Native-American Health

Between 2.5 and 4 million Americans are classified as American Indians/Native Alaskans. The lower figure encompasses those who not only report this as their sole race and ethnicity on census forms, but who also maintain an attachment to a tribe or community, and who live on or near a reservation. The larger figure includes those who do not have a formal attachment to a reservation but who claim American-Indian/Na-tive-Alaskan ancestry. The Native-American population, as a whole, is diagnosed with more diseases and disorders than many other racial/ethnic populations in the United States.

These health disparities are due to a complex set of factors, including genetic, behavioral, and cultural ones, and are often also attributed to a lack of economic resources to obtain healthcare services and/or to a lack of access to quality healthcare. Native Americans frequently rely upon both westernized medicine and traditional Native-American healing techniques for healthcare; when this type of integrated care is not available, it can prevent some of the population from seeking timely healthcare services.

To define the population more specifically, the 2.5 million individuals—or the 0.9 percent of the United States population—who list a wholly American-In-dian/Native-Alaskan ancestry are descended from the original people residing in north, south, or central America, and they have kept an affiliation with one of the 569 federally recognized tribes. The majority of these people live in the western, southwestern, or midwestern states, with the greatest numbers living in Alaska, Arizona, Montana, New Mexico, Oklahoma, or South Dakota. The federal government projects that the American-Indian/Native-Alaskan population will [Page 1205]reach over 5 million by 2065, which is estimated to be 1.1 percent of the projected population.

Fourteen percent of Native Americans are categorized as being in fair or poor health, with 15 percent having limitations in at least one activity because of a chronic health condition. Thirty-five percent of Native Americans under the age of 65 are without health insurance coverage, and 19 percent of Native Americans over the age of 18 do not report a steady source of healthcare.

The 10 leading causes of death for this population, using 2002 figures, are in this order: heart disease; cancer; unintentional injuries; diabetes; stroke; chronic liver disease and cirrhosis; chronic lower respiratory disease, such as emphysema and chronic bronchitis; suicide; influenza and pneumonia; and homicide. Native Americans are 2.6 times more likely to have diabetes mellitus than non-Hispanic whites of similar age, and they have a greater-than-average risk of mental health issues, becoming obese, abusing substances, or having a child die from sudden infant death syndrome (SIDS).

To provide for the healthcare of Native Americans and to advocate for their healthcare needs, the United States federal government established an agency, the Indian Health Service (IHS). Through this agency, efforts are made to prevent disease, with initiatives focused on traditional medicine, elder care, women's health, children and adolescents, injury prevention, domestic violence and child abuse, healthcare financing, state healthcare, sanitation facilities, and oral health. Although this agency was officially granted public health service status in 1988, the federal government had been involved in healthcare legislation for Native Americans for a significantly longer period of time, with mixed results; throughout the early half of the 20th century, health-based legislation was sometimes used as a tool to attempt to terminate any special racial or ethnic designation for Native Americans.

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