Health Disparities Between Indians and Non-Indians
Health Disparities Between Indians And Non-Indians
American Indians experience health and disease in a way different from that of any other group of people in the United States. Their life expectancy is the lowest of any group in the United States, and Indians have the highest prevalence of Type 2 diabetes in the world. It is not uncommon to see alarming statistics in the press concerning the health of North American indigenous people. According to the National Congress of American Indians, the most recent statistics recount stunning differences in the infant mortality rate for Native American babies—150 percent higher than that of white infants. Additionally, the suicide rate for American Indians and Alaska Natives is two-and-a-half times greater than the national average. A 2003 report from the U.S. Commission on Civil Rights also indicated that American Indians are 630 percent more likely to die from alcoholism and 650 percent more likely to die from tuberculosis than other persons in the United States. American Indians have high death rates from motor-vehicle crashes, unintentional injuries, alcohol-induced injuries, and malignant neoplasm.
Countless scientific research projects and subsequent reports indicate that Native Americans are in the midst of a public-health crisis concerning diabetes and other health-related problems. While many scientific studies tend to focus on genetic and lifestyle choices and their relationships to Native American health, more often than not, the sociopolitical and sociohistorical aspects of Native American health are not addressed. These aspects, however, are essential to understanding health disparities in Native North America. Traditional health to most Native Americans is a balance of spiritual, physical, mental, and emotional components. This balance is not addressed by Western medicine, and patients are apprehensive about seeking health care because of what they consider to be incomplete care.
Access to health care, poverty, discrimination, cultural differences, low educational attainment, and poor social conditions are often cited as reasons for Native American health disparities. Some policy analysts would argue that access is no longer an issue for Native Americans. However, it is imperative to understand the political nature of American Indian health care when attempting to address the numerous disparities, because funding levels for government-sponsored health care are directly tied into appropriations by politicians and are subject to the political climate of the time. As of mid-2007, the Indian Health Care Improvement Act (Public Law 94–437) had not been renewed, and the Bush administration was attempting to limit the number of Native Americans the act could serve. The Snyder Act of 1921 (Public Law 67–85), the same law that conferred citizenship on all American Indians, authorizes Congress to appropriate funds for “the relief of distress and conservation of health” of American Indians, but it is up to the discretion of the government to determine how much relief is offered.
The federal responsibility to provide health care is carried out by the secretary of the Department of Health and Human Services through the Indian Health Service (IHS). The IHS provides directly or indirectly the majority of funds for the health care of American Indians and Alaska Natives (AI/AN). The U.S. government has been negligent in its responsibility to provide health care to
AI/ANs. Funding for AI/ANs is neither a congressional nor presidential priority, as the IHS budget lacks funds to provide adequate services. Per capita, the IHS budget ($1,914) is percent that of federal prisoners ($3,803) and is far behind that of Medicare ($5,915), the Department of Veterans Affairs ($5,214), and the U.S. population in general ($5,065). The IHS non-medical budget is $614 per person served.
An important feature of this act is that it sets the programmatic and legal framework for the government in meeting its responsibility to provide health care to American Indians. Another important political feature that impedes access is the uncertainty of services. Most recently, the Bush administration attempted to eliminate clinical health care services that directly serve urban American Indians. Approximately two-thirds of AI/ANs do not reside on reservations because of migration and ethnocidal relocation programs to force assimilation. During the period when the Indian Health Care Improvement Act was in effect, mainstream health care and health care delivery changed dramatically to emphasize prevention and the “whole person” approach, which some say is analogous to the balance recognized by AI/AN. Most recently in mainstream health care, mental health is recognized as a “health threat,” and practitioners have begun to incorporate a strong health promotion and preventative emphasis. Another important feature of the Indian Health Care Improvement Act is the ability to create local level health care models that, coupled with the 1975 Indian Self-Determination Act (Public Law 638), allow tribes to run their own health care clinics. These clinics work hard to incorporate traditional models into health care promotion and delivery. But because of the politicized nature of health care services, a common adage in areas with significant Indian populations is that one should not get sick after June because no funding is available. Against this complicated political backdrop, American Indians receive their health care. The availability of clinics has improved over the years, but the highly political nature of health care has not.
Diabetes is a major health threat to American Indians. “Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces” (World Health Organization, 2006). There are several forms of diabetes, including Type 1 and Type 2. Type 1 is an insulin-dependent type, usually with childhood onset (and hence formerly called juvenile diabetes). This type results from low insulin production in the pancreas. Type 2 is generally an adult onset type, but Native American children as young as ten years old have been diagnosed with this type. Type 2 results primarily from insulin resistance, or the inability of cells to absorb insulin, along with other factors, and until recently was attributed to the combination of poor diet and lack of exercise. Once a person is diagnosed with Type 2 diabetes, the first-line treatment is generally diet and exercise. If these fail to bring down blood glucose, the next step is oral medication, then combined oral medications and insulin. If the first regime is not effective, then different medications are introduced.
As of 2007, the National Institutes of Health recognized that stress is a contributor to uncontrolled Type 2 diabetes. Stress, especially from trauma, including physical and sexual abuse, or witnessing abuse, is now considered a contributor to an increase in blood glucose. Many of the ethnocidal federal policies—manifested as day-to-day stress on Native American people—have contributed to the high levels of Type 2 diabetes among Native American communities. Some of the historical stressors were and are (1) removal of people from their homelands, disrupting their indigenous diet, and subsequently making many of them dependent upon government food programs (which are inherently political); (2) imposing a new religion; (3) forced removal of children from their families and their subjection to abuse for being “Indian” at federal American Indian boarding schools, and subsequent loss of culture and traditional child-rearing practices through forced assimilation.
Diabetes also creates comorbidities associated with the disease, including diabetic retinopathy, renal failure, heart disease and stroke, diabetic neuropathy, and peripheral vascular disease, to name a few. The Web site for the Centers for Disease Control and Prevention (CDC) lists heart disease, diabetes, and stroke as, respectively, the first, fourth, and fifth leading causes of death among AI/ANs. Even though a person may die of heart disease or stroke, a person with diabetes likely developed these conditions as a result of the disease.
Until American Indian health care is depoliticalized and American Indians are allowed to exercise their sovereign rights as outlined in law and treaty, they are more vulnerable to experience disease and public-health-related issues than other populations in the United States.
Stempel, Thomas K. 2007. “Indian Health Service: Providing Care to Native Americans and Alaska Natives.” Bulletin of the American College of Surgeons 92 (6).
World Health Organization. 2006. “Diabetes.” Available from http://www.who.int/mediacentre/factsheets/fs312/en.
Zhang, Y., E. T. Lee, R. B. Devereux, J. Yeh, L. G. Best, R. R. Fabsitz, and B. V. Howard. 2006. “Prehypertension, Diabetes, and Cardiovascular Disease Risk in a Population-Based Sample: The Strong Heart Study.” Hypertension 47 (3): 410–414.
L. Marie Wallace
Isaac F. Parr