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Friday, November 30, 2018

Let's Honor American Indians and Alaska Natives by Eliminating Health Inequities

Jamie Ischomer

Deputy Director, National Council of Urban Indian Health

Denisse Sanchez

Policy Analyst

November is Native American Heritage month. It’s a time to celebrate the rich history, culture, and traditions of American Indian and Alaska Natives (AI/ANs), and elevate the many contributions they have made to our nation. This year, we have even more reason to celebrate with the historic wins of the first two Native American women elected to Congress: Sharice Davids, a member of the Ho-Chunk nation, who will represent Kansas’ 3rd District, and Deb Haaland, member of the Laguna Pueblo tribe, who will represent New Mexico’s 1st district. But to truly honor American Indians and Alaska Natives, celebrating victories is not enough. We must work together to eliminate the profound health inequities AI/AN people face, and ensure that our government honors their treaty responsibilities to ensure the health and welfare of these communities.   

Our collective responsibility to eliminate Native American health inequities

American Indian and Alaska Natives contend with some of the deepest health inequities of any group in the United States. In some states, life expectancy is 20 years lower than the national average. Compared to non-Hispanic white people, AI/AN people are not only more likely to be diagnosed with certain conditions, they are also more likely to die from them—including chronic diseases, mental health issues, and cancer. Among adults, AI/ANs are twice as likely to have type II diabetes, and 2.4 times as likely to die from the condition. Adults are roughly one third more likely to experience depression, and teens are twice as likely to attempt suicide. Cancer mortality is also high. For example, compared to non-Hispanic whites, AI/ANs are almost 50 percent more likely to die of stomach cancer, and almost 2/3 more likely to die of liver cancer. Their infant mortality rate is the second highest in the nation with AI/AN infants being 55% more likely to die, while AI/AN maternal mortality is more than double that of whites.

Many factors contribute to these pervasive health inequities such as high poverty rates, lower educational attainment, housing issues, and job discrimination. In addition, AI/AN people are living the effects of generation after generation of discrimination and displacement. The historical trauma of colonization, forced displacement, and federal policies intended to “civilize” American Indian children, among other damaging actions, have transcended generations. And it continues with federal policies that systematically under resource these communities, despite the US’s treaty responsibilities.

Health care is one of the most egregious examples.  The U.S. government’s mechanism to meet its trust responsibility to provide health care services to AI/ANs is the Indian Health Service (IHS). The IHS is a federal agency with the US Department of Health and Human Services that provides services and runs programs to AI/ANs directly, as well as through contracts with Indian Tribes, Tribal organizations, and urban Indian organization. It is responsible for the care of more than 5 million AI/AN people from 537 federally recognized tribes, yet currently reaches only 2.2 million AI/AN people in 37 states. In part, this is because severe and chronic federal underfunding of the IHS, which is provided only 59% of needed resources, creates profound barriers to care. In addition, this forces providers to prioritize emergent crisis care over preventive services that can improve health outcomes. Further, while over 70% of AI/ANs live off-reservation, in large part due to the federal government’s policies aimed at assimilating this population, Urban Indian health organizations receive only 1% of the IHS budget.

We must do better

As the country grows increasingly diverse, ensuring that everyone has an equitable shot at a healthy and productive life must be a top priority. The introduction of new diseases nearly wiped out the American Indian and Alaska Native population when settlers moved to the New World and their health continues to be neglected for over 500 years. It’s past time more resources were made available to eliminate the health gaps that exist among AI/ANs to ensure they have an equitable opportunity to be as healthy as possible, prosper, and continue breaking political, and other, ceilings. To learn more about other health inequities affecting AI/ANs, check out our American Indian & Alaska Native Health Inequities Compared to Non-Hispanic Whites infographic.