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

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.)

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.

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 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.)

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

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.)

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

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.)