 70% of AI/AN lived on tribal land at the start of the Indian Health Services, 70% live in urban environments as of 2021 . 

Such a drastic SES constitutes the reconfiguration of IHS to accomodate its target population despite their proximity to reservations/protected land.

Grand Valley State University

Common concerns for rural AI/AN inhabitants include distance to providers, remoteness, and lack of local specialty care, whereas urban inhabitants may be barred by travel costs and proximity from reservation land that makes them eligible to recieve care from the IHS.

While Urban and Rural AI/AN face different geographic limitations, the underlying cause for both populations' inequities can be traced back to lack of infrastructure, provider retention, and funding for the IHS, the only provider of healthcare that many individuals have access to. 

Differences Between Urban and Rural Barriers to Healthcare

Khetpal, V., Roosevelt, J., & Adashi, E. Y. (2022). A Federal Indian Health Insurance Plan: Fulfilling a solemn obligation to American Indians and Alaska Natives in the United States. Preventive Medicine Reports, 25, 101669. https://doi.org/10.1016/j.pmedr.2021.101669
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