Native American identity in the United States

From Wikipedia, the free encyclopedia

Alaska Native dancers at the University of Alaska, Fairbanks Art Museum, 2006

 

Caddo members of the Caddo Cultural Club, Binger, Oklahoma, 2008

 

Native American writers Kim Shuck (Cherokee-Sac and Fox), Jewelle Gomez (Iowa), L. Frank (Tongva-Acjachemen) and Reid Gómez (Navajo)

 

Native American identity in the United States is an evolving topic based on the struggle to define "Native American" or "(American) Indian" both for people who consider themselves Native American and for people who do not. Some people seek an identity that will provide for a stable definition for legal, social, and personal purposes. There are a number of different factors which have been used to define "Indianness," and the source and potential use of the definition play a role in what definition is used. Facets which characterize "Indianness" include culture, society, genes/biology, law, and self-identity. An important question is whether the definition should be dynamic and changeable across time and situation, or whether it is possible to define "Indianness" in a static way. The dynamic definitions may be based in how Indians adapt and adjust to dominant society, which may be called an "oppositional process" by which the boundaries between Indians and the dominant groups are maintained. Another reason for dynamic definitions is the process of "ethnogenesis", which is the process by which the ethnic identity of the group is developed and renewed as social organizations and cultures evolve. The question of identity, especially aboriginal identity, is common in many societies worldwide.

The future of their identity is extremely important to Native Americans. Activist Russell Means spoke frequently about the crumbling Indian way of life, the loss of traditions, languages, and sacred places. He was concerned that there may soon be no more Native Americans, only "Native American Americans, like Polish Americans and Italian Americans." As the number of Indians has grown (ten times as many today as in 1890), the number who carry on tribal traditions shrinks (one fifth as many as in 1890), as has been common among many ethnic groups over time. Means said, "We might speak our language, we might look like Indians and sound like Indians, but we won’t be Indians."

Definitions

There are various ways in which Indian identity has been defined. Some definitions seek universal applicability, while others only seek definitions for particular purposes, such as for tribal membership or for the purposes of legal jurisdiction. The individual seeks to have a personal identity that matches social and legal definitions, although perhaps any definition will fail to categorize correctly the identity of everyone.

American Indians were perhaps clearly identifiable at the turn of the 20th century, but today the concept is contested. Malcolm Margolin, co-editor of News From Native California muses, "I don’t know what an Indian is... [but] Some people are clearly Indian, and some are clearly not." Cherokee Chief (from 1985–1995) Wilma Mankiller echoes: "An Indian is an Indian regardless of the degree of Indian blood or which little government card they do or do not possess."

Further, it is difficult to know what might be meant by any Native American racial identity. Race is a disputed term, but is often said to be a social (or political) rather than biological construct. The issue of Native American racial identity was discussed by Steve Russell (2002, p68), "American Indians have always had the theoretical option of removing themselves from a tribal community and becoming legally white. American law has made it easy for Indians to disappear because that disappearance has always been necessary to the 'Manifest Destiny' that the United States span the continent that was, after all, occupied." Russell contrasts this with the reminder that Native Americans are "members of communities before members of a race."

Traditional

Reservation life has often been a blend of the traditional and the contemporary. In 1877, this Lakota family living at South Dakota's Rose Bud Agency had both tipis and log cabins.

 

Traditional definitions of "Indianness" are also important. There is a sense of "peoplehood" which links Indianness to sacred traditions, places, and shared history as indigenous people. This definition transcends academic and legal terminology. Language is also seen as an important part of identity, and learning Native languages, especially for youth in a community, is an important part in tribal survival.

Some Indian artists find traditional definitions especially important. Crow poet Henry Real Bird offers his own definition, "An Indian is one who offers tobacco to the ground, feeds the water, and prays to the four winds in his own language." Pulitzer Prize-winning Kiowa author N. Scott Momaday gives a definition that is less spiritual but still based in the traditions and experience of a person and their family, "An Indian is someone who thinks of themselves as an Indian. But that's not so easy to do and one has to earn the entitlement somehow. You have to have a certain experience of the world in order to formulate this idea. I consider myself an Indian; I've had the experience of an Indian. I know how my father saw the world, and his father before him."

Constructed as an imagined community

Some social scientists relate the uncertainty of Native American identity to the theory of the constructed nature of identity. Many social scientists discuss the construction of identity. Benedict Anderson's "imagined communities" are an example. However, some see construction of identity as being part of how a group remembers its past, tells its stories, and interprets its myths. Thus cultural identity is made within the discourses of history and culture. Identity thus may not be a fact based in the essence of a person, but a positioning, based in politics and social situations.

Blood quantum

A common source of definition for an individual's being Indian is based on their blood (ancestry) quantum (often one-fourth) or documented Indian heritage. Almost two-thirds of all Indian federally recognized Indian tribes in the United States require a certain blood quantum for membership. Indian heritage is a requirement for membership in most American Indian Tribes. The Indian Reorganization Act of 1934 used three criteria: tribal membership, ancestral descent, and blood quantum (one half). This was very influential in using blood quantum to restrict the definition of Indian. The use of blood quantum is seen by some as problematic as Indians marry out to other groups at a higher rate than any other United States ethnic or racial category. This could ultimately lead to their absorption into the rest of multiracial American society.

Residence on tribal lands

BIA map of reservations in the United States

 

Related to the remembrance and practice of traditions is the residence on tribal lands and Indian reservations. Peroff (2002) emphasizes the role that proximity to other Native Americans (and ultimately proximity to tribal lands) plays in one's identity as a Native American.

Construction by others

Students at the Bismarck Indian School in the early twentieth century.

 

European conceptions of "Indianness" are notable both for how they influence how American Indians see themselves and for how they have persisted as stereotypes which may negatively affect treatment of Indians. The noble savage stereotype is famous, but American colonists held other stereotypes as well. For example, some colonists imagined Indians as living in a state similar to their own ancestors, for example the Picts, Gauls, and Britons before "Julius Caesar with his Roman legions (or some other) had ... laid the ground to make us tame and civil."

In the 19th and 20th century, particularly until John Collier's tenure as Commissioner of Indian Affairs began in 1933, various policies of the United States federal and state governments amounted to an attack on Indian cultural identity and attempt to force assimilation. These policies included but were not limited to the banning of traditional religious ceremonies; forcing traditional hunter-gatherer people to begin farming, often on land that was unsuitable and produced few or no crops; forced cutting of hair; coercing "conversion" to Christianity by withholding rations; coercing Indian parents to send their children to boarding schools where the use of Native American languages was not permitted; freedom of speech restrictions; and restricted allowances of travel between reservations. In the Southwest sections of the U.S. under Spanish control until 1810, where the majority (80%) of inhabitants were Indigenous, Spanish government officials had similar policies.

United States government definitions

President Coolidge stands with four Osage Indians at a White House ceremony

 

Some authors have pointed to a connection between social identity of Native Americans and their political status as members of a tribe. There are 561 federally recognized tribal governments in the United States, which are recognized as having the right to establish their own legal requirements for membership. In recent times, legislation related to Indians uses the "political" definition of identifying as Indians those who are members of federally recognized tribes. Most often given is the two-part definition: an "Indian" is someone who is a member of an Indian tribe and an "Indian tribe" is any tribe, band, nation, or organized Indian community recognized by the United States.

The government and many tribes prefer this definition because it allows the tribes to determine the meaning of "Indianness" in their own membership criteria. However, some still criticize this saying that the federal government's historic role in setting certain conditions on the nature of membership criteria means that this definition does not transcend federal government influence. Thus in some sense, one has greater claim to a Native American identity if one belongs to a federally recognized tribe, recognition that many who claim Indian identity do not have. Holly Reckord, an anthropologist who heads the BIA Branch of Acknowledgment and Recognition, discusses the most common outcome for those who seek membership: "We check and find that they haven't a trace of Indian ancestry, yet they are still totally convinced that they are Indians. Even if you have a trace of Indian blood, why do you want to select that for your identity, and not your Irish or Italian? It's not clear why, but at this point in time, a lot of people want to be Indian.".

The Arts and Crafts Act of 1990 attempts to take into account the limits of definitions based in federally recognized tribal membership. In the act, having the status of a state-recognized Indian tribe is discussed, as well as having tribal recognition as an "Indian artisan" independent of tribal membership. In certain circumstances, this allows people who identify as Indian to legally label their products as "Indian made", even when they are not members of a federally recognized tribe. In legislative hearings, one Indian artist, whose mother is not Indian but whose father is Seneca and who was raised on a Seneca reservation, said, "I do not question the rights of the tribes to set whatever criteria they want for enrollment eligibility; but in my view, that is the extent of their rights, to say who is an enrolled Seneca or Mohawk or Navajo or Cheyenne or any other tribe. Since there are mixed bloods with enrollment numbers and some of those with very small percentages of genetic Indian ancestry, I don't feel they have the right to say to those of us without enrollment numbers that we are not of Indian heritage, only that we are not enrolled.... To say that I am not [Indian] and to prosecute me for telling people of my Indian heritage is to deny me some of my civil liberties...and constitutes racial discrimination."

Some critics believe that using federal laws to define "Indian" allows continued government control over Indians, even as the government seeks to establish a sense of deference to tribal sovereignty. Critics say Indianness becomes a rigid legal term defined by the BIA, rather than an expression of tradition, history, and culture. For instance, some groups which claim descendants from tribes that predate European contact have not been able to achieve federal recognition. On the other hand, Indian tribes have participated in setting policy with BIA as to how tribes should be recognized. According to Rennard Strickland, an Indian Law scholar, the federal government uses the process of recognizing groups to "divide and conquer Indians: "the question of who is 'more' or 'most' Indian may draw people away from common concerns."

Self-identification

In some cases, one can self-identify about being Native American. For example, one can often choose to identify as Indian without outside verification when filling out a census form, a college application, or writing a letter to the editor of a newspaper. A "self-identified Indian" is a person who may not satisfy the legal requirements which define a Native American according to the United States government or a single tribe, but who understands and expresses her own identity as Native American. However, many people who do not satisfy tribal requirements identify themselves as Native American, whether due to biology, culture, or some other reason. The United States census allows citizens to check any ethnicity without requirements of validation. Thus, the census allows individuals to self-identify as Native American, merely by checking the racial category, "Native American/Alaska Native". In 1990, about 60 percent of the more than 1.8 million persons identifying themselves in the census as American Indian were actually enrolled in a federally recognized tribe. Using self identification allows both uniformity and includes many different ideas of "Indianness". This is practiced by nearly half a million Americans who receive no benefits because

• they are not enrolled members of a federally recognized tribe, or
• they are full members of tribes which have never been recognized, or
• they are members of tribes whose recognition was terminated by the government during programs in the 1950s and 1960s.

Identity is in some way a personal issue; based on the way one feels about oneself and one's experiences. Horse (2001) describes five influences on self-identity as Indian:

• "The extent to which one is grounded in one’s Native American language and culture, one’s cultural identity";
• "The validity of one’s American Indian genealogy";
• "The extent to which one holds a traditional American Indian general philosophy or worldview (emphasizing balance and harmony and drawing on Indian spirituality)";
• "One’s self-concept as an American Indian"; and
• "One’s enrollment (or lack of it) in a tribe."

University of Kansas sociologist Joane Nagel traces the tripling in the number of Americans reporting American Indian as their race in the U.S. Census from 1960 to 1990 (from 523,591 to 1,878,285) to federal Indian policy, American ethnic politics, and American Indian political activism. Much of the population "growth" was due to "ethnic switching", where people who previously marked one group, later mark another. This is made possible by our increasing stress on ethnicity as a social construct. In addition, since 2000 self-identification in US censuses has allowed individuals to check multiple ethnic categories, which is a factor in the increased American Indian population since the 1990 census. Yet, self-identification is problematic on many levels. It is sometimes said, in fun, that the largest tribe in the United States may be the "Wantabes".

Garroutte identifies some practical problems with self-identification as a policy, quoting the struggles of Indian service providers who deal with many people who claim ancestors, some steps removed, who were Indian. She quotes a social worker, "Hell, if all that was real, there are more Cherokees in the world than there are Chinese." She writes that in self-identification, privileging an individual's claim over tribes' right to define citizenship can be a threat to tribal sovereignty.

Personal reasons for self-identification

Many individuals seek broader definitions of Indian for personal reasons. Some people whose careers involve the fact that they emphasize Native American heritage and self-identify as Native American face difficulties if their appearance, behavior, or tribal membership status does not conform to legal and social definitions. Some have a longing for recognition. Cynthia Hunt, who self-identifies as a member of the state-recognized Lumbee tribe, says: "I feel as if I'm not a real Indian until I've got that BIA stamp of approval .... You're told all your life that you're Indian, but sometimes you want to be that kind of Indian that everybody else accepts as Indian."

The importance that one "look Indian" can be greater than one's biological or legal status. Native American Literature professor Becca Gercken-Hawkins writes about the trouble of recognition for those who do not look Indian; "I self-identify as Cherokee and Irish American, and even though I do not look especially Indian with my dark curly hair and light skin, I easily meet my tribe's blood quantum standards. My family has been working for years to get the documentation that will allow us to be enrolled members of the Eastern Band of Cherokee Indians. Because of my appearance and my lack of enrollment status, I expect questions regarding my identity, but even so, I was surprised when a fellow graduate student advised me—in all seriousness—to straighten my hair and work on a tan before any interviews. Thinking she was joking, I asked if I should put a feather in my hair, and she replied with a straight face that a feather might be a bit much, but I should at least wear traditional Native jewelry."

Louis Owens, an unenrolled author of Choctaw and Cherokee descent, discusses his feelings about his status of not being a real Indian because he's not enrolled. "I am not a real Indian. ... Because growing up in different times, I naively thought that Indian was something we were, not something we did or had or were required to prove on demand. Listening to my mother's stories about Oklahoma, about brutally hard lives and dreams that cut across the fabric of every experience, I thought I was Indian."

Historic struggles

Florida State anthropologist J. Anthony Paredes considers the question of Indianness that may be asked about pre-ceramic peoples (what modern archaeologists call the "Early" and "Middle Archaic" period), pre-maize burial mound cultures, etc. Paredes asks, "Would any [Mississippian high priest] have been any less awed than ourselves to come upon a so-called Paleo-Indian hunter hurling a spear at a woolly mastodon?" His question reflects the point that indigenous cultures are themselves the products of millennia of history and change.

The question of "Indianness" was different in colonial times. Integration into Indian tribes was not difficult, as Indians typically accepted persons based not on ethnic or racial characteristics, but on learnable and acquirable designators such as "language, culturally appropriate behavior, social affiliation, and loyalty." Non-Indian captives were often adopted into society, including, famously, Mary Jemison. As a side note, the "gauntlet" was a ceremony that was often misunderstood as a form of torture, or punishment but within Indian society was seen as a ritual way for the captives to leave their European society and become a tribal member.

Cherokee chief John Ross

 

Since the mid-19th century, controversy and competition have worked both within and outside tribes, as societies evolved. In the early 1860s, novelist John Rollin Ridge led a group of delegates to Washington D.C. in an attempt to gain federal recognition for a "Southern Cherokee Nation" which was a faction that was opposed to the leadership of rival faction leader and Cherokee Chief John Ross.

In 1911, Arthur C. Parker, Carlos Montezuma, and others founded the Society of American Indians as the first national association founded and run primarily by Native Americans. The group campaigned for full citizenship for Indians, and other reforms, goals similar to other groups and fraternal clubs, which led to blurred distinctions between the different groups and their members. With different groups and people of different ethnicities involved in parallel and often competing groups, accusations that one was not a real Indian was a painful accusation for those involved. In 1918, Arapaho Cleaver Warden testified in hearings related to Indian religious ceremonies, "We only ask a fair and impartial trial by reasonable white people, not half-breeds who do not know a bit of their ancestors or kindred. A true Indian is one who helps for a race and not that secretary of the Society of American Indians." 

In the 1920s, a famous court case was set to investigate the ethnic identity of a woman known as "Princess Chinquilla" and her associate Red Fox James (aka Skiuhushu). Chinquilla was a New York woman who claimed to have been separated from her Cheyenne parents at birth. She and James created a fraternal club which was to counter existing groups "founded by white people to help the red race" in that it was founded by Indians. The club's opening received much praise for supporting this purpose, and was seen as authentic; it involved a Council Fire, the peace pipe, and speeches by Robert Ely, White Horse Eagle, and American Indian Defense Association President Haven Emerson. In the 1920s, fraternal clubs were common in New York, and titles such as "princess" and "chief" were bestowed by the club to Natives and non-Natives. This allowed non-Natives to "try on" Indian identities. 

Just as the struggle for recognition is not new, Indian entrepreneurship based on that recognition is not new. An example is a stipulation of the Creek Treaty of 1805 that gave Creeks the exclusive right to operate certain ferries and "houses of entertainment" along a federal road from Ocmulgee, Georgia to Mobile, Alabama, as the road went over parts of Creek Nation land purchased as an easement.

Unity and nationalism

1848 drawing of Tecumseh was based on a sketch done from life in 1808.

 

The issue of Indianness had somewhat expanded meaning in the 1960s with Indian nationalist movements such as the American Indian Movement. The American Indian Movement unified nationalist identity was in contrast to the "brotherhood of tribes" nationalism of groups like the National Indian Youth Council and the National Congress of American Indians. This unified Indian identity has been cited to the teachings of 19th century Shawnee leader Tecumseh to unify all Indians against "white oppression." The movements of the 1960s changed dramatically how Indians see their identity, both as separate from whites, as a member of a tribe, and as a member of a unified category encompassing all Indians.

Examples

Different tribes have unique cultures, histories, and situations that have made particular the question of identity in each tribe. Tribal membership may be based on descent, blood quantum, and/or reservation habitation.

Cherokee

Historically, race was not a factor in the acceptance of individuals into Cherokee society, since historically, the Cherokee people viewed their self-identity as a political rather than racial distinction. Going far back into the early colonial period, based upon existing social and historical evidence as well as oral history among the Cherokee themselves, the Cherokee society was best described as an Indian republic. Race and blood quantum are not factors in Cherokee Nation tribal citizenship eligibility (like the majority of Oklahoma tribes). To be considered a citizen in the Cherokee Nation, an individual needs a direct Cherokee by blood or Cherokee freedmen ancestor listed on the Dawes Rolls. The tribe currently has members who also have African, Latino, Asian, white and other ancestry, and an estimated 75 percent of tribal members are less than one-quarter Indian by blood. The other two Cherokee tribes, the Eastern Band of Cherokee Indians and the United Keetoowah Band of Cherokee Indians, do have a minimum blood quantum requirement. Numerous Cherokee heritage groups operate in the Southeastern U.S.

Theda Perdue (2000) recounts a story from "before the American Revolution" where a black slave named Molly is accepted as a Cherokee as a "replacement" for a woman who was beaten to death by her white husband. According to Cherokee historical practices, vengeance for the woman's death was required for her soul to find peace, and the husband was able to prevent his own execution by fleeing to the town of Chota (where according to Cherokee law he was safe) and purchasing Molly as an exchange. When the wives family accepted Molly, later known as "Chickaw," she became a part of their clan (the Deer Clan), and thus Cherokee.

Inheritance was largely matrilineal, and kinship and clan membership was of primary importance until around 1810, when the seven Cherokee clans began the abolition of blood vengeance by giving the sacred duty to the new Cherokee National government. Clans formally relinquished judicial responsibilities by the 1820s when the Cherokee Supreme Court was established. When in 1825, the National Council extended citizenship to biracial children of Cherokee men, the matrilineal definition of clans was broken and clan membership no longer defined Cherokee citizenship. These ideas were largely incorporated into the 1827 Cherokee constitution. The constitution did, state that "No person who is of negro or mulatlo [sic]parentage, either by the father or mother side, shall be eligible to hold any office of profit, honor or trust under this Government," with an exception for, "negroes and descendants of white and Indian men by negro women who may have been set free." Although by this time, some Cherokee considered clans to be anachronistic, this feeling may have been more widely held among the elite than the general population. Thus even in the initial constitution, the Cherokee reserved the right to define who was and was not Cherokee as a political rather than racial distinction. Novelist John Rollin Ridge led a group of delegates to Washington, D.C., as early as the 1860s in an attempt to gain federal recognition for a "Southern Cherokee Nation" which was a faction that was opposed to the leadership of rival faction leader and Cherokee Chief John Ross.

Navajo

Most of the 158,633 Navajos enumerated in the 1980 census and the 219,198 Navajos enumerated in the 1990 census were enrolled in the Navajo Nation, which is the nation with the largest number of enrolled citizens. It is notable as there is only a small number of people who identify as Navajo who are not registered.

Lumbee

When the Lumbee of North Carolina petitioned for recognition in 1974, many federally recognized tribes adamantly opposed them. These tribes made no secret of their fear that passage of the legislation would dilute services to historically recognized tribes. The Lumbee were at one point known by the state as the Cherokee tribe of Robeson County and applied for federal benefits under that name in the early 20th century. The Eastern Band of Cherokee Indians has been at the forefront of the opposition of the Lumbee. It is sometimes noted that if granted full federal recognition, the designation would bring tens of millions of dollars in federal benefits, and also the chance to open a casino along Interstate 95 (which would compete with a nearby Eastern Cherokee Nation casino).

Native American disease and epidemics

From Wikipedia, the free encyclopedia

In pre-columbian exchange times, a variety of diseases existed in the Americas. The limited populations and interactions between those populations (as compared to places like Europe), hampered the development of widespread, deadly diseases in the Americas. One notable disease of American origin is syphillis. The American era of limited disease would end with the arrival of Europeans in the Americas. European diseases and epidemics, while still present among Native American populations today, were especially influential in Native American life of the past. Diseases and epidemics can be chronicled from centuries ago when European settlers brought forth diseases that devastated entire tribes. Transitioning into more modern times, similar diseases still plague Native American populations. The current crises in diseases and epidemics are being addressed by many different groups, both governmental and independent, and are done through a multitude of programs. 

 

Because Native American populations were not previously exposed to most diseases introduced by European colonists, populations rarely had built up individual or population immunities to those diseases. In addition, Europe's position as a crossroads between many different peoples, many of whom were separated by hundreds, if not thousands, of miles (through things like constant war spreading localized afflictions throughout the continent, and the silk road bringing diseases from the East), resulted in Europeans being immune to a large variety of diseases. Therefore, the diseases, which were brought by the Europeans and had little effect on them, greatly affected, and often continue to affect, Native Americans. This phenomenon is known as the virgin soil effect.

European contact

An ill Native American in the 19th century, being cared for by a medicine man.

 

Graph of population decline in central Mexico caused by successive epidemics

 

Sixteenth-century Aztec drawings of victims of smallpox (above) and measles (below)

 

The arrival of Europeans also brought on the Columbian Exchange. During this period European settlers brought many different technologies and lifestyles with them. Arguably, the most harmful effect of this exchange was the arrival and spread of disease or biological warfare; it was the genocide of entire civilizations.

Numerous diseases were brought to North America, including smallpox, bubonic plague, chickenpox, cholera, the common cold, diphtheria, influenza, malaria, measles, scarlet fever, sexually transmitted diseases, typhoid, typhus, tuberculosis, pertussis (whooping cough), etc. Each of these brought destruction through sweeping epidemics, involving disability, illness, and extensive deaths. Native Americans, due to the lack of prior contact with Europeans, had not previously been exposed to the diseases that were prevalent on the distant continent. Therefore, they had not built up internal immunities to the diseases or formed any medicines to combat them. Europeans came into the New World bearing various diseases. Those infected with diseases either possessed them in a dormant state or were not quarantined in such a way that distanced them enough from Native Americans not to spread the diseases, allowing them to spread into epidemics.

The trade of Native American captives, and the use of commercial trade routes continued the spread of disease. The diseases brought by Europeans are not easily tracked, since there were numerous outbreaks and all were not equally recorded. Suzanne Austin Alchon writes that “indirect evidence suggests that some serious illness may have arrived with the 1500 colonists who accompanied Columbus's second expedition in 1493. [...] And by the end of 1494, disease and famine had claimed two-thirds of the Spanish settlers.” The most destructive disease brought by Europeans was smallpox. The first well-documented smallpox epidemic happened in 1518. The Lakota Indians called the disease the running face sickness. Smallpox was lethal to many Native Americans, bringing sweeping epidemics and affecting the same tribes repeatedly. 

Between 1837 and 1870, at least four different epidemics struck the Plains tribes. When the plains Indians began to learn of the "white man’s diseases", they intentionally avoided contact with them and their trade goods. But many tribes were enamored with things like metal pots, skillets, and knives, and they traded with the white newcomers anyway, inadvertently spreading diseases to their villages.

Certain cultural and biological traits made Native Americans more susceptible to these diseases. Emphasis placed on visiting the sick led to the spread of disease through consistent contact. Native Americans first exposed to these diseases also had a unique approach to illness, relating primarily to religious beliefs. There is the belief that disease is caused by either a lack of charm use, an intrusion of an object by means of sorcery, or the free soul's absence from the body. Disease was understood to enter the body if one is not protected by the spirits, as it is a natural occurrence. Religious powers were believed to be related to curing diseases as well. Native American illness has been treated through the practice of shamanism in the past, though this decreased as the influence of Europeans increased. 

Disease evolution and host pathogen interactions should be considered in Native American disease history. Disease evolution is the result of the interaction of the following parameters: hosts, parasites, and setting. Such an example of disease evolution is the direct biological effects of crowding that directly influences a host's susceptibility to disease. Research by Power et al. (1998) demonstrated that, at low doses of micro-bacterial pathogens, hosts were able to make an appropriate immune response and avoid tuberculosis; higher doses resulted in a less efficient form of a vaccination. The crowding that was a result of widespread relocation and concentration of native groups by the expanding America greatly impacted the susceptibility native people initially had to the foreign diseases.

Impact on population numbers

Many Native American tribes experienced great depopulation, averaging 25–50 percent of the tribes' members lost to disease. Additionally, smaller tribes neared extinction after facing a severely destructive spread of disease. The significant toll that this took is expounded upon in the article Population history of indigenous peoples of the Americas. A specific example was Cortes' invasion of Mexico. Before his arrival, the Mexican population is estimated to have been around 25 to 30 million. Fifty years later, the Mexican population was reduced to 3 million, mainly by infectious disease. This shows the main effect of the arrival of Europeans in the new world. With no natural immunity against these pathogens, Native Americans died in huge numbers. Yale historian David Brion Davis describes this as "the greatest genocide in the history of man. Yet it's increasingly clear that most of the carnage had nothing to do with European barbarism. The worst of the suffering was caused not by swords or guns but by germs." By 1700, less than five thousand Native Americans remained in the southeastern coastal region. In Florida alone, there were seven hundred thousand Native Americans in 1520, but by 1700 the number was around 2000. In summer 1639, a smallpox epidemic struck the Huron natives in the St. Lawrence and Great Lakes regions. The disease had reached the Huron tribes through traders returning from Québec and remained in the region throughout the winter. When the epidemic was over, the Huron population had been reduced to roughly 9000 people, about half of what it had been before 1634. The Iroquois people faced similar losses.

Disease did not only have a direct impact on death, but an indirect impact as well. Losses from disease weakened communities, as they had fewer people to contribute to their community. There were fewer people to hunt, plant crops, and otherwise support their society through other physical means. Loss of cultural knowledge transfer also impacted the population. By missing the right time to hunt or plant the crops, the food supply would be affected, thus weakening the community from not having enough food, and becoming more vulnerable for the next epidemic. Communities were also impacted by disease if many of their population who regularly did the physical tasks of providing food and water suddenly could not. The communities under such crisis were often unable to care for the disabled, elderly, or young.

The colonization of the Americas by Europeans killed so much of the indigenous population that it resulted in climate change and global cooling.

Disability

Epidemics killed a large portion of people with disabilities and also created a large number of people with disabilities. Disabled people in native communities were not considered disabled in Native American communities as long as they could fulfill their responsibilities to the community. The increase in disability due to diseases and epidemics began to affect Native American communities, as well as displacement, environmental decline, and war. While disability affected European settlers, the material and societal realities of disability for Native American communities was tangible.

Smallpox epidemics led to blindness and depigmented scars. Smallpox specifically led indirectly to higher rates of suicide. Many Native American tribes prided themselves in their appearance, and the resulting skin disfigurement of smallpox deeply affected them psychologically. Unable to cope with this psychological development, tribe members were said to have committed suicide. Scarlet fever could result in blindness or deafness, and sometimes both.

Disease as a weapon against Native Americans

"You will do well to try to inoculate the Indians, by means of blankets, as well as to try every other method that can serve to extirpate this execrable race." — Jeffery Amherst

The spread of disease from European contact was not always accidental. Europeans arriving in the Americas had long been exposed to the diseases, attaining a measure of immunity, and thus were not as severely affected by them. Therefore, disease could be an effective biological weapon.

During the French and Indian War, Jeffery Amherst, 1st Baron Amherst, Britain's commander in chief in North America authorized the use of smallpox to wipe out their Native American enemy. In his writings to Colonel Henry Bouquet about the situation in western Pennsylvania, Amherst suggested that the spread of disease would be beneficial in achieving their aims. Colonel Bouquet confirmed his intentions to do so.

Biological warfare during the Siege of Fort Pitt

"Out of our regard to them we gave them two Blankets and an Handkerchief out of the Small Pox Hospital. I hope it will have the desired effect." William Trent, William Trent's Journal at Fort Pitt

This event is well known for the documented instances of biological warfare. British officers, including the top British commanding generals, ordered, sanctioned, paid for and conducted the use of smallpox against the Native Americans. As described by one historian, "there is no doubt that British military authorities approved of attempts to spread smallpox among the enemy", and "it was deliberate British policy to infect the indians with smallpox".

In this instance, as recorded in his journal by sundries trader and militia Captain William Trent, on June 24, 1763, allied lords from the Delaware tribe met with Fort Pitt officials, warned them of "great numbers of Indians" coming to attack the fort, and threatened them to leave the fort while there was still time. But the commander of the fort refused to abandon the fort. Instead, the British gave as gifts two blankets, one silk handkerchief and one linen from the smallpox hospital, to two Delaware delegates after the parley, a principal warrior named Turtleheart, and Maumaultee, a Chief. The tainted gifts were, according to their inventory accounts, given to the Indian dignitaries "to Convey the Smallpox to the Indians".

INVOICE for 1763 June
Levy, Trent and Company: Account against the Crown, Aug. 13, 1763

"To Sundries got to Replace in kind those which were taken from people in the Hospital to Convey the Smallpox to the Indians Vizt: 2 Blankets @ 20/ £299 099 0
1 Silk Handkerchef 10/
& 1 linnen do: 3/6 099 1399 6

Captain Ecuyer later certified that the items "were had for the uses above mentioned", in the inventory reimbursement request, and General Thomas Gage would later approve that invoice for payment, endorsing it with a comment and his signature.

While Ecuyer, Trent and McKee were conducting their early form of biological warfare upon the Indian lords at Fort Pitt, their superiors were discussing similar plans. General Amherst, having learned that smallpox had broken out among the garrison at Fort Pitt, and after learning on July 7 of the loss of his forts at Venango, Le Boeuf and Presqu'Isle, wrote to Colonel Bouquet, "Could it not be contrived to send the small pox among the disaffected tribes of Indians? We must on this occasion use every stratagem in our power to reduce them." In addition, Amherst wrote, "Captain Ecuyer Seems to Act with great Prudence, & I approve of everything he mentions to have done." Bouquet, who was already marching to relieve Fort Pitt and Fort Detroit, responded on the 13th, "I will try to inoculate the Indians with some blankets that may fall into their hands, and take care not to get the disease myself. I wish we could make use of the Spanish method to hunt them with English dogs, supported by rangers and some light horse, who would, I think, effectually extirpate or remove that vermin." On July 16, Amherst replied, "You will do well to try to inoculate the Indians by means of blankets, as well as to try every other method that can serve to extirpate this execrable race. I should be very glad your scheme for hunting them down by dogs could take effect, but England is at too great a distance to think of that at present."

General Amherst, July 8: "Could it not be contrived to Send the Small Pox among those Disaffected Tribes of Indians? We must, on this occasion, Use Every Stratagem in our power to Reduce them."
Colonel Bouquet, July 13: "I will try to inoculate the Indians by means of Blankets that may fall in their hands, taking care however not to get the disease myself."
Amherst, July 16: "You will Do well to try to Inoculate the Indians by means of Blankets, as well as to try Every other method that can serve to Extirpate this Execrable Race."
Bouquet, July 19: "all your Directions will be observed." Papers of Col. Henry Bouquet, ed. Stevens and Kent, ser. 21634, p. 161.

A devastating smallpox epidemic plagued Native American tribes in the Ohio Valley and Great Lakes area through 1763 and 1764, but the effectiveness of individual instances of biological warfare remains unknown. After extensive review of surviving documentary evidence, historian Francis Jennings concluded the attempt at biological warfare was "unquestionably effective at Fort Pitt"; Barbara Mann deduced "it is important to note that the smallpox distribution worked"; Howard Peckham noted the resulting fatal epidemic "certainly affected their vigorous prosecution of the war". Philip Ranlet notes that there is no evidence that the scheme worked: there is no information about how fresh the blankets were or how they were stored, Trent would have likely bragged in his journal if the scheme had worked, but he is silent as to what happened, and the tribe had just had a smallpox epidemic, so the blankets would have been fairly pointless in any case.

Frequency and efficacy of biological weapon usage

There has been some dissent to the accepted history that certain outbreaks of smallpox were caused by the intentional spreading of disease, for example when smallpox-infested blankets were intentionally given to Native Americans in 1763 at the Siege of Fort Pitt. Nineteenth century historian Francis Parkman, the first to research these events, described "the shameful plan of infecting the Indians" as "detestable". There is persuasive scholarly support that such incidents likely have occurred more frequently than scholars have acknowledged, but with such actions considered beyond the pale of civilized behavior, incriminating documentation would be scarce. Efforts have since been made to justify the acts of biological aggression, deny that they happened, minimize the injury or otherwise reduce the stigma associated with being the perpetrators of such acts. Captain Ecuyer's official report, written at the time of the incident and in great detail, notably did not mention the tainted gifts. According to biological warfare expert Mark Wheelis, Ecuyer considered concealing the event and acknowledged the deed in his ledgers only after learning that his superiors were ordering the same course of action. The most widely cited expert on the subject, Elizabeth Fenn, has observed, "It is also possible that documents relating to such a plan were deliberately destroyed." Peckham noted that, "oddly enough", the incriminating pages from Amherst and Bouquet were missing from the Canadian Archives transcripts as well as the collection published by the Pennsylvania Historical Commission. Likewise, Mann has described documents which have gone missing after "later sanitation", and has documented efforts by "Amherst apologists" and others who conjecture about, minimize and even dispute the instances of European perfidy. One historian says that though blankets containing smallpox were distributed to Native Americans by the Europeans, they may have been given with good will and intentions, instead of for the purpose of disseminating disease, contrary to what was clearly recorded in the trade ledgers and personal journals. Additionally, scholars such as Gregory Dowd, are of the opinion that disease was also spread by Native Americans returning from battling infected Europeans, and therefore it may also have been spread by Native Americans to their own people. Dixon has suggested that the attempt to infect the Indians near Fort Pitt "may well have been a failure", and Ranlet has speculated that "either the smallpox virus was already dead on the unpleasant gifts or that the presents simply failed to fulfill Trent's ardent desire to infect the Indians". Mann has called such assumptions "demonstrably false", and Wheelis has concluded that while there may have been several simultaneous routes of transmission for the epidemic, and the effect of each attempt is impossible to determine, "the act of biological aggression at Fort Pitt is indisputable".

Colonist accounts of smallpox effects on the native peoples

These foreign diseases were a constant threat to the native peoples of the Americas since the late fifteenth century. The attempt to "inoculate" the native tribes in the area by giving tainted objects to their dignitaries Turtle's Heart and Mamaltee, is documented in William Trent's journal. Thomas Hutchins, in his August 1762 Journal entry among the Natives at Ohio's Fort Miami, named for the Mineamie people, reports:

The 20th, The above Indians met, and the Ouiatanon Chief spoke in behalf of his and the Kickaupoo Nations as follows: '"Brother, We are very thankful to Sir William Johnson for sending you to enquire into the State of the Indians. We assure you we are Rendered very miserable at Present on Account of a Severe Sickness that has seiz'd almost all our People, many of which have died lately, and many more likely to Die. ... '"The 30th, Set out for the Lower Shawneese Town' and arriv'd 8th of September in the afternoon. I could not have a meeting with the Shawneese untill the 12th, as their People were Sick and Dying every day.

Gershom Hicks, held captive by the Shawnee and Delaware between May 1763 and April 1764, reported to the 42nd Regiment Captain William Grant "that the Small pox has been very general & raging amongst the Indians since last spring and that 30 or 40 Mingoes, as many Delawares and some Shawneese Died all of the Small pox since that time, that it still continues amongst them".

John McCullough, a Delaware captive since July, 1756, who was then 15 years old, wrote: "Soon after we got home to Mahoning, instead of taking me to Pittsburgh, agreeable to their promise, they set out on their Fall hunt, taking me along with them; we staid out till some time in the Winter before we returned." He continues that, on June 2, 1763, "Shortly after the commencement of the war, they plundered a tanyard near to Pittsburgh, and carried away several horse-loads of leather" and recalled that, beginning on July 5, 1763. the Lenape people, under the leadership of Shamokin Daniel, "committed several depredations along the Juniata; it happened to be at a time when the smallpox was in the settlement where they were murdering, the consequence was, a number of them got infected, and some died before they got home, others shortly after; those who took it after their return, were immediately moved out of the town, and put under the care of one who had the disease before."

Mary Jemison, a Seneca captive, was taken in 1755 in what is now Adams County, Pennsylvania. She married a Delaware, and later chose to remain with the Seneca. In James E. Seaver's (Jemison's biographer) interview, she described her many hardships, including travels to Fort Pitt. In 1762, her seventh year of captivity, she reported the death of her first husband from "sickness".

Contemporary diseases

The leading causes of death by percentage for Native Americans and Alaska Natives for 2005. Heart disease accounted for 25% of deaths, cancer 22%, accidents 19%, diabetes 7%, liver disease 6%, suicide 6%, respiratory diseases 6%, stroke 4%, homicide 3%, and influenza and pneumonia 3%.

 

Native Americans share many of the same health concerns as their non-Native American, United States citizen counterparts. For instance, Native Americans leading causes of death include "heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke". Other health concerns include "high prevalence and risk factors for mental health and suicide, obesity, substance abuse, sudden infant death syndrome (SIDS), teenage pregnancy, liver disease, and hepatitis." The leading causes of death for Native Americans include the following diseases: heart disease, cancer, diabetes, and chronic liver disease / cirrhosis. Overall, Native American life expectancy at birth (as of 2008) is 73.7 years, 4.4 years shorter than the United States average.

Though many of these appear to be concerns paralleling those of non-Native Americans, some of these diseases present a much greater threat to Native Americans' well-being. American Indians and Alaska Natives die at greater rates from: chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases. These discrepancies in disease patterns vary significantly between diseases, but have a significant impact on the population.

The genetic composition of Native Americans and clans can have an influence on many diseases and their continuing presence. The commonly lower socioeconomic status limits the ability of many to receive adequate health care and make use of preventative measures. Also, certain behaviors that take place commonly in the Native American culture can increase risk of disease. When the period of tribal termination in the 20th century occurred, post termination many tribes could no longer afford to keep their hospitals open.

Native Americans have higher rates of tobacco use than white, Asian, or black communities. Native American men are about as likely to be moderate to heavy drinkers as white men, but about 5–15% more likely to be moderate to heavy drinkers than black or Asian men. Native Americans are 10% less likely to be at a healthy weight than white adults, and 30% less likely to be at a healthy weight than Asian adults. On a similar note, they have far greater rates of obesity, and were also less likely to engage in regular physical activity than white adults.

Data collected by means of secondary sources such as the US Census Bureau and the Centers for Disease Control and Prevention's National Center for Health Statistics showed that from 1999 to 2009 Alaska Natives and Native Americans had high mortality rates to infectious diseases when compared to the mortality rate of white Americans. Alaska natives from the age groups 0–19 and 20–49 had death rates 4 to 5 times higher than compared to whites. Native Americans from the 20–49 age group in the Northern Plains were also 4 to 5 times more likely to die to infectious diseases than whites. Also found was that Native American and Alaska Natives were 13 times more likely to contract tuberculosis than whites.

Native Americans were at least twice as likely to have unmet medical needs due to cost and were much less likely to have seen a dentist within the last five years compared with white or Asian adults, putting them at risk for gingivitis and other oral diseases. As it stands, Native American/ Alaska Natives face high rates of health disparity compared to other ethnic groups.

Heart disease

The leading cause of death of Native Americans is heart disease. In 2005, it claimed 2,659 Native American lives. Heart disease occurs in Native American populations at a rate 20 percent greater than all other United States races. Additionally, the demographic of Native Americans who die from heart disease is younger than other United States races, with 36% dying of heart disease before age 65. The highest heart disease death rates are located primarily in South Dakota and North Dakota, Wisconsin, and Michigan.

Heart disease in Native Americans is not only due to diabetic complications; the increased risk is also due to higher rates of hypertension. Native American populations have been documented as being more likely to have high blood pressure than other groups, such as white Caucasians. Studies have also been conducted that associate the exposure to stress and trauma to an increased rate of heart disease. It has been documented in Native American populations that adverse childhood experiences, which are significantly more common in the Native American demographic, have a positively linear relationship with heart disease, as well an increasing influence on symptoms of heart disease.

Cancer

Cancer has a documented presence among Native Americans, and the rates of certain types of cancer exceed that of the general population of the United States. For instance, Native American males were twice as likely to have liver cancer than white males in 2001–05. Women are 2.4 times as likely to contract and die from liver cancer as their white counterparts. Rates of alcoholism of Native Americans are also greater than in the general population.

Stomach cancer was also 1.8 times more common in Native American males than white males, in addition to being twice as likely to be fatal. Other cancers, such as kidney cancer, are more common among Native American populations. It is important to note that overall cancer rates are lower among Native Americans compared to the white population of the United States. For cancers that are more prevalent in Native Americans than the white United States population, death rates are higher.

Diabetes

The rates of death by diabetes for each race and ethnicity in the United States in 2005

 

Diabetes has posed a significant health risk to Native Americans. Type I diabetes is rare among Native Americans. Type II diabetes is a much more significant problem and is the type of diabetes referred to in the remainder of this section. The prevalence of diabetes began primarily in the middle of the twentieth century and has grown into an epidemic. This time frame coincides with the fact that Indians were now living on reservations. With the uprooting of Indians and their traditional way of life, and being put onto reservations, this removed not only their main source of exercise with hunting and gathering, but also the healthier food that they were used to eating. About 16.3% of Native American adults have been diagnosed with diabetes. Type two diabetes and the complications that follow have gone from being acute infectious diseases to chronic illnesses within Native American and Alaska Native communities. Native Americans and Alaska Natives experience high rates of end-stage renal disease, which is mainly driven by, and directly correlates with, the increase in diabetes within their communities.

Native Americans are about 2.8 times more likely to have Type II diabetes than white individuals of comparable age. The rates of diabetes among Native Americans also continue to rise. During the eight-year span of 1990 to 1998, diabetes grew 65% among the Native American population. This is very significant growth, and this growth continues in the present day.

The highest rates of diabetes in the world are also found among a Native American tribe. The Pima tribe of Arizona took part in a research study on diabetes which documented diabetes rates within the tribe. This study found that the Pimas had diabetes rates 13 times that of population of Rochester, Minnesota, a primarily white populace. Diabetes was documented in over one third of Pimas from ages 35–44, and in over sixty percent of those over 45 years of age.

There are multiple causes for diabetes to cast such a presence on the Native American demographic:

Genetic predisposition 

Native Americans with the "least genetic admixture with other groups" have been found to be at a higher risk of developing diabetes. the genetic makeup of the American Indian allowed their bodies to store energy for use in times of famine. When food was plentiful, their bodies would store excess carbs through an exaggerated secretion of insulin called hypersulinemia, and be able to use this stored energy when food was scarce. When feast or famine was no longer an issue, and food was always plentiful, with modern, high caloric foods, their bodies may not have been able to handle the excess fat and calories, resulting in type II diabetes.

Obesity 

Native Americans have a significant health problem with obesity, as they are 1.6 times more likely to be obese than a white American.; Native Americans are as likely as black adults to be obese. Obesity is known as a general causative factor of diabetes, which is generally caused by Food Deserts, a lack of readily available nutritious foods, in reservations.

Low birth weight 

The correlation between low birth weight and increased risk of diabetes has been documented in Native American populations

Diet 

Changes in Native American diets have been associated with the increase in diabetes, as more high calorie and high fat foods are consumed, replacing the traditionally agriculturally driven diet. As time has gone there has been a push for Native Americans to return to their traditional ways; including growing and eating traditional foods. The Centers for Disease Control and Prevention (CDC) has been a huge proponent of Native Americans returning to traditional diets. Even going as far as too make a PSA in 2013, which involved Cherokee actors discussing diabetes, and the impact diet has on their increased risk. In the past several years agencies such as the IHS (part of the U.S. Public Health Svc.) & the Division of Diabetes Treatment and Prevention (DDTP) have offered up 19 diabetes programs, 12 control officers, and 399 grant programs such as SDPI (Special Diabetes program for Indians), aimed at educating and helping Native Americans to hopefully one day abolish diabetes for good.

Mental health

Other issues that Native Americans are facing are mental health and suicide. Native Americans have the highest rate of suicide out of any ethnic group in the United States, in 2009 suicide was the leading cause of death among Native Americans and Native Alaskans between the ages of 10 and 34. 75% of deaths among Native Americans and Native Alaskans over the age of 10 are due to unintentional injury, homicide, and suicide. Suicide rates among Native American youths is significantly higher than the suicide rates among white youths. The head of the IHS, Mary L. Smith, says that there will be a new focus on mental health issues in Native American communities, and that since there is a tremendous amount of suicide among teens on the Pine Ridge reservation they are designating it a Promise Zone and sending extra help.

Impact

The significant presence of diabetes also brings other health complications, such as end-stage renal disease. Each of these are more prevalent in the Native American population. Diabetes has caused premature death of Native Americans by vascular disease, especially in those diagnosed with diabetes later in life. It has been reported among the Pima Tribe to cause elevated urinary albumin excretion. Native Americans with diabetes have a significantly higher rate of heart disease than those without diabetes, and cardiovascular disease is the "leading underlying cause of death in diabetic adults" in Native Americans.

Diabetes has caused nephropathy among Native Americans, leading to renal function deterioration, failure, and disease. Prior to the increase in cardiovascular disease among diabetic Native Americans, renal disease was the leading cause of death. Another complication documented in diabetic Native Americans, as well as other diabetic populations, is retinopathy.

Lower extremity amputations are also higher among Native American populations with diabetes. In studies of the Pima tribes, those with diabetes were found to have much higher prevalence of periodontal disease. Additionally, those with diabetes have higher instances of bacterial and fungal infection. This is seen in statistics such as "diabetic Sioux (Lakota people) Tribes were four times as likely to have tuberculosis as those without diabetes."

Prior to the 1940s diabetes was virtually unheard of, but ever since the 1960s the prevalence has been on the rise. This rise is thought to be in part due to their food history and culture. Native Americans had a diverse food history prior to colonization, but after colonization the natives were forced to live on non-traditional lands and eat government hand-outs for food. Much of this food was of low quality, meaning that here is not much nutritional content for the caloric intake and led to many Natives being malnourished. 

Native Americans with diabetes have a death rate three times higher than those in the non-Native population. Diabetes can shorten a person's life by approximately 15 years. As of 2012, diabetes was not the leading cause of death for Native Americans itself but contributed significantly to the top leading causes of death.

The barriers for Native Americans and Alaskan Natives to receive proper health care include the isolated locations of some tribes make traveling to facilities far too difficult to travel the distance, hazardous roads, high rates of poverty, and too few staff in hospitals near reservations. Another contributing factor is that Native people generally wait longer for organ transplants than white people. Diabetes is primary cause of end-stage renal disease, and dialysis treatments and kidney transplants remain the most effective methods of treatment

Alcoholism

Another significant concern in Native American health is alcoholism. Alcoholism in the modern day is approached as a disease, and has been strongly linked to genetics and social circumstances. The rate of death from alcoholism in Native Americans is about five times that of all races in the United States. However, due to the nature of alcoholism and the behaviors involved, the disease model is not always applicable. It is clearly a disorder that has many factors, but the behavioral component distinguishes it from many other diseases, such as those previously discussed. Alcoholism, along with drug use, is discussed in Modern social statistics of Native Americans. However, In contrast to enduring and often racist stories about extraordinarily high rates of alcohol abuse among Native Americans, University of Arizona researchers have found that Native Americans’ binge and heavy drinking rates actually match those of whites. The groups differed regarding abstinence: Native Americans were more likely to abstain from alcohol use. 

The “Drunken Indian” myth perpetuates a stereotype that affects everything from the kind of jobs a native person gets, to the kind of diagnosis that a doctor gives a native person.

From the National Survey on Drug Use and Health (spanning from 2009 to 2013 which included data from more than 4,000 Native Americans and 170,000 whites), and The Behavioral Risk Factor Surveillance System survey (conducted between 2011 and 2013, covered more than 21,000 Native Americans and 1 million whites) about 17 percent of whites and Native Americans were binge drinkers. When asked about the last time they had a drink, 40% percent of Native Americans had a drink during the previous month, compared to 43 percent of whites who did consume alcohol in the previous month. Despite only drinking marginally less than white people, Native Americans may be more vulnerable to the risks associated with drinking because of other issues, such as a lack of access to health care, safe housing and clean water

HIV/AIDS

HIV and AIDS are growing concerns for the Native American population. The overall percentage of Native Americans diagnosed with either HIV or AIDS within the entire United States population is relatively small. Native American AIDS cases make up approximately 0.5% of the nation's cases, while they account for about 1.5% of the total population.

Native Americans and Alaska Natives rank third in the United States in the rate of new HIV infections. Native Americans, when counted with Alaskan Natives, have a 40% higher rate of AIDS than white individuals. Also, Native American and Alaskan Native women have double the rate of AIDS of white women.

These statistics have multiple suggested causes:

Sexual behaviors 

Previous studies of high rates of sexually transmitted diseases among Native Americans lead to the conclusion that the sexual tendencies of Native Americans lead to greater transmission

Illicit drug use 

The use of illicit drugs is documented to be very high among Native Americans, and not only does the involvement of individuals with illicit drugs correlate with greater rates of sexually transmitted disease, but it can facilitate the spread of diseases

Socio-economic status 

Due to the poverty and lower rates of education, the risk of getting AIDS or any other sexually transmitted disease can be increased indirectly or directly

Testing and data collection 

Native Americans may have limited access to testing for HIV/AIDS due to location away from certain health facilities; data collected on Native American sexually transmitted diseases may be limited for this same reason as well as for under-reporting and the Native American race being misclassified

Culture and tradition 

Native American culture is not always welcoming of open discussion of sexually transmitted diseases

Stroke

Stroke is the sixth-leading cause of death in the Native American population. Native Americans are sixty percent more likely than white adults in the United States to have a stroke. Native American women have double the rate of stroke of white women. About 3.6% of Native American and Alaska Native men and women over 18 have a stroke. The stroke death rate of Native Americans and Alaska Natives is 14 percent greater than among all races.

Combating disease and epidemics

Many initiatives have been put in place to combat Native American disease and improve the overall health of this demographic. One primary example of such initiative by the government is the Indian Health Service which works "to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to Native American and Alaska Native people". There are many other governmental divisions and funding for health care programs relating to Native American diseases, as well as a multitude of programs administered by tribes themselves.

Legislature

Healthcare for Native Americans were provided through the Department of War (throughout the 1800s) until it became a focus of the Office of Indian Affairs in the late 1800s. It again switched government agencies in the early 1950s, going under the supervision of the Department of Health, Education, and Welfare's Public Health Service (PHS). In 1955, the Indian Health Service division was created, which still enacts the majority of Native American specific healthcare.

The Snyder Act of 1921 (23 U.S.C. 13) was one of the first formal legislative pieces to allow healthcare to be provided to Native Americans.

In the 1970s, more legislature began passing to expand the healthcare access for Native Americans.

Diabetes programs

Eagle books are a book series produced by the CDC to inform Native American children about healthy lifestyles to prevent diabetes.

 

As diabetes is one of the utmost concerns of the Native American population, many programs have been initiated to combat this disease.

Governmental programs

One such initiative has been developed by the Centers for Disease Control and Prevention (CDC). Termed the "Native Diabetes Wellness Program", this program began in 2004 with the vision of an "Indian Country free of the devastation of diabetes". To realize this vision, the program works with Native American communities, governmental health institutions, other divisions of the CDC, and additional outside partners. Together they develop health programs and community efforts to combat health inequalities and in turn prevent diabetes. The four main goals of the Native Diabetes Wellness Program are to promote general health in Native communities (physical activity, traditional foods), spread narratives of traditional health and survival in all aspects of life, utilize and evaluate health programs and education, and promote productive interaction with the state and federal governments.

Funding for these efforts is provided by the Balanced Budget Act of 1997, Public Law 105-33, and the Indian Health Service. One successful aim of this program is the Eagle Books series, which are books using animals as characters to depict a healthy lifestyle that prevents diabetes, including embracing physical activity and healthy food. These books were written by Georgia Perez, who worked with the University of New Mexico's Native American Diabetes Project. Other successful efforts include Diabetes Talking Circles to address diabetes and share a healthy living message and education in schools. The Native Diabetes Wellness Program also has worked with tribes to establish food programs that support the "use of traditional foods and sustainable ecological approaches" to prevent diabetes. 

The Indian Health Service has also worked to control the diabetes prevalence among Native Americans. The IHS National Diabetes Program was created in 1979 to combat the escalating diabetes epidemic. The current head of the IHS, Mary L. Smith, Cherokee, took the position in March 2016 and had pledged to improve the IHS and focus on comprehensive health care for all the tribes and people covered by the department. A sector of the service is the Division of Diabetes Treatment and Prevention, which "is responsible for developing, documenting, and sustaining clinical and public health efforts to treat and prevent diabetes in Native Americans and Alaska Natives".

This division contains the Special Diabetes Program for Indians, as created by 1997 Congressional legislation. This program receives $150 million a year in order to work on "Community-Directed Diabetes Programs, Demonstration Projects, and strengthening the diabetes data infrastructure". The Community-Directed Diabetes Programs are programs designed specifically for Native American community needs to intervene in order to prevent and treat diabetes. Demonstration Projects "use the latest scientific findings and demonstrate new approaches to address diabetes prevention and cardiovascular risk reduction". Strengthening the diabetes data infrastructure is an effort to attain a greater base of health information, specifically for the IHS electronic health record.

In addition to the Special Diabetes Program for Native Americans, the IHS combats diabetes with Model Diabetes Programs and the Integrated Diabetes Education Recognition Program. There are 19 Model Diabetes Programs which work to "develop effective approaches to diabetes care, provide diabetes education, and translate and develop new approaches to diabetes control". The Integrated Diabetes Education Recognition Program is an IHS program that works towards high-quality diabetes education programs by utilizing a three-staged accreditation scale. Native American programs in healthcare facilities can receive accreditation and guidance to effectively educate the community concerning diabetes self-management.

Tribal programs

Many tribes themselves have begun programs to address the diabetes epidemic, which can be specifically designed to address the concerns of the specific tribe. The Te-Moak Tribe of Western Shoshone have created their diabetes program. With this program, they hope to promote healthy lifestyles with exercise and modified eating and behavior. The means of achieving these ends including "a Walking Club, 5 a Day Fruits and Vegetable, Nutrition teaching, Exercise focusing, 28 day to Diabetes Control, and Children's Cookbook". Additionally, the Te-Moak tribe has constructed facilities to promote healthy lifestyles, such as a center to house the diabetes program and a park with a playground to promote active living.

The Meskwaki Tribe of the Mississippi has also formed diabetes program to provide for the tribe's people. The Meskwaki Tribe facilitates their program to eliminate diabetes as a health concern through prevention and control of complications. The program has a team mentality, as community, education and clinical services are all involved as well as community organizations and members.

There are many facets of this diabetes program, which include the distribution of diabetes information. This is achieved through bi-weekly articles in the Meskwaki Times educating the population about diabetes prevention and happenings in the program and additional educational materials available about diabetes topics. Other educational is spread through nutrition and diabetes classes, such as the Diabetes Prevention Intensive Lifestyle Curriculum Classes, and events like health fairs and walks. Medical care is also available. This includes bi-weekly diabetes clinics, screenings for diabetes and related health concerns and basic supplied.

HIV-AIDS programs

Official seal of the National Native HIV/AIDS Awareness Day

 

Multiple programs exist to address the HIV and AIDS concerns for Native Americans. Within the Indian Health Service, an HIV/AIDS Principal Consultant heads an HIV/AIDS program. This program involves many different areas to address "treatment, prevention, policy, advocacy, monitoring, evaluation, and research". They work through many social outputs to prevent the masses from the epidemic and enlist the help of many facilities to spread this message.

The Indian Health Service also works with Minority AIDS Initiative to use funding to establish AIDS projects. This funding has been used to create testing, chronic care, and quality care initiatives as well as training and camps. The Minority AIDS Initiative operates through the Ryan White HIV/AIDS Program, under the Public Health Service Act. This is in recognition of the disproportionate impact of HIV/AIDS on racial and ethnic minorities.

There has also been a National Native HIV/AIDS Awareness Day held on March 20 for Native Americans, Alaska Natives, and Native Hawaiians, with 2009 marking its third year. This day is held to:

1. encourage Native people to get educated and to learn more about HIV/AIDS and its impact in their community;
2. work together to encourage testing options and HIV counseling in Native communities; and
3. help decrease the stigma associated with HIV/AIDS.

This day takes place across the United States with many groups working in coordination, groups like the CDC and the National Native Capacity Building Assistance Network. By putting out press releases, displaying posters, and holding community events, these groups hope to raise awareness of the HIV/AIDS epidemic.

Heart disease and stroke programs

The United States CDC contains a Division for Heart Disease and Stroke Prevention, and collects data and specifically releases information to form policy for Native Americans. They have identified many areas in which lifestyles of Native Americans need to be changed in order to greatly decrease the prevalence of heart disease and stroke. One major concern to prevent is diabetes, which directly relates to the presence of heart disease. Many general health concerns also need to be addressed, according to the CDC's observations, including moderating alcohol use, eliminating tobacco use, maintaining health body weight, regularizing physical activity, diet, and nutrition, preventing and controlling high blood cholesterol, and preventing and controlling high blood pressure.

The Indian Health Service works in collaboration with the University of Arizona College of Medicine to maintain the Native American Cardiology Program. This is a program that acknowledges the changes in lifestyle and economics in the recent past which have ultimately increased the prevalence of heart attacks, coronary disease, and cardiac deaths. The Native American Cardiology Program prides itself in its cultural understanding, which allows it to tailor health care for its patients.

The program has many bases but has placed an emphasis on providing care to remote, rural areas in order for more people to be cared for. The Native American Cardiology Program's telemedicine component allows for health care to be made more accessible to Native Americans. This includes interpreting medical tests, offering specialist input and providing triage over the phone. The Native American Cardiology Program also has educational programs, such as lectures on cardiovascular disease and its impact, and outreach programs.