Native American Health Disparities

There is a relative lack of data on the health of Native American populations in the United States.¹ Existing information, however, suggests that Native American populations face significant health disparities compared to the general US population. For example, these groups experience a shorter life expectancy – 5.5 years less – than the overall US population.² They also endure a lower quality of life and a greater burden of chronic conditions.^3,4  

The physical health disparities this population faces are clearly shown by data. The age-adjusted death rate for Native American adults exceeds the rate in the general population by almost 40%.⁵ Deaths due to diabetes, chronic liver disease and cirrhosis, and accidents occur at three times the national rate.⁵ Similarly, Native Americans suffer more deaths due to tuberculosis, pneumonia, influenza, suicide, homicide, and heart disease than in the general population.⁵ Studies that specifically examine urban Native American populations find similar health disparities. This data suggests higher rates of injuries and deaths due to accidents, liver disease and cirrhosis, diabetes, alcohol abuse, and tuberculosis in urban Native American populations.^6,7  

A 2017 health-focused report compared Native American Arizonians to non-Native Arizonians.⁸ Native Americans reported a higher prevalence of sugar-sweetened beverage consumption (33% vs 26.8%), being overweight or having obesity (76.7% vs 63.2%), diabetes (21.4% vs 8%), and high blood pressure (32.9% vs 27.6%). More Native Americans also reported leisure-time physical inactivity over the past month than non-Native Arizonians did (31.1% vs 23%). Furthermore, they self-reported fair or poor health status more frequently (28.7% vs 16.3%). This population also appeared less likely to have a personal doctor or healthcare provider (53.1% vs 72.8%).  

Native American populations also face disproportionate mental health challenges. Native Americans die by suicide at a rate 72% higher than in the general population⁵ and experience post-traumatic stress disorder (PTSD) at two to three times the national rate.¹ In addition, alcohol dependence affects Native American men 50% more and Native American women up to 100% more.¹ Native American youth particularly suffer a greater mental health burden than their peers. They experience a three to six times higher suicide rate than their non-Native counterparts.^9–11 Generally, mental health disorder rates appear higher in Native American youth than their peers.  

The healthcare system as it exists today does not sufficiently support health improvement for Native Americans. The Indian Health Service (IHS) remains underfunded and understaffed to adequately serve its communities.^12–14 Healthcare often improves when a physician understands the community’s culture, however, there is a shortage of Native American physicians and healthcare providers.¹⁵ The IHS faces an especially significant clinician shortage to address mental health disparities, ¹⁶ and only 7% of the IHS budget supports mental health services.¹⁷ Similarly, only two psychiatrists and four psychologists practice in the IHS per 100,000 people, compared to 14 psychiatrists and 24 psychologists available to the general public.¹⁷ 

These health disparities that Native Americans face, however, do not exist in a vacuum. This population experiences significant social inequities too. ¼ of the population lives in poverty, a rate more than double that of the general population.¹⁸ Fewer possess a high school diploma or GED (71%) or a bachelor’s degree (11.5%) than in the general population (80% and 24.4%, respectively).¹⁸ In addition, overall unemployment reaches 14.4%, and Native Americans face broader economic challenges, such as geographic isolation.^19,20 Healthcare interventions need to consider the wider social context in which Native Americans experience health disparities. Any interventions must honor collaboration with the communities themselves, recognize and respect cultural norms, and provide infrastructure support for sustainable improvements.¹ 

References 

1. Sarche, M. & Spicer, P. Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects. Ann. N. Y. Acad. Sci. 1136, 126–136 (2008). https://doi.org/10.1196/annals.1425.017. 

2. Indian Health Service. Disparities | Fact Sheets. Newsroom https://www.ihs.gov/newsroom/factsheets/disparities/ (2013). 

3. Arias, E., Xu, J. & Jim, M. A. Period Life Tables for the Non-Hispanic American Indian and Alaska Native Population, 2007–2009. Am. J. Public Health 104, S312–S319 (2014). https://doi.org/10.2105/AJPH.2013.301635. 

4. Cobb, N., Espey, D. & King, J. Health Behaviors and Risk Factors Among American Indians and Alaska Natives, 2000–2010. Am. J. Public Health 104, S481–S489 (2014). https://doi.org/10.2105/AJPH.2014.301879. 

5. Shalala, D., Trujillo, M., Hartz, G. & D’Angelo, A. Regional differences in Indian Health: 1998-1999. (1999). https://www.ihs.gov/PublicInfo/Publications/trends98/RD_98a.pdf. 

6. Castor, M. L. et al. A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties. Am. J. Public Health 96, 1478–1484 (2006). https://doi.org/10.2105/AJPH.2004.053942. 

7. Grossman, D. C., Krieger, J. W., Sugarman, J. R. & Forquera, R. A. Health status of urban American Indians and Alaska Natives. A population-based study. JAMA 271, 845–850 (1994). https://doi.org/10.1001/jama.1994.03510350055037. 

8. Adakai, M. Health Disparities Among American Indians/Alaska Natives — Arizona, 2017. MMWR Morb. Mortal. Wkly. Rep. 67, (2018). https://doi.org/10.15585/mmwr.mm6747a4. 

9. Centers for Disease Control and Prevention. Injury Mortality Among American Indian and Alaska Native Children and Youth – United States, 1989-1998. 697–701 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5230a2.htm (2003). 

10. Harrop, A. R., Brant, R. F., Ghali, W. A. & Macarthur, C. Injury Mortality Rates in Native and Non-Native Children: A Population-Based Study. Public Health Rep. 122, 339–346 (2007). https://doi.org/10.1177/003335490712200307. 

11. Yoder, K. A., Whitbeck, L. B., Hoyt, D. R. & LaFromboise, T. Suicidal ideation among American Indian youths. Arch. Suicide Res. Off. J. Int. Acad. Suicide Res. 10, 177–190 (2006). https://doi.org/10.1080/13811110600558240. 

12. Katz, R. J. Addressing the Health Care Needs of American Indians and Alaska Natives. Am. J. Public Health 94, 13–14 (2004). https://doi.org/10.2105/ajph.94.1.13. 

13. Zuckerman, S., Haley, J., Roubideaux, Y. & Lillie-Blanton, M. Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play? Am. J. Public Health 94, 53–59 (2004). https://doi.org/10.2105/ajph.94.1.53. 

14. Roubideaux, Y. Perspectives on American Indian Health. Am. J. Public Health 92, 1401–1403 (2002). https://doi.org/10.2105/ajph.92.9.1401. 

15. Marcinko, T. More Native American Doctors Needed to Reduce Health Disparities in Their Communities. AAMC. https://www.aamc.org/news-insights/more-native-american-doctors-needed-reduce-health-disparities-their-communities (2016). 

16. Johnson, J. L. & Cameron, M. C. Barriers to Providing Effective Mental Health Services to American Indians. Ment. Health Serv. Res. 3, 215–223 (2001). https://doi.org/10.1023/A:1013129131627. 

17. Gone, J. P. Mental Health Services for Native Americans in the 21st Century United States. Prof. Psychol. Res. Pract. 35, 10–18 (2004). https:/doi.org/10.1037/0735-7028.35.1.10. 

18. U.S. Census Bureau. We the People: American Indians and Alaska Natives in the United States. http://www.census.gov/population/www/socdemo/race/censr-28.pdf (2007). 

19. Sandefur, G. D. & Liebler, C. A. The Demography of American Indian Families. Popul. Res. Policy Rev. 16, 95–114 (1997). https://doi.org/10.1023/a:1005788930351. 

20. Tootle, D. M. American Indians: Economic Opportunities and Development. 14 (1996).