November is Native American Heritage Month, a time to celebrate our nation’s many Native American traditions and cultures. This is also an important moment to raise awareness of the unique challenges American Indians and Alaska Natives have faced in our nation’s past as well as ones that persist today, including health equity.
A recent Princeton University study found that COVID-19 hit Native American communities harder than other racial and ethnic groups. As the study notes, Native Americans experience socioeconomic and health-related risk factors at higher levels. Since 80 percent of a person’s health is determined by the community in which they eat, live, work, play and pray, these factors have had dire consequences on overall tribal health. Today, the average Native American person is only expected to live as long as the average American did in 1944.
Education and visibility are key components in this equation—many healthcare providers are unaware of the challenges tribes face in receiving quality care. A tendency to view American Indians and Alaska Natives as a monolith instead of members and citizens of 574 federally recognized tribes contributes to this issue, making it difficult to accurately assess each nation’s needs.
Native American Heritage Month is a timely reminder that healthcare leaders must bring Native Americans to the table to learn from them and better understand how systemic barriers to health affect their lives. Here’s a closer look at some of the issues impacting American Indian and Alaska Native communities, as well as potential solutions and actions to address growing health disparities.
The Impact of Systemic Barriers on Quality Care
According to the Indian Health Service (IHS), the federal health program for American Indians and Alaska Natives, Native Americans have a life expectancy that is five and a half years lower than the average for all other racial and ethnic groups in the U.S. Native Americans also face much higher mortality rates from a host of causes, including heart disease, cancer, diabetes, and mental health issues.
Part of the issue stems from Native Americans experiencing the highest poverty level of any racial or ethnic group in the United States. High rates of housing and food insecurity, lack of running water on reservations, and chronic underfunding of IHS contribute to health disparities more broadly. Additionally, a lack of broadband access leaves communities unable to leverage telehealth and other online care resources.
This is compounded by a lack of statistically valid data that prevents American Indians and Alaska Natives from accessing the resources they need most. As Dr. Malia Villegas, Former Director of the National Congress of American Indians Policy Research Center (Native Village of Afognak in Alaska), put it, when it comes to data, Native Americans could be described as the “Asterisk Nation.” That’s because an asterisk is often used as a placeholder in the absence of statistically valid data, which is too often missing due to data collection and reporting issues.
Tribal affiliation data is critical to address barriers to care, but many data collection forms give users an “American Indian/Alaska Native” option to tick without collecting information on the specific tribal group. This leaves tribal leaders—who are invested in taking care of members—in the dark regarding overall needs and member location. A tribal affiliation option more fully captures the diversity of the Native American population, but it’s missing from most health intake forms.
How Healthcare Organizations Can Help Drive Better Outcomes
As the saying goes, the first step to addressing a problem is recognizing it exists. Healthcare organizations need to learn more about the tribes located in the areas they serve. They should reach out to leaders in the tribal community with respect for their sovereignty, ready to listen and learn so that they can take the proper steps in building trust. Representation is essential, so healthcare leaders should proactively seek input from tribal communities in the areas they serve.
Another way to foster relationships is to make healthcare services more accessible and available in tribal communities. By strengthening relationships with trusted organizations that already serve the community, providers can work together to streamline referrals and meet people where they are.
Better access to online care coordination resources and data collection methods are additional ways healthcare organizations can reduce health disparities. For example, adhering to ONC Health IT Standards [PDF], which includes tribal affiliation with other patient demographics, will help stakeholders better account for Native American populations outside reservations and allocate necessary resources and funding toward their needs.
We can acknowledge the past during Native American Heritage Month, but we must recognize how much work still needs to be done. It’s time we work together to dismantle systemic barriers and address the health disparities in Native American communities once and for all.