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Monday, January 9, 2023

Health of Native Americans in the United States

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Health_of_Native_Americans_in_the_United_States

Native Americans are affected by noncommunicable illnesses related to social changes and contemporary eating habits. Increasing rates of obesity, poor nutrition, sedentary lifestyle, and social isolation affect many Americans. While subject to the same illnesses, Native Americans have higher morbidity and mortality to diabetes and cardiovascular disease as well as certain forms of cancer. Social and historical factors tend to promote unhealthy behaviors including suicide and alcohol dependence. Reduced access to health care in Native American communities means that these diseases as well as infections affect more people for longer periods of time.

Noncommunicable 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 use disorder, sudden infant death syndrome (SIDS), teenage pregnancy, liver disease, and hepatitis." The leading causes of death for Native Americans include the following: 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 these diseases are also prevalent among non-Native Americans, some present a much greater threat to Native Americans' health. 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 among diseases, but have a significant effect 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 preventive 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, some tribes that were terminated could no longer afford to keep their hospitals open.

In the early 21st century, Native Americans were documented as having 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 from 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 4 to 5 times more likely to die to infectious diseases than whites. 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. They 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. 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, 2,659 Native Americans died of this cause. 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 among Native Americans is due not only to diabetic complications, but also 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 European Americans. Some studies 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 is documented among Native Americans. The rates of certain types of cancer exceed that of the general population of the United States. For instance, in 2001–05 Native American males were twice as likely to have liver cancer than in white males. Women are 2.4 times as likely to contract and die from liver cancer as their white counterparts. Rates of alcohol use disorder of Native Americans are greater than in the general population.

Stomach cancer was 1.8 times more common in Native American males than white males, and was twice as likely to be fatal. Other cancers, such as kidney cancer, are more common among Native American populations. But overall cancer rates are lower among Native Americans than among 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; it is the type of diabetes discussed in the remainder of this section. Diabetes began to occur at higher rates among Native Americans in the middle of the twentieth century and has increased into what is called an epidemic. This time frame relates to generations having grown up on reservations, and, in some cases, adopting mainstream food and cultural patterns. They were largely prevented from following their traditional patterns of hunting and gathering, and they changed their traditional eating patterns. About 16.3% of Native American adults have been diagnosed with diabetes. Type two diabetes and its complications have become chronic illnesses within Native American and Alaska Native communities. Native Americans and Alaska Natives have 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 whites of comparable age. The rates of diabetes among Native Americans continue to rise. from 1990 to 1998, the rate of diabetes increased 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 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, which is predominately European American in ethnicity. Diabetes was documented in over one third of the Pima from ages 35–44, and in over sixty percent of those over 45 years of age.

There are multiple factors contributing to the prevalence of diabetes among Native Americans:

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 stored excess carbohydrates through an exaggerated secretion of insulin called hypersulinemia, and were 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: Obesity is a significant health problem for Native Americans, as they are 1.6 times more likely to be obese than white Americans. Native Americans are as likely as black adults to be obese. Obesity is known as a general causative factor of diabetes, and is related to the changes if diet as noted above.
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. Some tribes have begun programs to encourage their people to return to traditional ways to include growing, preparing, and eating traditional foods.

Several federal agencies are also trying to help. The Centers for Disease Control and Prevention (CDC) has also encouraged this approach; in 2013, it produced a public service announcement (PSA), in which Cherokee actors discussed diabetes, and the significance of diet on their increased risk. In the early 21st century, such agencies as the IHS (part of the U.S. Public Health Svc.) & the Division of Diabetes Treatment and Prevention (DDTP) have offered 19 diabetes programs, 12 control officers, and 399 grant programs such as SDPI (Special Diabetes program for Indians), aimed at aiding Native Americans to abolish diabetes for good.

Diabetes' effects

The prevalence of diabetes has resulted in related health complications, such as end-stage renal disease. Each of these is more prevalent in the Native American population. Diabetes has increased the rate of premature death of Native Americans by vascular disease, especially among 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. Cardiovascular disease is the "leading underlying cause of death in diabetic adults" in Native Americans.

Diabetes can cause nephropathy, 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 for this population. Another complication documented in diabetic Native Americans, as well as other diabetic populations, is retinopathy, causing the loss of sight.

Because of vascular and nerve damage from diabetes, Native Americans have a higher rate of lower extremity amputations than European Americans. In studies of the Pima tribes, those with diabetes were also found to have much higher prevalence of periodontal disease, and higher rates of bacterial and fungal infection. For instance, "diabetic Sioux (Lakota people) Tribes were four times as likely to have tuberculosis as those without diabetes."

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 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, and social isolation related to poverty. Travel to health facilities can be too difficult, given distance, hazardous roads, high rates of poverty, and too few staff in hospitals near reservations. Diabetes is the primary cause of end-stage renal disease. Dialysis treatments and kidney transplants remain the most effective methods of treatment, but distance limits access to the first, as noted above. In addition, Native people are documented as having to wait longer for organ transplants than white people.

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.

Psychosocial problems

Suicide

Native Americans face issues of depression and the highest rate suicide rate 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 are significantly higher than among white youths. The head of the IHS, Mary L. Smith, says that her agency is focusing on mental health issues in Native American communities. Because of numerous suicides among teens on the Pine Ridge Indian Reservation, it has been designated as a Promise Zone and the government is sending extra help.

A British Columbia study, published in 2007, reported an inverse correlation between Indigenous youth suicide and use of their heritage language. Language use is considered a cultural continuity factor, and it was more highly correlated to youth suicide than six other such cultural factors. Those bands that had higher rates of indigenous language use had lower rates of suicide. Since the late 20th century, numerous tribes have undertaken language revitalization programs in order to maintain their cultures. This study indicates such language use can also have positive effects on teens' mental health. The study recorded suicides among bands with higher use and those with lower use of indigenous languages. Communities with lesser language knowledge estimated 96.59 suicides per 100,000 individuals; the bands with greater language knowledge estimated 13 suicides per 100,000 people. Indigenous youths' mental health can be affected by the community's use of Indigenous language.

Alcohol use disorder

Another significant concern in Native American health is alcohol use disorder. From 2006 to 2010, alcohol-attributed deaths accounted for 11.7 percent of all Native American deaths, more than twice the rates of the general U.S. population. The median alcohol-attributed death rate for Native Americans (60.6 per 100,000) was twice as high as the rate for any other racial or ethnic group. Alcohol use disorder is often approached using the disease model of addiction, with biological, neurological, genetic, and environmental sources of origin. This model has been challenged by research showing that Native American behavior is frequently affected by trauma resulting from domestic violence, racial discrimination, poverty, homelessness, historical trauma, disenfranchised grief, and internalized oppression. Statistically, the incidence of alcohol use disorder among survivors of trauma is significantly elevated, with survivors of physical, emotional and sexual abuse in childhood having the highest rates of alcohol use disorder.

However, at least one recent study refutes the belief that Native Americans drink more than white Americans. Analysis of data from the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013 revealed that Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined. The survey included responses from 171,858 whites compared to 4,201 Native Americans. The majority (59.9%) of Native Americans abstained from drinking alcohol, whereas less than half (43.1%) of the white population surveyed abstained. Approximately 14.5% of Native Americans were light/moderate-only drinkers, versus 32.7% of whites. Native American and white binge drinking (5+ drinks on an occasion 1–4 days during the past month) estimates were similar: 17.3% and 16.7%, respectively. The two populations' heavy drinking (5+ drinks on an occasion 5+ days in the past month) estimates were also similar: 8.3% and 7.5%, respectively. Nonetheless, Native Americans may be more vulnerable to higher risks associated with drinking because of lack of access to health care, safe housing and clean water.

After colonial contact, white drunkenness was interpreted by whites as the misbehavior of an individual. Native drunkenness was interpreted in terms of the inferiority of a race. What emerged was a set of beliefs known as "firewater myths" that misrepresented the history, nature, sources and potential solutions to Native alcohol problems. These myths claim that:

American Indians have an inborn, insatiable appetite for alcohol.
American Indians are hypersensitive to alcohol (cannot "hold their liquor") and are inordinately vulnerable to addiction to alcohol.
American Indians are inordinately prone to violence when intoxicated.
These very traits produced immediate, devastating effects when alcohol was introduced to Native tribes via European contact.
The solutions to alcohol problems in Native communities lie in resources outside these communities.

Scientific literature has debunked many of these myths by documenting the wide variability of alcohol problems across and within Native tribes and the very different response that certain individuals have to alcohol as opposed to others.

The 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III) found that 19.2% of Native Americans surveyed had had an alcohol use disorder during the previous twelve months, and 43.4% had had an alcohol use disorder at some time during their lives (compared to 14.0% and 32.6% of whites, respectively). This contrasts sharply with the 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services, which surveyed adolescents and adults receiving treatment and found that 9.7% of Native Americans surveyed had had an alcohol use disorder during the previous twelve months (compared to 6.1% of whites). An analysis of surveys conducted between 2002 and 2016 determined that 34.4% of Native American adults used alcohol in 2016 (down from 44.7% in 2002).

Native American tribes with a higher level of traditional social integration and less pressure to modernize appear to have fewer alcohol-related problems. Tribes in which social interactions and family structure are disrupted by modernization and acculturative stress (i.e. young people leaving the community to find work) have higher rates of alcohol use and misuse. Native Americans living in urban areas have higher rates of alcohol use than those living in rural areas or on reservations, and more Native Americans living on reservations (where cultural cohesion tends to be stronger) abstain altogether from alcohol. Alaska Natives who follow a more traditional lifestyle have reported greater happiness and less frequent alcohol use for coping with stress.

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

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 legislation 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:

encourage Native people to get educated and to learn more about HIV/AIDS and its impact in their community;
work together to encourage testing options and HIV counseling in Native communities; and
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 Centers for Disease Control and Prevention contain a Division for Heart Disease and Stroke Prevention, which 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.

Alcohol treatment and prevention programs

SAMHSA's Office of Tribal Affairs and Policy

The Office of Tribal Affairs and Policy (OTAP) serves as primary point of contact between the Substance Abuse and Mental Health Services Administration (SAMHSA) and tribal governments, tribal organizations, and federal agencies on behavioral health issues that impact tribal communities. OTAP supports SAMHSA's efforts to implement the Tribal Law and Order Act (TLOA) of 2010 and the National Tribal Behavioral Health Agenda. The Office of Indian Alcohol and Substance Abuse (OIASA), an organizational component of OTAP, coordinates federal partners and provides tribes with technical assistance and resources to develop and enhance prevention and treatment programs for substance use disorders, including alcohol.

Indian Health Services

The Alcohol and Substance Abuse Program (ASAP) is a program for American Indian and Alaska Native individuals to reduce the incidence and prevalence of alcohol and substance use disorders. These programs are administered in tribal communities, including emergency, inpatient and outpatient treatment and rehabilitation services for individuals covered under Indian Health Services. It addresses and treats alcohol use disorder from a disease model perspective.

Tribal Action Plan

The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 was updated in 2010 to make requirements that the Office of Indian Alcohol and Substance Abuse (OIASA), a subdivision of SAMHSA, is to work with federal agencies to assist Native American communities in developing a Tribal Action Plan (TAP). The TAP coordinates resources and funding required to help mitigate levels of alcohol and substance abuse among the Native American population, as specified in the Indian Alcohol and Substance Abuse Memorandum of Agreement of August 2011, and executed by OIASA.

Contemporary Native American issues in the United States

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Contemporary_Native_American_issues_in_the_United_States

Contemporary Native American issues in the United States are issues arising in the late 20th century and early 21st century which affect Native Americans in the United States. Many issues stem from the subjugation of Native Americans in society, including societal discrimination, racism, cultural appropriation through sports mascots, and depictions in art. Native Americans have also been subject to substantial historical and intergenerational trauma that have resulted in significant public health issues like alcohol use disorder and risk of suicide.

Demographics

Poldine Carlo, author of Nulato: An Indian life on the Yukon, a Koyukon writer from Alaska

A little over one third of the 2,786,652 Native Americans in the United States live in three states: California at 413,382, Arizona at 294,137 and Oklahoma at 279,559. 70% of Native Americans lived in urban areas in 2012, up from 45% in 1970 and 8% in 1940. Many Urban Indians live in cities due to forced relocation by the United States government with legislative pieces such as the Indian Relocation Act of 1956 or due to the need for healthcare services not provided on or near reservations and tribe locations.

In the early 21st century, Native American communities have exhibited continual growth and revival, playing a larger role in the American economy and in the lives of Native Americans. Communities have consistently formed governments that administer services such as firefighting, natural resource management, social programs, health care, housing and law enforcement. Numerous tribes have founded tribal colleges.

Most Native American communities have established court systems to adjudicate matters related to local ordinances. Most also look to various forms of moral and social authority, such as forms of restorative justice, vested in the traditional culture of the tribal nation. Native American professionals have founded associations in journalism, law, medicine and other fields to encourage students in these fields, provide professional training and networking opportunities, and entry into mainstream institutions.

To address the housing needs of Native Americans, Congress passed the Native American Housing and Self Determination Act (NAHASDA) in 1996. This legislation replaced public housing built by the BIA and other 1937 Housing Act programs directed towards Indian Housing Authorities, with a block-grant program. It provides funds to be administered by the Tribes to develop their own housing.

Terminology differences

Native Americans are also commonly known as Indians or American Indians. A 1995 U.S. Census Bureau survey found that more Native Americans in the United States preferred American Indian to Native American. Most American Indians are comfortable with Indian, American Indian, and Native American, and the terms are often used interchangeably.

They have also been known as Aboriginal Americans, Amerindians, Amerinds, Colored, First Americans, Native Indians, Indigenous, Original Americans, Red Indians, Redskins or Red Men. The term Native American was introduced in the United States by academics in preference to the older term Indian to distinguish the indigenous peoples of the Americas from the people of India. Some academics believe that the term Indian should be considered outdated or offensive while many indigenous Americans, however, prefer the term American Indian.

Criticism of the neologism Native American comes from diverse sources. Some American Indians question the term Native American because, they argue, it serves to ease the conscience of "white America" with regard to past injustices done to American Indians by effectively eliminating "Indians" from the present. Others (both Indians and non-Indians) argue that Native American is problematic because "native of" literally means "born in," so any person born in the Americas could be considered "native". Others point out that anyone born in the United States is technically native to America, so "native" is sometimes substituted for "indigenous." The compound "Native American" is generally capitalized to differentiate the reference to the indigenous peoples. Russell Means, an American Indian activist, opposes the term Native American because he believes it was imposed by the government without the consent of American Indians. He has also argued that the use of the word Indian derives not from a confusion with India but from a Spanish expression En Dio, meaning "in God".

Societal discrimination and racism

A discriminatory sign posted above a bar. Birney, Montana, 1941.

Universities have conducted relatively little public opinion research on attitudes toward Native Americans. In 2007 the non-partisan Public Agenda organization conducted a focus group study. Most non-Native Americans admitted they rarely encountered Native Americans in their daily lives. While sympathetic toward Native Americans and expressing regret over the past, most people had only a vague understanding of the problems facing Native Americans today. For their part, Native Americans told researchers that they believed they continued to face prejudice and mistreatment in the broader society.

Affirmative action issues

Federal contractors and subcontractors such as businesses and educational institutions are legally required to adopt equal opportunity employment and affirmative action measures intended to prevent discrimination against employees or applicants for employment on the basis of "color, religion, sex, or national origin". For this purpose, an American Indian or Alaska Native is defined as "A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment." However, self-reporting is permitted, "Educational Institutions and Other Recipients Should Allow Students and Staff To Self-Identify Their Race and Ethnicity Unless Self-Identification Is Not Practicable or Feasible."

Self-reporting opens the door to "box checking" by people, who, despite not having a substantial relationship to Native American culture, either innocently or fraudulently "check the box" for Native American. On August 15, 2011, the American Bar Association passed a resolution recommending that law schools require supporting information such as evidence of tribal enrollment or connection with Native American culture.

Racial achievement gap regarding language

To evade a shift to English, some Native American tribes have initiated language immersion schools for children, where a native Indian language is the medium of instruction. For example, the Cherokee Nation instigated a 10-year language preservation plan that involved growing new fluent speakers of the Cherokee language from childhood on up through school immersion programs as well as a collaborative community effort to continue to use the language at home. This plan was part of an ambitious goal that in 50 years, 80% or more of the Cherokee people will be fluent in the language. The Cherokee Preservation Foundation has invested $3 million into opening schools, training teachers, and developing curricula for language education, as well as initiating community gatherings where the language can be actively used. Formed in 2006, the Kituwah Preservation & Education Program (KPEP) on the Qualla Boundary focuses on language immersion programs for children from birth to fifth grade, developing cultural resources for the general public and community language programs to foster the Cherokee language among adults.

There is also a Cherokee language immersion school in Tahlequah, Oklahoma that educates students from pre-school through eighth grade. Because Oklahoma's official language is English, Cherokee immersion students are hindered when taking state-mandated tests because they have little competence in English. The Department of Education of Oklahoma said that in 2012 state tests: 11% of the school's sixth-graders showed proficiency in math, and 25% showed proficiency in reading; 31% of the seventh-graders showed proficiency in math, and 87% showed proficiency in reading; 50% of the eighth-graders showed proficiency in math, and 78% showed proficiency in reading. The Oklahoma Department of Education listed the charter school as a Targeted Intervention school, meaning the school was identified as a low-performing school but has not so that it was a Priority School. Ultimately, the school made a C, or a 2.33 grade point average on the state's A-F report card system. The report card shows the school getting an F in mathematics achievement and mathematics growth, a C in social studies achievement, a D in reading achievement, and an A in reading growth and student attendance. “The C we made is tremendous,” said school principal Holly Davis, “[t]here is no English instruction in our school's younger grades, and we gave them this test in English." She said she had anticipated the low grade because it was the school's first year as a state-funded charter school, and many students had difficulty with English. Eighth graders who graduate from the Tahlequah immersion school are fluent speakers of the language, and they usually go on to attend Sequoyah High School where classes are taught in both English and Cherokee.

Native American mascots in sports

A student acting as Chief Osceola, the Florida State University mascot

American Indian activists in the United States and Canada have criticized the use of Native American mascots in sports as perpetuating stereotypes. European Americans have had a history of "playing Indian" that dates back to at least the 18th century. While supporters of the mascots say they embody the heroism of Native American warriors, AIM particularly has criticized the use of mascots as offensive and demeaning. In fact, many Native Americans compare this discrimination to examples for other demographics like black face for African Americans.

Could you imagine people mocking African Americans in black face at a game?" he said. "Yet go to a game where there is a team with an Indian name and you will see fans with war paint on their faces. Is this not the equivalent to black face?
— "Native American Mascots Big Issue in College Sports", Teaching Tolerance, May 9, 2001

While many universities and professional sports teams (for example, the Cleveland Indians, who had a Chief Wahoo) no longer use such images without consultation and approval by the respective nation, some lower-level schools continue to do so. However, others like Tomales Bay High and Sequoia High in the Bay Area of California, have retired their Indian mascots.

In August 2005, the National Collegiate Athletic Association (NCAA) banned the use of "hostile and abusive" Native American mascots in postseason tournaments. An exception was made to allow the use of tribal names if approved by that tribe (such as the Seminole Tribe of Florida's approving use of their name for the team of Florida State University.)

Environmental justice

Environmental justice academic case studies examine the erasure of indigenous culture and ways of life, resource exploitation, destruction of sacred land, environmental and indigenous health, and climate justice. From the arrival of white settlers, explorers and colonizers, Native Americans have suffered from genocide, introduced diseases, warfare, and the legacy of environmental racism persists in modern day. The environmental justice movement has largely left out the Native American experience, but findings have shown that Native land is being, and has been, used for landfills, dump sites, and locations to test nuclear weapons. However, while these uses cause harm to the peoples health, they are not always unwanted. The Mescalero Apache welcomed the proposal to have a monitored retrievable nuclear waste storage facility built on their land because over one-third of the tribal citizens were unemployed, and they lacked enough housing and any sort of school system. Jamie Vickery and Lori M. Hunter have stated that the natives are being coerced into accepting the nuclear waste storage facility by their own economic hardships, which in turn has been caused by the US government direct exploitation and marginalization.

Historical depictions in art

Secotan Indians' dance in North Carolina, watercolor by John White, 1585

American Indian on five-dollar silver certificate, 1899

A number of 19th and 20th-century United States and Canadian painters, often motivated by a desire to document and preserve Native culture, specialized in Native American subjects. Among the most prominent of these were Elbridge Ayer Burbank, George Catlin, Seth Eastman, Paul Kane, W. Langdon Kihn, Charles Bird King, Joseph Henry Sharp and John Mix Stanley. While many 19th-century images of Native Americans conveyed negative and unrepresentative messages, artists such as Charles Bird King portrayed Native American delegates with accuracy. His paintings are often used as records for Native American formal dress and customs. During the 16th century, the artist John White made watercolors and engravings of the people native to the southeastern states. John White's images were, for the most part, faithful likenesses of the people he observed. However, some like artist Theodore de Bry used White's original watercolors to alter the poses and features of White's figures to make them appear more European.

1892 sculpture by Alexander Milne Calder, installed on the Philadelphia City Hall.

There are also many depictions of Native Americans on federal buildings, statues, and memorials. During the construction of the Capitol building in the early 19th century, the U.S. government commissioned a series of four relief panels to crown the doorway of the Rotunda. The reliefs encapsulate a vision of European—Native American relations that had assumed mythic historical proportions by the 19th century. The four panels depict: The Preservation of Captain Smith by Pocahontas (1825) by Antonio Capellano, The Landing of the Pilgrims (1825) and The Conflict of Daniel Boone and the Indians (1826–27) by Enrico Causici and William Penn’s Treaty with the Indians (1827) by Nicholas Gevelot. The reliefs by European sculptors present versions of the Europeans and the Native Americans, in which the Europeans appear refined and the natives appear ferocious.

In the 20th century, early portrayals of Native Americans in movies and television roles were first performed by European Americans dressed in mock traditional attire. Examples included The Last of the Mohicans (1920), Hawkeye and the Last of the Mohicans (1957), and F Troop (1965–67). In later decades, Native American actors such as Jay Silverheels in The Lone Ranger television series (1949–57) came to prominence. Roles of Native Americans were limited and not reflective of Native American culture. For years, Native people on U.S. television were relegated to secondary, subordinate roles relative to the white protagonists as shown in notable works like Cheyenne (1957–1963) and Law of the Plainsman (1959–1963).

By the 1970s some Native American film roles began to show more complexity, such as those in Little Big Man (1970), Billy Jack (1971), and The Outlaw Josey Wales (1976) which depicted Native Americans in important lead and supporting roles. Regardless, the European narrative perspective was prioritized in popular media. The "sympathetic" yet contradictory film Dances With Wolves (1990) intentionally, according to Ella Shohat and Robert Stam, related the Lakota story through a Euro-American voice for wider impact among a general audience. Like the 1992 remake of The Last of the Mohicans and Geronimo: An American Legend (1993), Dances with Wolves employed a number of Native American actors, and made an effort to portray Indigenous languages. Many film scholars and Native Americans still criticize films like Dances with Wolves for its 'white savior' narrative that asserts European-Americans are the necessary saviors of people of color like Native Americans. In 1996, Plains Cree actor Michael Greyeyes would play renowned Native American warrior Crazy Horse in the 1996 television film Crazy Horse. Greyeyes would also later play renowned Sioux chief Sitting Bull in the 2017 movie Woman Walks Ahead.

The 1998 film Smoke Signals, which was set on the Coeur D'Alene Reservation and discussed hardships of present-day American Indian families living on reservations, featured numerous Native American actors as well. The film was also the first feature film to be produced and directed by Native Americans, and also the first feature to include an exclusive Native American cast. At the annual Sundance Film Festival, Smoke Signals would win the Audience Award and it's producer Chris Eyre, an enrolled member of the Cheyenne and Arapaho Tribes of Oklahoma, would win the Filmmaker's Trophy.

Many documentaries have been created partly in response to unbalanced coverage of Native American perspectives in history and partly to educate the public about the shared history of conflict between Native Americans and European colonists. In 2004 producer Guy Perrotta presented the film Mystic Voices: The Story of the Pequot War (2004), a television documentary on the Pequot War, which was the first major conflict between European colonists and indigenous peoples in North America. The documentary portrayed the conflict as a struggle between different value systems, which included not only the Pequot, but a number of other Native American tribes in Massachusetts, most of which allied with the colonists. Perrotta and Charles Clemmons, another producer, intended to increase public understanding of the significance of this early event. In 2009 We Shall Remain (2009), a television documentary by Ric Burns and part of the American Experience series, presented a five-episode series "from a Native American perspective". It represented "an unprecedented collaboration between Native and non-Native filmmakers and involves Native advisors and scholars at all levels of the project." The five episodes explore the impact of King Philip's War on the northeastern tribes, the "Native American confederacy" of Tecumseh's War, the US-forced relocation of Southeastern tribes known as the Trail of Tears, the pursuit and capture of Geronimo and the Apache Wars, and concludes with the Wounded Knee incident, participation by the American Indian Movement, and the increasing resurgence of modern Native cultures since.

Education

The majority of Native American youth attend public schools that are not tribally controlled. For those Native Americans who view education as a means of preserving their ancient knowledge, culture and language, this raises questions about tribal self-determination.

History

The first educational institutions for Native Americans were founded by missionaries. The primary objectives of missionary education were to civilize, individualize and Christianize Native American youth. Early colonial colleges, Harvard, William and Mary, Dartmouth and Hamilton, were established in part to educate Native Americans. Dartmouth College was the first college founded primarily for the education of Native Americans. Lack of support from the public and infighting amongst the missionaries led to the closure of most missionary schools in the 19th century.

During the 19th century, the Bureau of Indian Affairs (BIA) began to fund Native American education. The BIA founded boarding schools for Native American youth that were modeled after the off-reservation Carlisle Indian Industrial School. These government-run boarding schools were located at former military posts and used an assimilationist education model. Native American students were enrolled in the "outing system," a system where they were placed in white homes to work during the summers. Between 1870 and 1920, the federal government increased its role in providing Native American elementary and secondary school education, and boarding schools became the predominant form of Native American education.

In the 1960s, the Native American self-determination movement pushed for more tribal involvement in education. The Higher Education Act of 1965 provided for the development of postsecondary institutions for minority students. The passage of the Indian Self-Determination and Education Assistance Act of 1975 gave tribes the power to control their funds for welfare and education.

Today, approximately 92 percent of Native American youth attend public schools, and approximately eight percent attend schools operated or funded by the Bureau of Indian Education (BIE). Tribally controlled education has become a key part of the Native American self-determination movement.

Tribally controlled schools

In the early 1800s, the first tribally controlled schools were established by five Southeastern tribes: the Cherokee, Choctaw, Chickasaw, Cree and Seminole. The Indian Removal Act of 1830 and other federal forced relocation policies shut down these tribally controlled schools. The next 100 years of Native American education were dominated by missionary and federal run off-reservation boarding schools.

The 1960s saw the emergence of the Native American self-determination movement and a renewed support for tribally controlled education. The Bilingual Education Act (BEA) was passed in 1968 and recognized the need for community-controlled bilingual programs.

In 1965, the Navajo Education Department in cooperation with the Bureau of Indian Affairs (BIA), the U.S. Office of Economic Opportunity (OEO), and a nonprofit (DINE) established the first school with an all-Indian governing board—Rough Rock Community School. In 1968, Diné College (Navajo Community College originally) was established as the first tribally controlled college. Other tribes followed suit and in 1971 formed the Coalition of Indian-Controlled Schools. This coalition drove the creation and enactment of the Indian Self-Determination and Education Assistance Act of 1975.

In the years following the passage of the 1972 Indian Education Act and the Indian Self-Determination and Education Assistance Act of 1975, more than 75 tribally controlled primary and secondary schools, and 24 community colleges were established.

In 1973, the first six tribally controlled colleges joined together to found the American Indian Higher Education Consortium (AIHEC). Today, 37 tribally controlled colleges are part of the AIHEC.

The passage of the Native American Languages Act of 1990 guaranteed Native Americans the right to maintain and promote their languages and cultural systems through educational programs.

Currently, the Bureau of Indian Education (BIE) oversees 183 elementary and secondary schools, 126 of these schools are tribally controlled.

Contemporary challenges

Native American communities face significant educational challenges, such as inadequate school funding, lack of qualified teachers, student achievement gap, underrepresentation in higher education and high dropout rates.

Tribally controlled schools receive funding directly from the BIE. The implementation of the No Child Left Behind Act in 2001 at a state level made it so that tribally controlled schools had to assume responsibility for state-level tasks without support. The Act linked funding to test scores, which resulted in decreased funding for many tribally controlled schools.

Native American students have the lowest high school graduation rates of any minority in the United States. Dropout rates amongst Native American youth are also the highest in the nation. There is a 15 percent drop-out rate amongst Native American 16- to 24-year-olds, compared to the national average of 9.9 percent.

Native American students are underrepresented in higher education at the bachelor's, master's and doctoral levels. The recruitment and retention of Native American students at a university level is a major issue. Native American professors are also underrepresented; they make up less than one percent of higher education faculty.

There is a need for adequately trained teachers and appropriate curriculum in Native American education. Western education models are not hospitable to indigenous epistemologies. The No Child Left Behind Act and English-only ballot initiatives make it difficult to adopt culturally relevant curriculum.

STEM education

Tribes are attempting to incorporate Science, technology, engineering, and mathematics, STEM, curriculum into their education systems, but there is as yet no consensus on how to do so.

Native Americans are underrepresented by a factor of at least four in STEM disciplines. In 2012, Native American students accounted for only 0.6 percent of bachelor's degrees, 0.4 percent of master's degrees and 0.2 percent of doctoral degrees in science and engineering.

Benefits

Some tribes have used technology to preserve their culture and languages through digital storytelling, computer language platforms, audio recordings, webpages and other forms of media.

Technology also contributes to economic and educational development. STEM knowledge helps Native youth enter into Western jobs. Increased representation in STEM fields could aid the Native American self-determination movement. Native Americans in STEM could assume the role of controlling their own land and resources.

Concerns

Native and non-native scholars have developed curricula to integrate Western knowledge with indigenous knowledge, but there is no agreement on a best approach.

The federal government has funded projects in collaboration with Native American schools that focus on the use of technology to support culturally responsive curriculum. The implementation of these technologies and curricula remains almost non-existent at an institutional level.

Elders in tribal communities often fear that exposure to technology will result in assimilation. Underrepresentation in digital content contributes to this fear.

Digital equity is a concern as tribes have to appropriate resources for technological infrastructure maintenance, develop standards to protect sacred tribal information and determine how to promote tribal goals.

STEM curriculum is often dismissive of Native worldviews. Western STEM models contradict Native science because they emphasize individuality and humans as separate from the natural world. Science curriculum does not respect cultural taboos. Native American students view human and animal dissections as the most problematic STEM activities. Research suggests that a majority of Native American students would be more likely to take STEM classes if the curriculum was more respectful of taboos.

Potential solutions

Practices proven to increase Native student's interest in STEM are: caring mentors, hands-on learning, observational learning, collaboration, real-world applications and community involvement. Some tribal STEM programs are employing community-based science curriculum. The characteristics of community-based science curriculum are that it is local, place-based, hands-on, involves the community, incorporates system-thinking and a holistic view a science and explores multiple epistemologies.

The Science, Technology, Society (STS) model asks students to explore a problem that is relevant to them and their community. It incorporates human experiential context with science. Other models emphasize the value of incorporating Traditional ecological knowledge (TEK) and "indigenous realism," the recognition of the interconnectedness of everything in nature.

The Maker culture, or maker movement, is another model that has the potential to support minority youth in learning STEM. The Hackerspace can provide a positive, non-school based STEM learning experience for youth who are marginalized in school.

Crime on reservations

Prosecution of serious crime, historically endemic on reservations, was required by the 1885 Major Crimes Act, 18 U.S.C. §§1153, 3242, and court decisions to be investigated by the federal government, usually the Federal Bureau of Investigation, and prosecuted by United States Attorneys of the United States federal judicial district in which the reservation lies. An investigation by The Denver Post in 2007 found that crimes in Indian Country have been a low priority both with the FBI and most federal prosecutors. As of November 2012 federal resources were being reduced while high rates of crime continued to rise in Indian Country.

Often serious crimes have been either poorly investigated or prosecution has been declined. Tribal courts were limited to sentences of one year or less, until on July 29, 2010, the Tribal Law and Order Act was enacted which in some measure reforms the system permitting tribal courts to impose sentences of up to three years provided proceedings are recorded and additional rights are extended to defendants. The Justice Department on January 11, 2010, initiated the Indian Country Law Enforcement Initiative which recognizes problems with law enforcement on reservations and assigns top priority to solving existing problems.

The Department of Justice recognizes the unique legal relationship that the United States has with federally recognized tribes. As one aspect of this relationship, in much of Indian Country, the Justice Department alone has the authority to seek a conviction that carries an appropriate potential sentence when a serious crime has been committed. Our role as the primary prosecutor of serious crimes makes our responsibility to citizens in Indian Country unique and mandatory. Accordingly, public safety in tribal communities is a top priority for the Department of Justice.

Emphasis was placed on improving prosecution of crimes involving domestic violence and sexual assault.

Passed in 1953, Public Law 280 (PL 280) gave jurisdiction over criminal offenses involving Indians in Indian Country to certain States and allowed other States to assume jurisdiction. Subsequent legislation allowed States to retrocede jurisdiction, which has occurred in some areas. Some PL 280 reservations have experienced jurisdictional confusion, tribal discontent, and litigation, compounded by the lack of data on crime rates and law enforcement response.

As of 2012, a high incidence of rape continued to impact Native American women and Alaskan native women. According to the Justice Department 1 in 3 women have suffered rape or attempted rape, more than twice the national rate. 80% of Native American sexual assault victims report that their attacker was "non-Indian". As of 2013 inclusion of offenses by non-native men against native women in the Violence Against Women Act continued to present difficulties over the question of whether defendants who are not tribal members would be treated fairly by tribal courts or afforded constitutional guarantees. On June 6, 2012, the Justice Department announced a pilot plan to establish joint federal-tribal response teams on 6 Montana reservations to combat rape and sexual assault.

Gambling industry

Sandia Casino, owned by the Sandia Pueblo of New Mexico

Gambling has become a leading industry. Casinos operated by many Native American governments in the United States are creating a stream of gambling revenue that some communities are beginning to use as leverage to build diversified economies. Native American communities have waged and prevailed in legal battles to assure recognition of rights to self-determination and to use of natural resources. Some of those rights, known as treaty rights, are enumerated in early treaties signed with the young United States government. These casinos have brought an influx of money to the tribes; according to tribal accounting firm Joseph Eve, CPAs, the average net profit of Indian casinos is 38.85%.

Tribal sovereignty has become a cornerstone of American jurisprudence, and at least on the surface, in national legislative policies. Although many Native American tribes have casinos, the impact of Native American gaming is widely debated. Some tribes, such as the Winnemem Wintu of Redding, California, feel that casinos and their proceeds destroy culture from the inside out. These tribes refuse to participate in the gambling industry.

Public health

As of 2004, according to the United States Commission on Civil Rights: "Native Americans die of diabetes, alcohol use disorder, tuberculosis, suicide, and other health conditions at shocking rates. Beyond disturbingly high mortality rates, Native Americans also suffer a significantly lower health status and disproportionate rates of disease compared with all other Americans."

In addition to increasing numbers of American Indians entering the fields of community health and medicine, agencies working with Native American communities have sought partnerships, representatives of policy and program boards, and other ways to learn and respect their traditions and to integrate the benefits of Western medicine within their own cultural practices.

A comprehensive review of 32 articles about Indigenous Historical Trauma and its relation to health outcomes in Indigenous populations affirmed that historical hardships experienced by previous Indigenous generations can have a transmitted impact on the health and wellbeing of current Indigenous generations. The articles examined Indigenous populations in both the United States and Canada. The systematic review resulted in three categories of research.

19 articles focused on health outcomes for Indigenous people who experienced historical loss either personally or transgenerationally. Historical loss was measured in accordance with the Historical Loss Scale created by Whitbeck, Adams, et al.(2004). Twelve types of loss were identified, including "loss of our land" “loss of our language", and "loss of our traditional spiritual ways".
11 articles focused on the theme of residential school ancestry studies which took a closer look at Indigenous people mainstreamed into Indian boarding school systems and the correlated health impacts of those individuals or the relatives of those individuals.
three articles were categorized as "other". Two of the articles focused on the outcomes of a psychoeducation intervention and the remaining article examined the health outcomes of families who had a grandparent subjected to a relocation program.

Alcohol use disorder

The community suffers a vulnerability to and a disproportionately high rate of alcohol use disorder. Excess alcohol consumption is widespread in Native American communities. Native Americans use and misuse alcohol and other illicit substances at younger ages, and at higher rates, than that of all other ethnic groups. Consequently, their age-adjusted alcohol-related mortality rate is 5.3 times greater than the general population. The Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's National Household Survey on Drug Abuse reported the following for 1997: 19.8 percent of Native Americans ages 12 and older reported using illegal drugs that year, compared with 11.9 percent for the total U.S. population. Native Americans had the highest prevalence rates of marijuana and cocaine use, in addition to the need for drug abuse treatment.

Tribal governments have long prohibited the sale of alcohol on reservations, but generally, it is readily for sale in nearby border towns, and off-reservation businesses and states gain income from the business. As an example, in 2010, beer sales at off-reservation outlets in Whiteclay, Nebraska generated $413,932 that year in federal and sales taxes. Their customers are overwhelmingly Lakota from the Pine Ridge Indian Reservation in South Dakota.

Acknowledging that prohibition has not worked, in a major change in strategy since the late 20th century, as of 2007, 63 percent of the federally recognized tribes in the lower 48 states had legalized alcohol sales on their reservations. Among these, all the other tribes in South Dakota have legalized sales, as have many in Nebraska. The tribes decided to retain the revenues that previously would go to the states through retail sales taxes on this commodity. Legalizing the sales enables the tribes to keep more money within their reservation economies and support new businesses and services, as well as to directly regulate, police and control alcohol sales. The retained revenues enable them to provide health care and build facilities to better treat individuals and families suffering from alcohol use disorder. In some cases, legalization of alcohol sales also supported the development of resorts and casinos, to generate revenues for other economic enterprises.

Consequences of alcohol use disorder

Native Americans and Whites have the highest rates of Driving Under the Influence (DUI). A 2007 study conducted by the National Survey on Drug Use and Health (NSDUH) reports that 13.3% of Native Americans report past-year DUI.

Of 1660 people from seven Native American tribes, the lifetime prevalence of alcohol dependence ranged from 21%–56% for men and 17%–30% for women among all tribes. Physical and sexual abuse significantly increased the chances of alcohol dependence for men. Sexual abuse and boarding school attendance increased the odds of alcohol dependence among women. Native Americans, especially women, are at high risk for alcohol-related trauma, such as rape and assault.

Unintentional injuries due to alcohol use disorder

Unintentional injuries account for the third leading cause of death for Native Americans and the leading cause of death for Native Americans under 44 years old. Unintentional injuries include motor vehicle crashes, pedestrian-related motor vehicle crashes, drowning, and fire-related injuries. From 1985 to 1996, 1,484 Native American children died in motor vehicle crashes, which is twice the rate for white children.

National estimates of alcohol-related motor vehicle deaths show that Native Americans have a 250% higher death rate compared to the US population.