American Indians and Alaska N... Health Article

AMERICAN INDIANS AND ALASKA NATIVES

The term "American Indian and Alaska Native" (AI/AN) is used to refer to indigenous peoples of the United States. It is encompassed by the broader term "Native American," which also includes indigenous peoples of Canada (known as Aboriginal Canadians, Native Canadians, or First Nations), Mexico, and Central and South America. "Alaska Native" is used to refer jointly to Eskimos (Inuit), Indians, and Aleuts living in that state. (The Inuit are also native to Canada.) "Native American" is widely accepted as the "correct" term for the indigenous peoples that were residing in North America when Europeans first arrived on the continent, and for their descendants. Although the terms Native American and AI/AN imply a certain degree of cultural homogeneity, the indigenous peoples of North America do not form a monolithic ethnic or cultural group, despite their sharing broadly similar experiences. There are hundreds of Native American groups, each with distinctive traditions, customs, values, spiritual beliefs, lifestyles, and languages. In considering Native Americans generally, or AIs/ANs specifically, it is important to recognize their internal diversity.

DEMOGRAPHICS

Contemporary AI/AN populations live in urban areas and on reservations. In the United States an estimated 2.5 million persons were projected to identify themselves in the 2000 Census as American Indian or Alaska Native, nearly 0.9 percent of the total United States population. These persons, most of whom will indicate an affiliation with one of the more than five hundred federally designated tribal organizations, are predominantly located in the western United States (48%), the South (29%), and the Midwest (17%), with just 6 percent in the Northeast. This distribution of the AI/AN population reflects the consequences of the historical pattern of settlement of the United States and the displacement of American Indians to primarily western and southern parts of the country. Alaska Natives numbered some 106,000 persons in 1999, approximately 4.3 percent of the total AI/AN population. Of persons who identified themselves as AI/AN in the 1990 Census, 1.2 million (57%) resided in the 33 reservation states served by the Indian Health Service (IHS), an agency of the U.S. Department of Health and Human Services. The AI/AN population, however, has become increasingly urbanized; in 1990, close to 66 percent of AIs/ANs resided in urban areas, while just 20 percent lived on reservations. This was a marked increase from 1980, when 54 percent of AIs/ANs lived in urban areas, and from 1970, when 45 percent did so.

According to 1990 Census projections to November 1, 2000, the estimated median age for AIs/ANs was twenty-eight—a full eight years below that of the national population. The distribution of sex for AIs/ANs (51% female and 49% male) did not differ from that of the national population. The AI/AN population did have a greater prevalence of poverty (32% versus 13% nationally) and unemployment (16% versus 6% nationally), and a lower prevalence of high school graduates (65% versus 75% nationally) and college graduates (9% versus 20% nationally).

HISTORICAL, SOCIAL, AND POLITICAL CONTEXTS OF NATIVE-AMERICAN HEALTH

Since their initial contact with Europeans in the late fifteenth century, AI/AN populations have experienced catastrophic losses of life, land, political autonomy, and social cohesion. Illness was often the first, and most ravaging, effect of colonization felt by indigenous peoples. Infectious diseases such as smallpox, measles, and influenza were introduced by Europeans and reached epidemic proportions among Native Americans, who had never been exposed to these diseases and had no immunity to them. As colonization and westward expansion continued, Native Americans were subject to war, genocide, removal from tribal lands, relocation, and forced labor. These factors all contributed to the decimation of 50 to 90 percent of the indigenous populations by the end of the nineteenth century.

The experience of forcible relocation onto reservations under the Bureau of Indian Affairs' assimilation program, and similar programs of Canadian churches and other institutions, designed to "civilize" AIs/ANs in the late nineteenth century, brought drastic changes to the social organization and living conditions of Native Americans. These changes led to an increase in health problems, including diseases such as tuberculosis, venereal disease, and alcoholism. The transfer in 1954 of responsibility for Indian health from the Bureau of Indian Affairs to the IHS heralded not only an administrative change but also the emergence of a new medical ideology by which the poor health status of Native Americans was no longer attributed to "savage ignorance," but to a lack of sufficient medical knowledge. The IHS did in fact bring many infectious diseases under control; however, chronic diseases emerged to take their place. Further, social pathologies began to have an increasing impact on the AI/AN population in the latter half of the twentieth century.

In the 1950s and 1960s, the federal government again pursued a policy of "assimilation," by which AIs/ANs were encouraged to relocate from reservations to urban areas. At the same time, though, the IHS was establishing itself as a highly centralized, largely reservation-based (and thus rural), health care service. In the 1970s the IHS reversed this trend with an increasingly decentralized service—concomitant with encouragement of tribes to directly operate or contract their own health services. Today there are problems not only with the ongoing provision of adequate health services in rural areas, but the AIs/ANs living in urban areas also have difficulty gaining care from the IHS, which devotes just 2 percent of its budget to urban programs.