Understanding Native American Health Disparities and Inequities

It’s an unfortunate reality that communities in the United States continue to struggle with healthcare inequity, especially among minority groups. Indigenous Peoples are one of the groups that face discrepancies within healthcare, despite a legal obligation on the part of the U.S. to provide adequate healthcare. 

One of the first steps to rectifying this disparity is educating ourselves on the unique health issues Native Americans face, the disparities in care, and the contributing factors to these inequalities. This National Native American Heritage Month, we would like to take a moment to address this important healthcare issue and share what healthcare providers can do to make a difference. 

Unique Health Issues in Native American Populations

When you look at the list of health concerns in Native American communities, you might notice that they are issues faced by many other patient populations in the United States. However, Native Americans have long experienced greater rates of these problems and lower health status when compared with other Americans, according to the Indian Health Service (IHS).

Many of these conditions are connected, but it is important to note that they are the symptoms of systemic disparities in healthcare. Some areas where Native Americans face health discrepancies are:

• Lower life expectancy: Native American patients’ life expectancy is 5.5 years less than the overall United States population: 73 years to 78.5 years, respectively. 
• Mental health issues and suicide: Native American communities have a high prevalence and risk factors for mental health issues and suicide.In 2019, the Health and Human Services (HHS) found that suicide was the second leading cause of death among Native Americans between the ages of 10 and 34 and around 20 percent higher than among non-Hispanic white individuals. 
• Struggles with obesity: Native Americans are 50 percent more likely to be obese than non-Hispanic white individuals, which leads to high blood pressure, diabetes, and heart disease and stroke. 
• Substance abuse: In 2018, the National Survey on Drug Use and Health (NSDUH) found that 10 percent of Native American individuals have a substance use disorder. In addition, nearly 25 percent reported binge drinking in the past month, and Native American respondents are more likely to report drug abuse in the past month than any other ethnic group measured. 
• Disproportionate number of infant deaths: Native American infants are at a much higher risk of infant mortality, accidental deaths, SIDS, and death related to low birth weight. In 2003, data from the National Institute of Health showed that SIDS deaths were 2.4 times higher for Native American infants than non-Hispanic white infants.
• Higher levels of teenage pregnancy: Native American populations have the highest teen birth rate in the U.S.: four in ten Native American women will have a child in their teen years. 
• Higher rates of liver disease: Liver disease is a leading cause of death among Native Americans. Unfortunately, Native American patients are 1.6 times more likely to be diagnosed with chronic liver disease compared to non-Hispanic white Americans, and the death rate is four times as high. 
• Death from hepatitis: While deaths related to hepatitis have decreased dramatically since 1995, Native Americans are still twice as likely to die from viral hepatitis as compared to non-Hispanic white patients. 

Health Disparities Among Native Americans 

When looking at the health issues impacting Native American groups across the United States, it’s important to look at the causes, not just the symptoms. The National Indian Council on Aging (NICOA) has found six “Social Determinants of Health” that help explain “health outcomes, reduce risk factors, and implement system changes” in Native American communities.

Social Determinants of Health

1. Income and wealth gaps: An average Native American household has only eight cents for every dollar of wealth in an average white American household. CDC research concludes that Native Amercians face greater challenges than any other group in getting higher paying jobs, which are often associated with the other five determinants of health. 
2. Education: Historical trauma associated by government relocation of Native American children has deeply impacted their views on the American education system. Native Americans have the lowest educational attainment rates of any group in the U.S., and Bureau of Indian Education schools are vastly underfunded. Even when Native American children attend public schools, they often face discrimination or receive inadequate education on Indigenous Peoples history, culture, and identity. 
3. Social/community setting: Systemic racism in the United States institutional structures, policies, and cultural norms have transferred into individual behavior that impacts the neighborhoods where Native Americans live, transferring into healthcare. 
4. Health access and use: Native Americans struggle to find adequate health care because of barriers such as lack of insurance, an inability to take time off work, culturally insensitive healthcare providers, inequities in treatment, and the lack of transportation or childcare. 
5. Neighborhood and physical environment: Many Native Americans live in poor communities where there is a lack of public transportation, good education, housing, nutritious foods that are affordable, and access to healthcare. As a result, their neighborhoods often face higher crime rates, pollution, and accident and injury rates. 
6. Workplace conditions: Employed Native Americans often face a lack of worker safety measures, limited or zero health insurance, and discrimination based on their race. 

These six factors summarize much of the issues Native Americans face when it comes to health disparities, but it is important to note that these are broader issues. Many Native Americans face even more dramatic inequities that impact health such as access to healthy food, housing options, and environmental conditions. 

Other Contributing Factors

In addition, there are other factors that make it difficult for Native Americans to receive adequate and equitable healthcare. These include:

• Communication barriers: It’s not simply a different language that makes communication difficult, but also the ways people learn to communicate. The Institute for Public Relations reports that many Native American patients would understand, accept, and remember medical advice better if communicated more through storytelling. 
• Lack of diversity in the healthcare workforce: Only about 0.4 percent of the physician workforce is made up of Native Americans, according to the American Medical Association. Only nine percent of medical schools have more than four Native American students, and many of them struggle to complete medical school. When Native American populations don’t find themselves represented in the healthcare workforce, they are less likely to trust the advice they are given. 
• Lack of insurance coverage: Native American patients have the highest uninsured rates compared to other populations: nearly 15.2 percent (in all age categories) were uninsured in 2019. Lack of insurance makes affording healthcare nearly impossible for many individuals.
• Discrimination: A staggering 23 percent of Native Americans report experiencing discrimination in a healthcare setting. Nearly fifteen percent avoid seeking healthcare, as they anticipate discrimination when they arrive. A notable number have also reported experiencing violence or being threatened as well. 
• Inaccessible care: Many Native Americans experience transportation difficulties, making it impossible for them to obtain healthcare. In a recent survey, some Western tribes reported that nearly sixty-eight percent have no way to get to their appointments.

How Healthcare Providers Can Help

Healthcare providers can make a difference when it comes to disparities among Native American patients. As an individual or as a collective group (be it your nursing team, unit, or facility), you can support Native American patients by:

• Tailoring public health to Native American culture. Using preferred sources of health information greatly improves the healthcare experience for Native Americans. Understand their ways of communicating, take the time to educate yourself on their history (particularly local tribes), and make sure there are resources available to them.
• Educate yourself and/or your employees on implicit bias. Understand implicit biases in healthcare, including race/ethnicity, gender, and sexual identity and orientation. Be aware, promote diversity, have dialogs, and establish systems to help prevent bias. 
• Improve surveillance to identify priorities and implement interventions. Take care of discrimination immediately if it occurs. Make sure that your policies are clear to every member of staff on your team. Be sure to communicate with victims of discrimination on what steps were taken to rectify the situation and prevent it from happening again. 
• Improve representation in healthcare. Support local tribes and educational opportunities for young Native Americans to enter the healthcare workforce. Diversity in healthcare matters. Every patient deserves to feel their needs are met, and often that comes from seeing themselves in their providers. 

Healthcare Equality for All

Supplemental Health Care is committed to improving the disparities in Native American healthcare. Through education, supporting Native American patients and healthcare workers, and exposing disparities in care, Supplemental Health Care is part of a larger movement to end discrimination in the United States healthcare system and provide equitable healthcare to all.

---

This blog references the Indigenous Peoples of the continental United States, Native Americans, American Indians, and Alaska Natives. While all of these groups have their preferred names, this blog will use the term “Native Americans” for consistency and concise wording.