Health and Health Care for Indigenous People

November marks National Native American Heritage Month, in which the United States recognizes the culture, heritage, and contributions of Indigenous people, including those from Native American, Alaska Native, Native Hawaiian, and Pacific Island communities. While the country celebrates Indigenous knowledge and cultures, it is crucial to recognize that Indigenous people face many socioeconomic and health inequalities that limit their overall health and well-being.

In the United States, more than 8.6 million people who identify themselves as Native American Indian and Alaska Native (AIAN), alone or with another racial/ethnic origin, and who, alone or with another racial/ethnic origin, identify as Native Hawaiian and other Pacific Islander (NHOPI) There are close to 700,000 people who identify as combination with another group. Within these groups, 1.7 million people identify as AIAN only and 550,000 people identify as NHOPI only. The combined population of the AIAN and NHOPI people has grown by 45% over the past decade, from 6.4 million in 2010 to almost 9.3 million in 2021.

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The United States has a responsibility to provide certain rights, protections and services to the people of AIAN, including healthcare. However, the Health Service of India has historically been underfunded to meet the healthcare needs of the AIAN people and faces other social and economic challenges that contribute to their health problems. NHOPI people also face systemic challenges to health. Non-elderly AIAN and NHOPI persons are more likely to be uninsured than their White counterparts, and non-elderly AIAN and NHOPI adults are also more likely than their White counterparts to delay or abandon seeking health care because cost is a barrier. Also, AIAN and NHOPI households are less likely to have full-time workers and more likely to be poor than White households.

Reflecting these and other challenges, AIAN people are more likely than their White counterparts in a range of health measures, including being more likely to report fair or poor health (12% Whites versus 24% AIAN vs 12% NHOPI) and having chronic conditions. they are in bad shape. such as asthma and diabetes. NHOPI staff are no worse off than their White colleagues in some of these measures, but this may mask differences among this diverse community and/or more limited access to providers to diagnose chronic conditions. It may also reflect limitations in the ability to reliably capture their experience in survey data due to their small population size. AIAN people are also facing mental health challenges, including high death rates due to suicide and drug overdose deaths, which have increased over the past few years amid the pandemic. Separate data for NHOPI persons were not available for these measures. Moreover, COVID-19 took a different toll on AIAN and NHOPI people, with higher age-adjusted case and death rates than White people.

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Addressing the health and social challenges faced by indigenous people will be important to fulfilling the nation’s duties and responsibilities, improving the health and well-being of this diverse and growing population, and promoting generally improved health and well-being in the United States. As part of these efforts, it will be important to resolve the persistent gaps and limitations present in the data to understand health and healthcare experiences. The Biden Administration has recently invested heavily in addressing the COVID-19 pandemic and improving infrastructure in Indigenous communities. Continued focus on addressing health and health care needs will be important going forward.

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KFF analysis of the 2021 American Society Survey, 1-year Forecasts; 2021 Behavioral Risk Factors Surveillance System Data; Centers for Disease Control and Prevention, COVID-19 Response, COVID-19 Case Surveillance Public Use Data published Oct. 6, 2022; and the National Center for Health Statistics, Temporary COVID-19 Deaths by HHS Region, Race, and Age as of October 26, 2022.


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