It is no secret Native American communities face health disparities, high rates of alcoholism and suicide, struggles to protect their land and natural resources from industrial developments, and continual fights to gain social justice. Now, Indigenous communities are calling upon their culture and strengths to take the lead in overcoming what seem like insurmountable challenges. - BY Sharon Ross

Native American communities face a range of challenges that impact their well-being and quality of life, ranging from significant physical and mental health disparities to the constant battle to regain lost land and culture. The statistics show that the challenges and barriers result from an accumulation of over 200 years of injustice. Everything is connected. Today, there are Native American communities, many partnering with advocacy organizations, who are taking the lead in changing the downward spiral, directly confronting the challenges and issues with culturally appropriate programs and initiatives. Understanding the depth of the challenges is critical to bringing change. It will take a concerted effort to change the consequences of historical injustices that have dragged proud people deep into despair.

Healthcare Inequities and Historical Traumas

The healthcare statistics are grim for American Indians and Alaska’s Indigenous. They have a life expectancy 5.5 years lower than the rest of the U.S. population, though some statistics say the difference is nearly 10 years. They experience higher rates of death due to heart disease, cancer, diabetes, stroke, influenza, kidney disease, septicemia, and injuries due to accidents. More Native Americans and Indigenous die from alcohol-induced health issues, chronic liver disease and cirrhosis, and drug abuse. They also have a high prevalence and high-risk for suicide, mental health issues, sudden infant death syndrome, hepatitis, and teenage pregnancy. In 2019, the tuberculosis rate was seven times higher for Native Americans and Indigenous compared to non-natives. Another issue is poor health and social support access for tribal elders, of which there are almost one million who belong to a federally recognized tribe.

Approximately 87% of American Indians and Alaska Natives live outside tribal areas, and 60% live in metropolitan areas. The Indian Health Service (IHS) of the Department of Health and Human Services is responsible for providing health services to 2.8 million American Indians and Alaska Natives, and maintains more than 600 federal tribal health facilities and 41 Urban Indian Organizations in 37 states. Despite the facilities and desire to help, like most government agencies, IHS is underfunded and has difficulty delivering the services needed.

The American Bar Association says “…tribal members have a different health care reality than many other U.S. citizens. For example, to match the level of care provided to federal prisoners, funding would have to nearly double, according to an analysis by the National Congress of American Indians. Funding would need to be even higher to match the benefits guaranteed by programs such as Medicaid.”

The Centers for Disease Control statistics show that suicide disproportionately affects American Indians and Alaska Natives (AI/AN). Over half of the suicides were due to relationship problems with intimate partners, family, and interpersonal violence victimization. Other reasons include recent suicides of friends or family, alcohol or substance abuse, and mental health issues. One of the most important things the CDC says about suicide prevention, which can be applied to other health challenges, is this: “Suicide prevention efforts among AI/AN populations must consider the context and consequences of current inequities as well as historical trauma, including intergenerational transmission, that continue to affect AI/AN persons, families, and communities today.” This goes right to the heart of the challenge and why it is difficult to reverse the tragic trends. Many physical and mental health issues are founded on decades of inequities and historical tragedies.

It is Our Land

A book could be written about health inequities among Native Americans and the Indigenous, but it is not the only challenge the communities face. They have been legally fighting to return some culturally significant land. They want it returned because it was taken from their communities, but they also want it returned so they can restore and revitalize it. There have been over 100 tribal land recoveries among 73 state or federal tribes and six Indigenous-owned land trusts which are legal stewards of ancestral lands.

It is estimated that 80 percent of the earth’s biodiversity is in global Indigenous territories. In the U.S., as droughts, wildfires, and corporate activities like mining destroy natural habitats, Native Americans have become frontline leaders in finding ways to conserve and restore natural habitats. Climate change is impacting Native Americans even more than non-natives because they depend on their connection with the natural environment for livelihoods, health, and culture. In many cases, the Tribes experience more severe consequences due to climate change because of the location of reservations coupled with government projects interrupting the natural environment, like dams.

A Washington state report on how climate change is hurting Tribal treaty rights and natural resources was prepared by 20 member tribes of the Northwest Indian Fisheries Commission. The waterways impacted include the Pacific Ocean Coast, Hood Canal, the Strait of Juan de Fuca, and Puget Sound. There are declining runs of salmon and steelhead, declining shellfish harvests, loss of fish spawning grounds, declining population of wildlife and birds and their migration out of traditional hunting grounds, decreased plant productivity, loss of access routes to cultural sites, loss of water supplies, and loss of opportunities to conduct cultural activities.

The Challenge of Achieving Social Justice

Social justice is a complex topic because of the historical destruction of Native American cultures. It refers to Native Americans and Alaska Natives having equal economic, political, and social rights. It also refers to the distribution of wealth, privilege, and opportunities in society.

Achieving social justice requires addressing the health and environmental challenges because they are human rights issues. For Native Americans, it includes having the right to exercise sovereignty over themselves and their land and to not be discriminated against, especially through structural racism. Currently, Native Americans experience discrimination in employment and wage rates, which contributes to high poverty rates, experience higher incarceration rates, and struggle for acceptance, especially off-reservation. The stereotyping in society hurts everyone because it interferes with human rights and prevents Native Americans from contributing their innovative, culturally-based ideas to problem-solving.

Calling Upon Strengths to Prevail

When speaking to Native Americans, a common theme is that Native Americans have survived despite the extensive and ongoing challenges and issues. It reflects internal strength that enables them to prevail no matter what life sends their way. Today, the growing awareness that historical traumas live on through the generations is leading to Native Americans gaining a stronger public voice and working with advocacy groups that can assist with overcoming the challenges and recovering cultural practices, land, and respect while pursuing social justice. There is a long way to go, but like any journey, it must start somewhere.