American Indian and Alaska Native elders have long experienced disparities in health and healthcare. A health disparity is a difference in health outcomes for different groups within the population.
Historically, American Indian and Alaska Native communities have had limited access to quality healthcare. One outcome of treaties between American Indian and Alaska Native communities and the federal government is that all federally recognized tribes have a right to healthcare services. The Indian Health Service (IHS) was created to meet this federal commitment.
Although there are 574 federally recognized tribes to date, there are many more tribes still seeking federal recognition. Therefore, some American Indians and Alaska Natives are not eligible for IHS services. To further compound challenges, IHS services are primarily focused in rural areas in spite of the fact that 78 percent of American Indians and Alaska Natives now live in cities and urban areas. Disparities in health are a major issue in American Indian and Alaska Native communities and stronger advocacy is still required to address these pressing needs.
Health disparities for American Indians and Alaska Natives are clear. As of 2014, cancer is the leading cause of death for American Indians and Alaska Natives, followed by heart disease. The opposite is true for people of other races. American Indians and Alaska Natives experience certain cancers such as kidney, liver and stomach cancer, at higher rates than non-Hispanic white individuals. American Indians and Alaska Natives also face higher rates of obesity and diabetes than the general population, among other health disparities.
Social Determinants of Health
While it’s easy to focus on the numbers, these statistics represent the symptoms of the problem rather than the cause. The specific reasons for health disparities are complex and represent much more than who American Indians and Alaska Natives are.
They also represent where people live and the services available and accessible to them. Factors such as having a regular source of care, language and communication barriers, lack of diversity in the healthcare workforce, high rates of poverty, lack of insurance coverage, discrimination against American Indians and Alaska Natives, and large distances from healthcare services have all added to the disparities that effect American Indian and Alaska Native communities.
These factors are what the U.S. Department of Health and Human Services has defined as the “Social Determinants of Health.” Broadly, the factors fall into five categories: economic stability, education, social/community setting, health and healthcare, and the neighborhood/environment. Disparities in AI/AN health will not improve just by focusing on the numbers. Instead, improvement can be made through community health education, and economic standing, and by creating healthier and engaged communities.
The National Indian Council on Aging (NICOA) strives to inform American Indian and Alaska Native elders and others about healthcare disparities so that there is greater understanding about the many factors that influence health statistics — especially those that impact American Indian and Alaska Native communities. NICOA’s mission is to advocate for improved comprehensive health, social services and economic well-being for American Indian and Alaska Native elders.
To help improve health equity among American Indian and Alaska Native elders, NICOA supports policies that establish health education, awareness and prevention programs for American Indian and Alaska Native elders; fund on-going research of health disparities in aging; improve health care access and quality for elders; and promote inclusion of American Indians and Alaska Natives in gerontology and geriatric research.