Updated May 29, 2014
For decades, if you lived on South Dakota’s Pine Ridge Indian Reservation and wanted a drink, you'd have to stroll a few feet south of its border. But earlier last August, after furious debate, the tribe members voted to end its century-old prohibition of alcohol.
Supporters hoped to channel the money spent at outside liquor stores back into the community, and its underfunded alcohol treatment programs. But critics believe the new policy will only drive up the rate of alcohol abuse, a notorious scourge in Indian country.
Alcoholism is the most well-known health problem in the Native community, and a source of ample stereotyping. But there are many other reasons why Native Americans and Alaska Natives die younger, on average, than other Americans.
“We are the sickest racial, ethnic population in the United States,” said Irene Vernon, a professor at Colorado State University who specializes in Native American health.
Native communities suffer more of the usual predictors of poor health, such as poverty, unemployment and a steep high school dropout rate. There’s also a heavy history: the removal of Native Americans from their lands, and the boarding school movement, when many Native children were separated from their families, renamed, stripped of their language and often abused.
“These traumatic impacts -- loss of land, loss of community, loss of family, warfare -- have been passed on from generation to generation,” Vernon said.
Then there’s the issue of care. A large minority of Native Americans and Alaska Natives live on reservations in rural areas, mostly serviced by clinics, often a lengthy drive to a hospital, and usually strapped for funds. “The money we get for health is less than the money given to prisoners,” Vernon said. “It’s shamefully small, per person.”
For Native people, these are five of the biggest public health problems they face today:
American Indians and Alaska Natives have the highest rate of diabetes of any group, according to the American Diabetes Association (age-adjusted, as the Native population leans young). Rates vary wildly though; prevalence among Alaska Natives is lower than the national average. The Pima Indians in Arizona have the highest rate in the entire world.
Partly, this is an issue of poverty, and limited access to healthy food. But Native American food culture was also decimated when the community lost most of their lands, and ended up dependent on cheap and fatty federal rations. “We were a healthy people, generally, pre-contact. We had to hunt for our food, fish for our food, plant our own garden ” Vernon said. “Once we were placed on reservations, and given rations -- what were those rations? The same things you give anybody you give subsidized food. Yellow cheese, if you can call it cheese.”
Since 1998, the federally-funded Special Diabetes Program for Indians has made significant gains in improving the health of the diabetic. There is a mounting sovereign food movement to recover old agricultural practices and Native American cuisine. But incidence of diabetes --particularly among children -- continues to climb.
More Native Americans die by injury by the age of 44 than any other cause, according to the Center for Disease Control and Prevention. Compared to white Americans, Native people are twice as likely to die in a car crash, three and a half times more likely to die as a pedestrian, twice as likely to die by fire and three times more likely to drown, according to the Indian Health Service. According to Vernon, alcohol likely plays a role, as does pure distance from emergency care. But scattered reports suggest a downward slide in the numbers, except for suicide and deadly assaults.
Violent crime on many reserversations has skyrocketed in the last decade, even as its dropped across the country. too few tribal officers and federal police, and deeply underfunded tribal courts, have created a pervasive sense of lawlessness. For some tribal nations, brutal murders have become a normal part of life. Last year, the Department of Justice completed a two-year crime-fighting initiative on a handful of reservations modeled after the Iraq War surge.
One in three American Indian women is raped in her lifetime, according to the Justice Department, more than twice the national average. A survey by the Alaska Federation of Natives found that the rate of sexual violence within rural villages -- where everyone knows each other and a culture of silence is more oppressive -- is about 12 times higher, The New York Times reports. Because of a lack of resources, an unresponsive tribal police system, and high rates of alcohol abuse, a 2007 Amnesty International report determined that “sexual violence against women from Indian nations is at epidemic proportions and that survivors are frequently denied justice.”
One failure of the system is that it's impossible for tribal courts to prosecute non-Native men who rape Native women on tribal lands. On paper, President Obama closed that loophole when he signed the Violence Against Women Act in March. But not one tribe is currently capable of enforcing the new law, reports Frontline.
For centuries, tuberculosis ravaged the Native American population. A debate still rages over whether Europeans introduced the disease or not. Rates of TB have plummeted in the last half century, but disparities are stark. In 2008, its incidence was still five times higher for Native Americans and Alaska Natives than for non-Hispanic whites.
Many of the risk factors for tuberculosis are simply more common in low-income communities, like poor nutrition, inadequate medical care, diabetes, and alcohol and tobacco use. As immune systems improve, tuberculosis is beginning to retreat.
In recent decades, youth suicide has become an epidemic in Indian country. Young Native Americans are more likely to kill themselves than any other group. Native American teens and young adults are ending their own lives at triple the rate of their peers, according to government data, and the Alaska Native Tribal Health Consortium found that young Native women in Alaska were 19 times more likely to kill themselves than other women their same age.
Suicide is intertwined with so many other issues that disproportionately affect Native people, such as sexual assault, substance abuse, isolation, joblessness, limited mental health services and incarceration. “It’s helplessness,” Vernon said.