Library Index :: Family and Social Issues of the United States :: Health - Social Characteristics Of Minority Populations That Affect Health, Self-assessment Of Health, Pregnancy And Birth

Health - Health Care For Native Americans

Native American diets have been negatively affected by the introduction of nonnative foods. Although there are considerable tribal variations in diet, studies show that the less Native Americans eat of their traditional foods, the greater their levels of obesity and adult-onset diabetes. High-carbohydrate, high-sodium, and high-saturated-fat contents can characterize most current Native American diets. Also, Native American diets are relatively low in meat and dairy products. Factors contributing to these eating habits include food availability, preference for non-native food, and place of residence.

TABLE 6.12
Estimated numbers of persons living with HIV/AIDS by year and selected characteristics, 1999–2002

1999 2000 2001 2002
Age as of end of year (yrs)
<13 2,517 2,488 2,451 2,363
13—14 242 291 394 467
15—24 8,984 9,440 9,901 10,295
25—34 59,153 57,347 56,314 55,789
35—44 98,193 106,376 112,845 118,714
45—54 45,171 53,002 61,547 70,472
55—64 10,732 12,830 15,240 18,591
≥65 2,985 3,635 4,407 5,241
Race/ethnicity
White, not Hispanic 91,038 96,424 101,943 107,992
Black, not Hispanic 112,483 121,903 131,360 141,184
Hispanic 21,256 23,449 25,732 28,364
Asian/Pacific Islander 791 923 1,045 1,181
American Indian/Alaska Native 1,224 1,339 1,431 1,565
226,792 244,037 261,511 280,286
Exposure category
Male adult or adolescent
Male-to-male sexual contact 100,582 108,174 116,250 125,268
Injection drug use 31,554 32,880 34,093 35,380
Male-to-male sexual contact and injection drug use 14,900 15,290 15,696 16,1
Heterosexual contact 19,594 22,021 24,387 26,843
Other1 2,673 2,735 2,819 2,922
Subtotal 169,304 181,099 193,244 206,557
Female adult or adolescent
Injection drug use 16,666 17,504 18,209 18,831
Heterosexual contact 37,657 42,239 46,841 51,538
Other1 1,306 1,414 1,513 1,627
Subtotal 55,629 61,158 66,563 71,996
Child (<13 yrs)
Perinatal 2,741 2,855 3,006 3,114
Other2 297 291 279 260
Subtotal 3,038 3,146 3,285 3,374
Total3 227,976 245,409 263,098 281,931
Note: These numbers do not represent actual cases in persons living with HIV/AIDS. Rather, these numbers are point estimates of persons living with HIV/AIDS that have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk. The estimates have not been adjusted for incomplete reporting.
Data include persons with a diagnosis of HIV infection. This includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV infection and AIDS.
Since 1998, the following 30 areas have had laws or regulations requiring confidential name-based HIV infection reporting: Alabama, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, Wyoming, and the U.S. Virgin Islands. Since July 1997, Florida has had confidential name-based HIV infection reporting only for new diagnoses.
1Includes hemophilia, blood transfusion, perinatal, and risk not reported or not identified.
2Includes hemophilia, blood transfusion, and risk not reported or not identified.
3Includes persons of unknown or multiple race and of unknown sex. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
SOURCE: "Table 8. Estimated Numbers of Persons Living with HIV/AIDS by Year and Selected Characteristics, 1999–2002—30 Areas with Confidential Name-Based HIV Infection Reporting," in HIV/AIDS Surveillance Report, vol. 14, Centers for Disease Control and Prevention, Atlanta, GA, 2001 [Online] http://www.cdc.gov/hiv/stats/hasr1402/table8.htm [accessed March 11, 2004]

The customs and patterns of white culture imposed on Native Americans have disrupted their traditional way of life. As a result, the Native American population has been plagued by a sense of powerlessness and hopelessness. According to social researchers, the high incidence of alcohol abuse, suicide, and depression among Native Americans is likely to be related to this condition. In 2001 Native Americans/Alaska Natives had the second highest incidence of suicide, with a rate of 10.5 per 100,000 population, compared with 12.5 among non-Hispanic whites, 5.7 among Hispanics, 5.5 for African-Americans, and 5.4 among APIs. (See Table 6.16.)

Indian Health Service

Federal funding for Native American health care is provided through the Indian Health Service (IHS), which is "charged with raising Indians' health status to the highest possible level." Delivery of health care to Native Americans is complicated by the lack of services and the long distances that sometimes must be traveled to receive care. Alaska Natives are often able to get preventive medical care only by flying to a medical facility, and, while transportation costs are covered for emergency care, transportation costs are not provided for routine care.

Using Gambling Profits to Improve Health Services

Many Native American tribes have invested some of the money earned from their casinos to improve health services. The Sandia Pueblo in New Mexico, for example, now has a multimillion-dollar medical complex. This saves the residents the long drives to distant clinics that provide medical and dental care through the IHS. The center includes exam rooms, dental rooms, and state-ofthe-art equipment. There is an adjacent wellness and education center that houses a gymnasium, weight room, and aquatic therapy facilities.

Diabetes

Diabetes is a significant problem in the Native American community. According to the American Diabetes Association, nearly 108,000 Native Americans and Alaska Natives had diabetes in 2004. That represents about 14.5 percent of those who receive health care through the IHS. The Diabetes Association also reports that Native Americans in the Southeast are more likely to have diabetes, with a prevalence rate of 27 percent, compared with 6.8 percent of Alaska Natives. In 2001 there were 40.4 Native American/Alaska Native deaths per 100,000 people due to diabetes, compared to 49.2 among African-American deaths, 36.7 Hispanic deaths, 22.1 non-Hispanic white deaths, and 16.9 API deaths due to the disease. (See Table 6.16.)

Infant Mortality

The infant mortality rate for Native Americans and Alaska Natives fell from 15.2 deaths per 1,000 live births in 1983 to 8.3 per 1,000 live births in 2000, but 2001 saw an increase to 9.7 per 1,000 live births. The infant mortality rate for Native Americans and Alaska Natives was higher in 2001 than the rate for any other

TABLE 6.13
Pediatric AIDS cases by exposure category and race/ethnicity reported through December 2001

White, not Hispanic Black, not Hispanic Hispanic
2001 Cumulative total 2001 Cumulative total 2001 Cumulative total
Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Hemophilia/coagulation disorder 0 (0) 159 (10) 0 (0) 34 (1) 0 (0) 37 (2)
Mother with/at risk for HIV infection: 25 (76) 1,197 (76) 100 (88) 5,110 (96) 22 (85) 1,900 (92)
Injecting drug use 5 493 24 1,966 4 755
Sex with injecting drug user 9 242 4 741 2 495
Sex with bisexual male 1 67 4 75 0 41
Sex with person with hemophilia 1 19 0 6 0 8
Sex with transfusion recipient with HIV infection 0 8 0 8 0 9
Sex with HIV-infected person, risk not specified 4 155 27 895 7 274
Receipt of blood transfusion, blood components, or tissue 0 43 2 75 0 34
Has HIV infection, risk not specified 5 170 39 1,344 9 284
Receipt of blood transfusion, blood components, or tissue 2 (6) 191 (12) 0 (0) 86 (2) 0 (0) 93 (5)
Risk not reported or identified 6 (18) 32 (2) 13 (12) 107 (2) 4 (15) 30 (1)
Total 33 (100) 1,579 (100) 113 (100) 5,337 (100) 26 (100) 2,060 (100)
Asian/Pacific Islander American Indian/Alaska Native Cumulative totals*
2001 Cumulative total 2001 Cumulative total 2001 Cumulative total
Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Hemophilia/coagulation disorder 0 (0) 3 (6) 0 (0) 2 (6) 0 (0) 236 (3)
Mother with/at risk for HIV infection: 3 (100) 36 (67) 0 (0) 29 (94) 150 (86) 8,284 (91)
Injecting drug use 0 6 0 14 33 3,238
Sex with injecting drug user 0 6 0 6 15 1,491
Sex with bisexual male 0 2 0 0 5 186
Sex with person with hemophilia 0 0 0 0 1 33
Sex with transfusion recipient with HIV infection 0 0 0 0 0 25
Sex with HIV-infected person, risk not specified 0 9 0 4 38 1,339
Receipt of blood transfusion, blood components, or tissue 0 1 0 1 2 154
Has HIV infection, risk not specified 3 12 0 4 56 1,818
Receipt of blood transfusion, blood components, or tissue 0 (0) 11 (20) 0 (0) 0 (0) 2 (1) 381 (4)
Risk not reported or identified 0 (0) 4 (7) 0 (0) 0 (0) 23 (13) 173 (2)
Total 3 (100) 54 (100) 0 (0) 31 (100) 175 (100) 9,074 (100)
*Includes 13 children whose race/ethnicity is unknown.
SOURCE: "Table 15. Pediatric AIDS Cases by Exposure Category and Race/Ethnicity Reported through December 2001, United States," in HIV/AIDS Surveillance Report, vol. 13, no. 2, Centers for Disease Control and Prevention, Atlanta, GA, 2001

racial or ethnic group except for African-Americans. (See Table 6.4.) While the infant mortality rate among Native Americans/Alaska Natives was higher than that of most other groups, the percentage of babies born with a low birth weight was not significantly higher than that of other groups. Approximately 7.3 percent of Native American and Alaska Native babies were born with a low birth weight in 2001, compared to 6.8 percent of non-Hispanic whites and 6.5 percent of Hispanics. Native Americans and Alaska Natives had a lower percentage of low-birth-weight babies than non-Hispanic African-Americans (13.1 percent) and APIs (7.5 percent). (See Table 6.3.)

Causes of Death

Heart disease, the number one cause of death in America, also claims the highest number of Native American/Alaska Native lives. However, in 2001, only APIs, at 137.6 per 100,000, had a lower mortality rate for heart disease than Native Americans/Alaska Natives, at 159.6 deaths per 100,000 population. (See Table 6.16.)

Compared to the national average, Native Americans/Alaska Natives have lower rates of deaths due to lung cancer and breast cancer. In 2001 the Native American and Alaska Native lung cancer mortality rate was 34.2 per 100,000 people versus the national average of 55.3;

TABLE 6.14
Male adult/adolescent AIDS cases by exposure category and race/ethnicity, reported through December 2001

White, not Hispanic Black, not Hispanic Hispanic
2001 Cumulative total 2001 Cumulative total 2001 Cumulative total
Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Men who have sex with men 6,745 (60) 230,202 (74) 4,057 (29) 82,939 (37) 2,202 (35) 50,660 (42)
Injecting drug use 1,156 (10) 29,174 (9) 2,729 (20) 74,544 (33) 1,332 (21) 41,351 (34)
Men who have sex with men and inject drugs 682 (6) 25,960 (8) 548 (4) 16,718 (7) 231 (4) 8,050 (7)
Hemophilia/coagulation disorder 80 (1) 3,875 (1) 13 (0) 579 (0) 3 (0) 440 (0)
Heterosexual contact: 403 (4) 6,045 (2) 1,705 (12) 19,109 (8) 613 (10) 7,266 (6)
Sex with injecting drug user 94 2,060 330 5,752 117 1,929
Sex with person with hemophilia 1 32 4 25 0 11
Sex with transfusion recipient with HIV infection 7 168 8 176 2 90
Sex with HIV-infected person, risk not specified 301 3,785 1,363 13,156 494 5,236
Receipt of blood transfusion, blood components, or tissue 47 (0) 3,200 (1) 40 (0) 1,118 (0) 12 (0) 606 (1)
Risk not reported or identified 2,051 (18) 13,697 (4) 4,803 (35) 30,829 (14) 1,896 (30) 11,758 (10)
Total 11,164 (100) 312,153 (100) 13,895 (100) 225,836 (100) 6,289 (100) 120,131 (100)
Asian/Pacific Islander American Indian/Alaska Native Cumulative totals*
2001 Cumulative total 2001 Cumulative total 2001 Cumulative total
Exposure category No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Men who have sex with men 188 (53) 3,757 (71) 55 (36) 1,122 (55) 13,265 (42) 368,971 (55)
Injecting drug use 12 (3) 267 (5) 29 (19) 326 (16) 5,261 (16) 145,750 (22)
Men who have sex with men and inject drugs 7 (2) 200 (4) 33 (22) 351 (17) 1,502 (5) 51,293 (8)
Hemophilia/coagulation disorder 1 (0) 71 (1) 0 (0) 30 (1) 97 (0) 5,000 (1)
Heterosexual contact: 30 (8) 233 (4) 9 (6) 65 (3) 2,762 (9) 32,735 (5)
Sex with injecting drug user 3 55 4 19 549 9,821
Sex with person with hemophilia 0 1 0 0 5 69
Sex with transfusion recipient with HIV infection 2 9 0 2 19 446
Sex with HIV-infected person, risk not specified 25 168 5 44 2,189 22,399
Receipt of blood transfusion, blood components, or tissue 6 (2) 116 (2) 0 (0) 9 (0) 105 (0) 5,057 (1)
Risk not reported or identified 114 (32) 683 (13) 26 (17) 136 (7) 8,909 (28) 57,220 (9)
Total 358 (100) 5,327 (100) 152 (100) 2,039 (100) 31,901 (100) 666,026 (100)
*Includes 540 men whose race/ethnicity is unknown.
SOURCE: "Table 9. Male Adult/Adolescent AIDS Cases by Exposure Category and Race/Ethnicity, Reported through December 2001, United States," in HIV/AIDS Surveillance Report, vol. 13, no. 2, Centers for Disease Control and Prevention, Atlanta, GA, 2001 [Online] http://www.cdc.gov/hiv/stats/hasr1302.pdf [accessed March 11, 2004]

their female breast cancer mortality rate was 11.8 per 100,000 people versus the nationwide average of 26.0. The Native American and Alaska Native homicide rate of 6.8 per 100,000 population in 2001 compares with a nationwide average of 7.1 per 100,000, though the national average saw an unprecedented jump that year due to the homicides associated with the terrorist events of September 11, 2001. (See Table 6.16.)

In 2001 Native Americans and Alaska Natives were considerably more likely to die from injuries related to a motor vehicle accident than any other racial or ethnic group. The rate of Native American/Alaska Native deaths per 100,000 population was 25.9, compared to 15.5 among non-Hispanic whites, 15.4 among African-Americans, 15.0 for Hispanics, and 8.1 for APIs. (See Table 6.16.)

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