How long you live should not depend on how rich you are.

But recent studies show that richer you are, the longer you live.

For American Indians, this is not news.

Nearly a third of our people live in poverty, compared to approximately 12 percent of the rest of the country, and we suffer alarming gaps in life expectancy.

In Arizona, where I live, the average age at death is 72.2 years for the general population and 54.7 years for American Indians. Even people in Bangladesh and Ghana live longer.

Death rates from preventable causes like diabetes, alcoholism and mental illness are dramatically higher among American Indians than the rest of the population.

Despite this gross inequality, American Indians are the only population born with a legal right to health care in this country.

The treaties between the tribal nations and the federal government involved exchanges of vast amounts of Indian land and natural resources for federal guarantees of social services, including housing, education and health care.

The Bureau of Indian Affairs and the Indian Health Service were established to administer the federal government’s trust responsibility to provide health care and other vital services to American Indians.

But today, the Indian Health Service is underfunded to the tune of $2 billion.

Relative to the entire federal budget of $3.1 trillion, $2 billion is a tiny investment in Indian health.

This is not a question of money. It’s a question of priorities.

We can rapidly spend $150 billion to send taxpayers a $600 rebate to stimulate the economy, and we can spend about $2 billion per week on the war in Iraq.

But we can't fulfill our trust responsibility to honor our treaties with the country's first inhabitants, even though that additional $2 billion could make life and death differences.

Opponents of this funding claim that tribal casinos make it unnecessary. But most tribes do not have casinos, and most casinos are not making significant profits.

And even if that argument were solid, successful tribal economic development does not absolve federal trust responsibility to provide health care to American Indians.

Other opponents argue that successful casinos should fund the other tribes. Is this not advocating socialism? Until the rest of the nation is willing to socialize medicine and other services, tribes should not be held to a higher standard.

Each tribe is a sovereign entity, and it is not the tribes’ responsibility to provide health care to each other; it is the federal government's responsibility.

It ought to live up to that.

Dr. Donald Warne, M.D., MPH, (Oglala Lakota) is president and CEO of American Indian Health Management & Policy (www.aihmp.com) in Phoenix. He is featured in the PBS documentary “Unnatural Causes: Is Inequality Making Us Sick?” airing this month on some stations. He can be reached at pmproj@progressive.rg.