Health and Health Care for Indigenous Peoples

Health and Health Care for Indigenous Peoples

November marks National Native American Heritage Month, during which the United States recognizes the culture, heritage, and contributions of Indigenous peoples, including those of Native American, Alaska Native, Hawaiian, and Pacific Islander communities. As the country celebrates Indigenous knowledge and cultures, it is essential to recognize that Indigenous peoples face many socioeconomic and health disparities that limit their overall health and well-being.

In the United States, there are more than 8.6 million people who identify as American Indian and Alaska Natives (AIAN) alone or in combination with another race/ethnicity and nearly 700,000 people who identify as Native Hawaiians and Other Pacific Islanders (NHOPI) alone or in combination with another group. Within these groups, 1.7 million people identify only as AIAN and 550,000 people identify only as NHOPI. The combined population of AIAN and NHOPI people has increased by 45% over the past decade, from 6.4 million in 2010 to nearly 9.3 million in 2021.

The United States has a responsibility to provide certain rights, protections, and services to AIAN people, including health care. However, India’s health service has historically been underfunded to meet the health care needs of AIAN people and they face other social and economic challenges that contribute to poor health outcomes. The people of NHOPI also face systemic health challenges. Non-elderly AIAN and NHOPI are more likely to be uninsured than their white counterparts, and non-elderly AIAN and NHOPI adults are also more likely than their white counterparts to postpone or forgo seeking health care due to cost. which constitutes an obstacle. Additionally, AIAN and NHOPI households are less likely to have a full-time worker and more likely to be poor than white households.

Reflecting these and other challenges, AIAN people fare worse than their white counterparts on a range of health measures, including being more likely to report fair or poor health (24% AIAN vs. 12% NHOPI vs. 12% White) and have chronic conditions like asthma and diabetes. NHOPI people do not fare worse than their white counterparts on some of these measures, but this may mask differences within this diverse community and/or more limited access to providers to diagnose chronic conditions. It may also reflect limitations in the ability to reliably capture their experiences in survey data due to their small population sizes. AIAN people also face mental health issues, including high rates of suicide deaths and drug overdose deaths, which have increased in recent years amid the pandemic. Separate data for NHOPI people were not available for these measures. Additionally, COVID-19 has wreaked disparate havoc on AIAN and NHOPI people, with these experiencing higher age-adjusted case and death rates than white people.

Addressing the health and social challenges faced by Indigenous peoples will be important to fulfilling the duties and responsibilities of the nation, improving the health and well-being of this diverse and growing population, and supporting the overall improvement in the health and prosperity in the United States. As part of these efforts, it will be important to address persistent gaps and available limitations in the data to understand their health and healthcare experiences. The Biden administration has recently made significant investments to combat the COVID-19 pandemic and improve infrastructure in Indigenous communities. It will be important going forward to continue to focus on meeting their health and healthcare needs.


KFF analysis of the 2021 American Community Survey, 1-year estimates; Data from the Behavioral Risk Factor Surveillance System 2021; Centers for Disease Control and Prevention, COVID-19 Response, COVID-19 Case Surveillance Public Use Data, published October 6, 2022; and National Center for Health Statistics, Provisional COVID-19 Deaths by HHS Region, Race, and Age, as of October 26, 2022.

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