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American Indians in Minnesota

 

Common health equity issues for American Indian populations

Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.

Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.

Life expectancy for American Indians in the U.S. is 73 years, as compared to 78.5 years for the country as a whole.

American Indians in Minnesota

60,916 Minnesotans are American Indians or Alaska Natives. Although they are the original people in Minnesota, today they only account for 1.1 percent of the population. The Phillips neighborhood of Minneapolis has the third largest urban American Indian population in the United States. The largest portion of the multiracial U.S. population list their race as mixed American Indian and White.

Language

Nearly all American Indians speak English as their primary language. The most common American Indian language spoken in Minnesota is Ojibwa. Fewer than 10 percent of American Indian Minnesotans say they speak Native North American languages at home and only a fraction of these speakers say they speak English “less than very well.”

Health Check:
How do American Indians compare to your overall patient population across process and health outcome measures?

Health disparities

American Indians in Minnesota experience the worst social and health outcomes of any population. Some health issues could be biologically tied to race; many are tied to social inequities, including poverty. Health conditions experienced by American Indians include high rates of heart disease, cancer, diabetes, alcohol-induced illnesses, chronic liver disease and cirrhosis, influenza and pneumonia, drug-induced illnesses, kidney disease, mental illness, and Alzheimer’s and other dementia.

  • The premature death rate for American Indians in Minnesota is more than three times higher than the rate for whites.
  • American Indian adults in Minnesota have the highest rate of diagnosed diabetes (17.7%) of all racial or ethnic groups, compared to 8.4 percent of adult Whites.
  • 24 percent of American Indians in Minnesota experience optimal diabetes care, compared with 47 percent of Whites.
  • Adult American Indians in Minnesota (36.6%) have the highest rate of obesity, compared to Hispanics (35%), Blacks (33.3%), or Whites (27.7%).
  • 55 percent of American Indians age 50+ in Minnesota are up-to-date with colon screening compared with 73 percent for Whites.
  • The rate of heart disease among American Indians has doubled in the last 50 years.
  • 38.1 percent of American Indian adults in Minnesotan smoke, compared to the statewide rate of 16.2 percent.
  • Cancer is the leading cause of death for American Indians in Minnesota, who are 33 percent more likely to develop cancer and 78 percent more likely to die from cancer than whites.
  • Minnesota Clinical Quality Measures 2017

     

    Optimal diabetes care

    Optional vascular care

    Adolescent mental health screening

    Pediatric oversight counseling

    Optional asthma control-A

    Optional asthma control-B

    Colorectal cancer screening

    American Indian

     

    White

    ↑ = Above average, ↓= Below average, Blank = Similar to average

  • 28 percent of Ojibwe in Minnesota ages 45-64 have one or more disabilities, compared to 12 percent for the overall population.
  • American Indian patients had poorer health care outcomes than Whites for six of the seven Minnesota quality measures: optimal diabetes care, optional vascular care, adolescent mental health screening optional asthma control-A, optional asthma control-C, and colorectal cancer screening.

More data on disparities in health and healthcare for American Indians:

Social determinant disparities

Social determinants of health are economic and social conditions that influence the health of people and communities. American Indians often experience race or ethnicity discrimination, which may impact housing, employment, legal status, and suffering from violence and bullying. Dealing with discrimination is associated with higher reported stress and poorer reported health.

  • 31.4 percent of American Indians in Minnesota are below the federal poverty level, compared to 8.2 percent of Whites. 34 percent of American Indian children live in poverty.
  • The median income for American Indian families (regardless of family size) in Minnesota is $36,900, compared to $67,000 for White families.
  • 22 percent of Dakota and 18 percent of Ojibwe did not have a high school diploma or GED, compared to 3 percent of Whites.
  • 10.6 percent of American Indians in Minnesota lacked health insurance in 2017, compared to 4.6 percent of non-Hispanic Whites. Lack of health insurance may result in less preventive care and health education.
  • The teen birth rate for American Indians in Minnesota is 61 per 1,000 births, compared to 11 for Whites. Teen birth rate is a key indicator for future poverty, low educational achievement, and poor health.
  • American Indians make up 8 percent of homeless adults in Minnesota, but only 1 percent of the population.
  • American Indian children in Minnesota are five times more likely to be reported as victims of abuse than White children, and 10 times more likely to end up in foster care.

Social structure

Minnesota has 11 federally recognized Indian tribes, each with reservation land: seven Anishinaabe (Chippewa, Ojibwe) reservations and four Dakota (Sioux) communities. Although requirements differ, enrolled membership is based on each tribe’s constitution. Many aspects of American Indian culture today reflect the culture of the general U.S. population. Generational differences impact social practices.

The American-Indian concept of family includes immediate and extended family members, as well as community and tribal members who may not be biologically related. American Indians have a tradition of respect for elders. Many tribal communities have a custom of showing respect for elders by allowing them to speak first, without interrupting, and giving time for opinions and thoughts to be expressed. It is disrespectful to openly argue or disagree with an elder.

Minnesota’s American Indians have tobacco traditions that were passed down for generations. Today, the cigarette smoking rate for American Indians is 59 percent—four times that of the general population. Many are working to restore traditional tobacco practices and reduce commercial tobacco abuse like cigarette smoking.

Repeated unfulfilled agreements in treaties with American Indians, such as the 1787 agreement with tribes to provide American Indians with free health care on reservations, has resulted in a lack of trust of the majority culture.

Diet

Financial constraints often mean that American Indians in Minnesota consume a diet based on inexpensive fast food restaurant offerings and processed foods that are high in carbohydrates, sweeteners, and salt. Often called the “American diet,” this way of eating contributes to obesity, heart disease, and other health conditions. In Minnesota, native advocates and health experts are promoting a return to ancestral diets, which are believed to have been centered on locally available and lightly processed food ingredients. Alcohol use among American Indians, also associated with poverty, is high, contributing to the heavy carbohydrate intake and resulting in adverse health conditions.

Medical care

American Indians often have a concept of life and health that includes the full spectrum of life, including the spiritual, emotional, mental, and physical dimensions. In this holistic view, life must be lived in balance to support individual and family health and wellness. Native elders may incorporate traditional healing practices into treatment or wellness practices.

Poverty, a major social determinant of health for American Indians, results in lack of access to healthy food and preventive health care. Inadequate education may contribute to poor health decisions. Lack of availability of culturally appropriate or culturally sensitive health care may result in American Indians not accessing health care. The federal government established the Indian Health Service (IHS) in 1955, but Congress has never allocated sufficient funding for it to meet American Indian needs. While 55 percent of American Indians access health care and services through IHS or tribal-operated hospitals and clinics, 45 percent of American Indians use health care outside of tribal systems.

Mental health

Clinical depression and other mental health conditions are common among American Indians, as are alcohol and drug abuse. American Indian/Alaska Natives have the highest rates of suicide of any racial/ethnic group in the U.S., with rates increasing since 2003.

Genocide, forced relocation, banned languages, loss of cultural practices, second-class legal status, limited mobility to choose where to live, substandard public education, racism, and other barriers have resulted in historical trauma for some American Indians, the effects of which continue today. Carried across generations, this trauma should be considered in mental health treatment.

End of life

Life expectancy for American Indians in the U.S. is 73 years, compared to 78.5 years for the country as a whole. American Indians in the U.S. die from heart disease, influenza and pneumonia, chronic liver disease, suicide, alcohol-related causes, and septicemia at higher rates than other Americans. Geography and low population density hinder tribal hospice programs from being successful and a lack of cultural sensitivity in non-tribal programs is reported to keep tribal members away. Only 0.4 percent of hospice patients are American Indian.