university of north carolina chapel hill mhch/pubh understanding and addressing health disparities...
TRANSCRIPT
University of North Carolina Chapel Hill
MHCH/PUBH
Understanding and Addressing Health Disparities in the US
“Raising Awareness of American Indian/Alaska
Native Health Issues”
Dean S. Seneca, MPH, MCURPHealth Scientist Policy, Tribal Portfolio
Portfolio Management ProgramOffice of the Chief of Public Health Practice Centers for Disease Control and Prevention
American Indian/Alaska Native Health Disparities
The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions.
American Indian/Alaska Native Health Disparities
American Indians and Alaska Natives born today have a life expectancy that is 2.4 years less than the U.S. all races population (74.5 years to 76.9 years, respectively; 1999-2001 rates), and American Indian and Alaska Native infants die at a rate of nearly 12 per every 1,000 live births, as compared to 7 per 1,000 for the U.S. all races population (2002-2004 rates).
American Indian/Alaska Native Health Disparities
American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher).
(Rates adjusted for misreporting of Indian race on state death certificates; 2002-2004 rates. )
American Indian/Alaska Native Health Disparities
Given the higher health status enjoyed by most Americans, the lingering health disparities of American Indians and Alaska Natives are troubling. In trying to account for the disparities, health care experts, policymakers, and Tribal Leaders are looking at many factors that impact upon the health of Indian people, including the adequacy of funding for the Indian health care delivery system.
Who is an Indian?
Tribes establish criteria for membership1/4 tribal blood, BIA Standarda descendant of a tribal memberor a person recognized by the tribal members as
a member.
Alaska Native: The term collectively refers to Eskimos, Aleuts, and American Indians who are indigenous to Alaska.
American Indian: This includes enrolled members of Federal and/or State recognized tribes as well as people who are self-identified as “American Indian” on the U.S. Census and other similar reports.
What is an Indian Tribe?
Any Indian tribe, band, Nation, rancheria, Pueblo, or other organized group or community, including any Alaska Native village, group, regional, or village corporation as defined in or established by the Alaska Native Claims Settlement Act, and is recognized as eligible for the special programs and services provided by the United States to Indians through government to government relationships, specifically treaties. A tribe may be federally recognized, state recognized, or self-recognized.
What is a Reservation?
The geographic area reserved by treaty or other law for a federally recognized Indian tribe.
Navajo Nation -
1492Arrival of Columbus
1790ForcedInland
1830IndianCountry
1860ImmigrationStampede
1890Vanquished
2090Indian Country?
= Reservation Lands
Tribal Sovereignty
Treaty Tribes have a Nation to Nation
relationship with the US. Government
Tribes are Sovereign Nations
States do not have jurisdiction on tribal
lands
Movement towards Tribal Self-Governance
Tribes make and enforce your own Laws
Federal Indian Policy
• 1608-1830, “Treaties” – The Marshall Trilogy historic cases Johnson v. McIntosh, Cherokee Nation v. Georgia, and Worcester v. Georgia all recognized Indian Nations as Sovereign Entities. The Supreme Court found that Tribes were no longer territorially separate from the United States. Tribes (a) could not transfer lands to or sign treaties with any other colonizing power and (b) had placed themselves under the protection of the United States.
Federal Indian Policy Continued
• 1830-1850, “Removal Policy” – Indian Removal Act policies moved the Tribes west of the Mississippi into the Louisiana and Northwest Territories.
• 1850-1871, “Removal Shifts to Reservation System” – Over 100 treaties created moving Tribes to new, smaller territories or confined them to smaller territories reserved from their aboriginal territory.
Federal Indian Policy Continued 1871-1928, “Assimilation and Allotment Era” – The
United States sold or gave Indian Land to non Indians to make Indians Assimilate into non-Indian communities. Resulted in (a) the loss of 90 out of 138 million acres of land and (b) the displacement of thousands of Indians.
“Indian Reorganization Act of 1934” – The Act reaffirmed that tribal governments had inherent powers.
1943 – 1968, “Termination” – Reversed many of the reforms made in the 1930’s by terminating many federal state tribal relationships. Promoted assimilation of Indians into mainstream society.
Federal Indian Policy Continued
1968 – Present – “Self Determination” – In 1968, PL 280 was amended to require the consent of Indian Nations before state could assume jurisdiction. This era of various presidential policy statements and legislative acts that benefited Indians, strengthened tribal governments, reaffirmed tribal sovereignty and ended the termination period.
Reservation Boarding School System Existed between 1870-1928
Movement attributed to Manifest Destiny philosophy Mission: to educate Indian children and assimilate them
into the European language and culture. Allow the Indian people to become self-sufficient, and therefore reduce government spending.
“Social Evolution” of the Indian expectations included: - Speaking English - Learning a vocation - Practicing farming Founded to expand the land available to the Europeans
and confine the Indian people. Result-assimilation failed and Indian culture survived, but
Native children suffered serious repercussions
Fort Simcoe, Washington
Apache Children at Carlisle Indian School
Apache Children at Carlisle Indian School 4 months later
American Indian Facts
Data According to the U.S. Census 2000 Population Data of AI/AN in United States: -4.1 million Geographic Distribution: -West (43%) -Midwest (17%) -South (31%) -Northeast (9%)
U.S.Natives All Races
24 yrs. 33 yrs.
$19,900 $30,000
32% 13%
66% 75%
Median Age
Median Income
Below Poverty
High School
Demographics, 1990 Census
U.S.Natives All Races
28 yrs. 35.3 yrs.
$31,799 $42,148
25.9% 11.3%
70.9% 80.4%
Median Age
Median Income
Poverty Rate
High School
Demographics, 2000 Census
Public Law 93-638• To Provide maximum Indian Participation in the Government
and education of Indian People.
To provide for the full participation of Indian Tribes in programs and services conducted by the federal government.
After Careful review Congress finds:(1) The prolonged federal domination of Indian service
programs has served to retard rather than enhance the progress of Indian people and their communities by depriving Indians of full opportunity to develop leadership skills crucial to the realization of self-government
(2) The Indian people will never surrender their desire to control their relationships both among themselves and with non-Indian governments, organizations and persons
Public Law 93-638 Cont.
Contracting: allows the Tribes to take over planning and implementation of any or all federal services. Tribes can requests permission from the IHS to redesign those parts of the health care system they are responsible to address.
Compacting: Tribes enter into funding agreements where they assume control over the planning, and delivery of some or all federal services. Tribes can do what ever they want with the funding as long as it is intend for the desired purpose.
Direct Service: The Federal government provides a service directly to the tribe.
Sharing and generosity Allegiance to family, community and tribe Respect for Elders Non-Interference Orientation to present time Harmony with Nature Respect for status of the Woman and the
Child
Common Values Among Natives
Common Beliefs Related to Spirituality
A belief in an unseen power, Great Mystery
or Creator
All things in the universe are related
Worship reinforces bonds between the
individual, family and community (our
relatedness)
Spirituality is intimately connected to our
health
Respective Core Values
Traditional Native Main Stream Society, U.S.
Cooperative Competitive
Group/Tribal Emphasis Freedom, Progress, Efficiency
Extended Family Important Individualism
Modesty Sexy
Patience/Passive (SW) “Getting Ahead in Life”
Generous/Non-Materialistic Material Comfort
Respect for Age Youth
Spirituality External Conformity
Indirect Criticism Direct Criticism
Harmony with Nature Conquest of Nature
Presidential Memorandum on Government-to-Government Relations
with AI/AN Tribal Governments Operate within a government-to-government relationship with
federally-recognized Tribes Consult, to the greatest extent practicable and to the extent
permitted by law, with Indian tribal governments before taking actions that affect federally recognized tribes.
Assess the impact of executive department and agency activities on tribal trust resources and assure that tribal rights and concerns are considered.
Take appropriate steps to remove procedural impediments to working directly and effectively with tribal governments on activities that affect the trust responsibility and/or governmental rights of tribes.
Executive Order 13175 of November 6, 2000“Consultation and Coordination with Indian
Tribal Governments”
Funding Principles
Policy Making Criteria
Consultation
Increasing Flexibility for Indian Tribal Waivers
AI/AN Public Health:Challenges/Obstacles
• Few AI/AN public health professionals• Limited familiarity with AI/AN policies• Complexities/logistics – over 500 tribes• Public health legislation/legal
foundations• Lack of public health infrastructure• Funding issues
AI/AN (1992-1994) Age-Adjusted Death Rates Compared to U.S. All Races (1993)
Source: Trends in Indian Health, 1997IHS Epidemiology
1.1
1.6
1.7
3.1
3.3
4.4
5.3
0 1 2 3 4 5 6
Cardiovascular Diseases
Pneumonia & Influenza
Suicide
Accidents
Diabetes Mellitus
Chron. Liver Disease & Cirrhosis
Tuberculosis, All Forms
Ratio
Albuquerque82,818
Portland158,892
Billings58,794
California132,740 Phoenix
150,540
Oklahoma318,691
Nashville78,745
Navajo223,029
Tucson28,980
Alaska109,780
Aberdeen102,758
2001 IHS Service Population* by AreaTotal Population: 1,540,129
*Projected from 1990 CensusIHS Epidemiology
Bemidji94,362
Ten Leading Causes of Death for American Indians/Alaska Natives in
U.S.,2003
1. Heart disease2. Cancer3. Unintentional injuries4. Diabetes5. Stroke6. Chronic liver disease and Cirrhosis7. Chronic lower respiratory diseases8. Suicide9. Influenza and Pneumonia10. Nephritis, Nephrotic Syndrome, &
NephrosisSource: Health, United States, 2005, Table 31.
http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Ten Leading Causes of Death in the U.S. in 2004 for AI/AN as Compared to the Nation
AI/AN1. Heart disease2. Cancer3. Unintentional injuries4. Diabetes5. Stroke 6. Chronic liver disease &
Cirrhosis7. Chronic lower respiratory
diseases8. Suicide9. Influenza and Pneumonia10. Nephritis, Nephrotic
Syndrome, & Nephrosis
Source: Health, United States, 2005, Table 31.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
U.S.
Heart disease Cancer Stroke Chronic lower respiratory
diseases Unintentional injuries Diabetes Alzheimer’s Disease Influenza and Pneumonia Nephritis, Nephrotic Syndrome, &
Nephrosis Septicemia
Age-Adjusted Death Rate Per 100,000 Persons By Race & Hispanic Origin For All Causes U.S.,
2004
800.8 786.3
1027.3
650.0
443.9
586.7
0
200
400
600
800
1000
1200
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race
for All Causes: U.S. & IHS Service Area - 1997
479.1456.5 465.3
620.7
715.2
0
150
300
450
600
750
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2005, Table 31. And IHS Trends in Indian Healthhttp://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Source:IHS Trends in Indian Health, 2000-2001, Table 4.11, p.69.
0
250
500
750
1,000
1972-74 (1973) 1983-85 (1984) 1994-96 (1995) 1996-98 (1997)
Calendar Year(s)
Age-Adjusted Death Rate
Rate Per 1,000 PopulationAmerican Indians & Alaska Natives, Actual (3-Year)
U.S. White (1-Year)
U.S. All Races (1-Year)
American Indians & Alaska Natives, Adjusted (3-Year)
Deaths by Age and Race
0
5
10
15
20
25
30
35
Under 1
1 to
4
5 to
14
15 to
24
25 to
34
35 to
44
45 to
54
55 to
64
65 to
74
75 to
84
85 &
Ove
r
Age
AI/AN, 1996-1998 AdjustedU.S. All, 1997U.S. Black, 1997U.S. White, 1997
Percent Distribution
Source:IHS Trends in Indian Health, 2000-2001, Table 4.14, p.75.
Age-Adjusted Death Rates per 100,000 Persons by Race
for Cerebrovascular Diseases: U.S. & IHS Service Area - 1997
25.9
24.0
19.9
26.7
29.5
0
5
10
15
20
25
30
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
60
80
100
120
140
Age-Adjusted Malignant NeoplasmDeath Rates, 1973-1997
Rate Per 100,000 Population
1973 1975 1980 1985 1990 1995 1997
Calendar Year
American Indians & Alaska Natives, Actual
U.S. All Races
American Indians & Alaska Natives, Adjusted
Source:IHS Trends in Indian Health, 2000-2001, Table 4.33, p.109.
0
10
20
30
40
Age-Adjusted Lung Cancer Death Rates
Per 100,000 Population
1973 1975 1980 1985 1990 1995 1997
Calendar Year
American Indians & Alaska Natives, Actual
U.S. All Races
American Indians & Alaska Natives, Adjusted
Source:IHS Trends in Indian Health, 2000-2001, Table 4.35, p.113.
Age–Adjusted Death Rates Per 100,000 Persons By Race & Hispanic Origin
For Unintentional Injuries: U.S.
37.7 38.836.3
53.1
16.7
29.8
0
10
20
30
40
50
60
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race for Unintentional Injuries: U.S.
& IHS Service Area - 1997
30.1 29.6
58.5
82.2
94.7
0
10
20
30
40
50
60
70
80
90
100
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Unintentional Injuries Age-Adjusted Death Rates, per 100,000 Persons
U.S. and Selected States, 1995-1997
30.336.7
33.029.8 30.0
33.736.7
0.0
33.5
57.4
133.1
11.016.4
0.0
17.8
28.8
0.0
31.4
0
20
40
60
80
100
120
140
US SD TX
Age
-Adj
uste
d D
eath
Rat
es p
er 1
00,0
00 P
erso
ns
TotalWhiteBlackAI/ANAsian/PIHispanic
Source: Health, United States, 2007,
Unintentional Injuries Age-Adjusted Death Rates per 100,000 Persons U.S. and Selected States 1995-
1997
30.3
51.4
23.0
29.8
48.2
22.2
36.731.1
26.8
57.4
99.1
0.0
16.4
0.0
13.1
28.8
60.4
9.0
0
20
40
60
80
100
120
US NM MD
Age
-Adj
uste
d D
eath
Rat
es p
er 1
00,0
00 P
erso
ns
TotalWhiteBlackAI/ANAsian/PIHispanic
Source: Health, United States, 2007
Age Adjusted Death Rates Per 100,000 Persons By Race & Hispanic Origin For Motor
Vehicle-Related Injuries: U.S.,2004
15.2 15.614.8
26.0
7.8
14.4
0
5
10
15
20
25
30
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race for Motor Vehicle-related Injuries:
U.S. & IHS Service Area - 1997
15.9 15.9
32.3
46.6
54.8
0
10
20
30
40
50
60
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Age-Adjusted Mortality Rates Per 100,000 Persons By Race/Ethnicity for Suicide: U.S.,
2004.
10.912.0
5.3
12.2
5.8 5.9
0
5
10
15
20
25
All Races White African American AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Age
-Adj
uste
d D
eath
Rat
e pe
r 10
0,00
0 Per
sons
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race for Suicide:
U.S. & IHS Service Area - 1997
10.611.3
12.9
17.6
20.2
0
5
10
15
20
25
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary and IHS Trends AI/AN Health
Suicide Death Rates for Males Ages 15-24 Per 100,000 Persons by Racial/Ethnic Group
1990-2004
0
10
20
30
40
50
60
1990
2000
2002
2003
2004
Age
-Ad
just
ed D
eath
Rat
e p
er 1
00,0
00 P
erso
ns
Total
White
Black
AI/AN
Asian/PI
Hispanic
Source: Health, United States, 2007 http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary Table 46.
CDC, ADMH, GHR
Age-Adjusted Death Rates Per 100,000 Persons By Race and Hispanic Origin
For Diabetes Mellitus: U.S., 2004.
24.522.3
48.0
39.2
16.6
32.1
0
5
10
15
20
25
30
35
40
45
50
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race for Diabetes Mellitus:
U.S. & IHS Service Area - 1997
13.511.9
30.4
44.4
52.8
0
10
20
30
40
50
60
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary and IHS Trends in AI/AN Health
0 25 50 75 100 125 150 175 200
Tucson
Bemidji
Albuquerque
Phoenix
Aberdeen
Billings
Nashville
Navajo
Oklahoma
Portland
California
Alaska
Rate per 100,000 Population
Actual
Adjusted
Age-Adjusted Diabetes Mellitus Death RatesCY 1996-1998
IHS Adjusted Total - All Areas = 52.8
U.S. All Races (1997) = 13.5
IHS Regional Differences in Indian Health 2000-2001, Table 4.24, p 67.
AGE-ADJUSTED DIABETES DEATH RATES American Indians and Alaska Natives, IHS Service Area
0
10
20
30
40
50
60
70
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Per 100,000 population (single-year rates)
Calendar Year
U.S. All Races
American Indians and Alaska Natives, Actual
American Indians and Alaska Natives, Adjusted
IHS Trends in Indian Health
Age-Adjusted Death Rate Per 100,000 Persons By Race & Hispanic Origin For Chronic Liver
Disease and Cirrhosis: U.S., 2004.
9.0 9.27.9
22.7
3.2
14.0
0
5
10
15
20
25
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29.http://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race for Chronic Liver Disease and
Cirrhosis:U.S. & IHS Service Area - 1997
7.4 7.3
20.6
31.7
36.4
0
5
10
15
20
25
30
35
40
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2007, Table 29.
and IHS Trends in AI/AN Health ttp://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age-Adjusted Death Rates per 100,000 Persons by Race or Influenza & Pneumonia:
U.S. & IHS Service Area - 1997
12.9 12.413.4
19.8
21.5
0
5
10
15
20
25
All Races (HUS) White (HUS) American Indian/Alaska Native AI/AN
(HUS)
AI/AN UnAdjustedIHS Service Area
(IHS)
AI/AN Adjusted * IHSService Area (IHS)
Ag
e-A
dju
sted
Dea
th R
ate
per
100
,000
Per
son
s
Source: Health, United States, 2007, Table 29. and IHS Trends in AI/AN Health ttp://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
Age Adjusted Death Rate Per 100,000 Persons By Race & Hispanic Origin for Human
Immunodeficiency Virus (HIV) Disease : U.S., 2004.
4.5
2.3
20.4
2.9
0.7
5.3
0
5
10
15
20
25
All Races White AfricanAmerican
AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Ag
e-A
dju
ste
d D
ea
th R
ate
pe
r 1
00
,00
0 P
ers
on
s
Source: Health, United States, 2007, Table 29. ttp://www.cdc.gov/NCHS/data/hus/hus05.pdf#summary
IHS Appropriations Per Capita Compared to Other Federal Health Expenditure Benchmarks
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
Medicare
Expenditures
per Enrollee
Medical Care
for Veterans
Administration
Users
US Per Capita
Expenditures
for Personal
Medical
Services
Acute Medical
Care for
Medicaid
Enrollees
Medical Care
for Federal
Prison Inmates
FEHB Medical
Care
Benchmark per
IHS User
IHS
Appropriations
& Collections
Per User
5,915
1999
5,214
5,065
1999
3,879
1998
3,803
1999
3,725
1999 1,914
619Med
IHS2002
2001
Non-Med
IHS Per Capita Appropriations
American Indian/Alaska Native Elderly Issues, Social
Poorer Older Less Educated Less Likely to be Married Chronic Disease occur earlier among American
Indians/Alaska Natives Functional Limitations High rates of Disability Low rates of service for which they are eligible
American Indian/Alaska Native Elderly Issues, Behavioral cont.
Smoking Physical inactivity Obesity Diabetes Greater behavioral risk Access barriers Chronic Disease will increase as the number of elders
grows from approximately 310,000 to 459,000 in 2010 (1990 -2000 increase 23%)
American Indian/Alaska Native Elderly Issues, Health Status
20% more like to experience arthritis 49% more likely to experience congestive health
failure 18% more likely to have heart failure 18% more likely to have high blood pressure 18% more likely to have a stroke 44% more likely to asthma 173 % more likely to be afflicted with diabetes
Source IHS Directors Statement
American Indian/Alaska Native Elderly Issues Cultural cont.
Culture, Language and Resources The Seventh Generation Gate Keepers to Knowledge, Customs and
Traditions Respected source in the community The health of the elders is a measure of the
health of our culture and communities.
Total Enrollment of Minorities in Schoolsfor Selected Health Occupations: Nursing, Registered
According to Detailed Race, and Hispanic Origin: U.S. 2001-2002
100.0
78.4
11.8
1.1 3.8 4.9
0
10
20
30
40
50
60
70
80
90
100
All Races White Non-Hispanic
AfricanAmerican
Non-Hispanic
AmericanIndian
Asian Hispanic /Latino
Pe
rce
nt
Dis
trib
uti
on
of
Stu
de
nts
Total Enrollment of Minorities in Schoolsfor Selected Health Occupations: DentistryAccording to Detailed Race, and Hispanic
Origin: U.S. 2004-2005
100.0
66.1
5.40.5
22.1
5.8
0
10
20
30
40
50
60
70
80
90
100
All Races White Non-Hispanic
AfricanAmerican
Non-Hispanic
AmericanIndian
Asian Hispanic /Latino
Pe
rce
nt
Dis
trib
uti
on
of
Stu
de
nts
Total Enrollment of Minorities in Schoolsfor Selected Health Occupations: Medicine (Allopathic)According to Detailed Race, and Hispanic Origin: U.S.
2004-2005
100.0
63.3
7.40.9
20.7
6.7
0
10
20
30
40
50
60
70
80
90
100
All Races White Non-Hispanic
AfricanAmerican
Non-Hispanic
AmericanIndian
Asian Hispanic /Latino
Pe
rce
nt
Dis
trib
uti
on
of
Stu
de
nts
Total Enrollment of Minorities in Schoolsfor Selected Health Occupations:
Medicine (Osteopathic) According to Detailed Race, and Hispanic Origin: U.S. 2004-2005
100.0
73.5
3.70.7
15.7
3.8
0
10
20
30
40
50
60
70
80
90
100
All Races White Non-Hispanic
AfricanAmerican
Non-Hispanic
AmericanIndian
Asian Hispanic /Latino
Pe
rce
nt
Dis
trib
uti
on
of
Stu
de
nts
Percent Distribution of Enrollment of Minorities
in Medical and Dental Schoolsby Race/Ethnicity 2004-2005
63.366.1
73.5
7.45.4 3.7
0.9 0.5 0.7
20.7 22.1
15.7
6.7 5.8 3.8
0
10
20
30
40
50
60
70
80
Medicine (Allopathic) Dentistry Medicine (Osteopathic)
White
Black
AI/AN
Asian
Hispanic
Thought Provoking
Treat all men alike. Give
them all the same law. Give
them all an even chance to
live and grow. All men were
made by the same Great
Spirit Chief. They are all
brothers. The earth is the
mother of all people, and all
people have equal rights
upon it.
Chief Joseph, Nez
Perce