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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.
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.”
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.
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.
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.
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.
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.
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.
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