In 2013, total program funding was $5.46 billion. Although the IHS budget has increased over time, funds are not equally distributed across facilities and they remain insufficient to meet health care needs. As such, access to services through IHS varies significantly across locations, and American Indians and Alaska Natives who rely solely on IHS for care often lack access to needed care. Indigenous peoples often use their own words that translate roughly to "living well' which combines beliefs in the importance of balance. The four elements of life: physical, emotional, mental and spiritual are all are intricately woven together and interact to support a strong and healthy person.