There are over 5.2 million American Indians and Alaska Natives in the United States. These indigenous communities make up roughly 2% of the total population, with 14 different states holding more than 100,000 residents with this background.
That is a significant population considering these were widely considered to be the first residents of our country long before colonization or mass immigration.
While you would think we would be celebrating and protecting such ancient cultures in every way possible, we often run into legal challenges and political back and forth with sovereign nations related to taxes, education, social services, and healthcare.
Unfortunately, we have just the opposite, with indigenous people born today facing a life expectancy of 5.5 years less than the rest of all U.S. races population.
In this next section of articles, we will explore some of the more critical issues and implications of healthcare on these communities, including what we can do to overcome such challenges.
For now, let’s dive into more of the current state of healthcare to get a better grasp on the reality.
What is the Status?
While news media loves to talk about the Affordable Care Act (Obamacare) in terms of its efficacy and cost, these issues are not present for indigenous communities.
Most Native Americans are served by the IHS (Indian Health Service), which is an agency operating within the auspice of the United States Department of Health and Human Services.
Even though this agency is designed and tasked with the service of more than 560 recognized tribes, there have been repeated movements by government officials to defund, underfund, or restrict access to essential services.
As a result, hospitals and care centers in geographic relation to such communities often have to close or limit services due to understaffing without proper funding.
A recent study by the National Congress of American Indians showed funding would essentially have to double to receive “on par” services that the rest of the US population relies upon.
That has led to many nations echoing the call for managing their own healthcare through private funding.
That can work in areas where there are extreme funding resources like Casinos, cash crops, and the like, but not in areas where underdeveloped land and assets do not bring in a ton of financial resources.
Even then, there are some other challenges that will need to be overcome for any private organization to succeed.
Challenges of Indigenous Healthcare
We could all dream of a better tomorrow, but facing the facts of the situation is a far better way to address any systematic, cultural, or political issues.
That same is true for healthcare in rural communities that service indigenous people. Some of the more common challenges include:
Impact of Colonialism
History is not as old as we may think. The US government forced many indigenous communities away from their natural land to form reserves.
These are territories often remote and isolated from the rest of society and lacking in the essential infrastructure most of us consider “comfortable.”
That treatment has a long memory ingrained into the visceral feelings and minds of community members. It cultivates a natural distrust of anything being proposed by the federal government, especially when mistreatment and respect for sovereign land have been an ongoing issue.
Another harsh reality is most indigenous people live in hard-to-reach rural communities. They may not have the roadways, street signs, addresses, or easy access for significant healthcare services.
It is hard to drive an ambulance on a road poorly maintained to an address you cannot confirm.
This remote location also means it’s harder to find qualified professionals to do the work outside the community.
Instead of experienced doctors, most of the people providing care are nurses who are forced to cover a much broader scope of practice to make up for the lack of other providers.
There is growing evidence that indigenous people feel invisible inside the U.S. healthcare system.
This can be due to bias from providers to the availability of medication and ongoing medical support.
On top of this, some community members often feel isolated by their culture in a dominantly white or mixed space.
When a doctor doesn’t have any training or sensitivity to the unique background of these individuals, it often leads to mistrust or a lack of empathy that can negatively harm a medical appointment.
The Reality of Health
This disparity in care needs to be addressed because we already know indigenous communities suffer from an increase in medical needs. Even the recent global pandemic was enough to point out these disparities.
Understaffed hospitals, lack of running water, and limited internet access led to the rapid spread of Covid in communities ill-equipped to handle such a surge.
American Indians experience poorer health status compared to the rest of us.
These communities pass away at higher rates of chronic liver disease and cirrhosis, type 2 diabetes, unintentional injuries, assault/homicide, and self-harm or suicide.
You also tend to find chronic lower repository disease being more prevalent.
Some of this has to do with access to healthier lifestyle businesses similar to groceries, health clubs, and other things you would commonly find in a mid-sized town. The other part has to do with the poverty rate.
About 1 in 3 Native Americans are living in poverty, with a median income of $23,000 per year. That is significantly less than the average median household income of $70,784 across the nation.
Less money means fewer resources. If the government is actively underfunding healthcare facilities, the community has ingrained cultural hesitation of trust, and the financial resources are well below expectations, there is a formula for higher risk.
As we explore this world and consider what we can do about the future of healthcare for indigenous people in the United States, we need to be equally sensitive to their unique needs as well as point out the drastic inequality we are levying against these people.
There has to be a practical, rational pathway toward better healthcare so that it can be offered at increasingly more appropriate levels and trusted by the many patients hoping for more help.
Written by: Emmanuel J. Osemota