Reflecting on Indigenous health disparities on Columbus Day

This week we celebrated Columbus Day, when we mark the arrival of European culture to the shores of the ‘New World’. It can be easy to forget that there was nothing ‘new’ about these shores upon Columbus’s arrival. There were many existing cultures already present with their own religious beliefs, customs and ways of life. There are 566 recognized AI/AN tribes in the United States representing approximately 2% of the population. The effects of colonization on these groups has been permanent and detrimental and one facet where these effects continue to be visible is in health disparities which disproportionally affect American Indian (AI) and Alaskan Native (AN) people when compared to the broader community.
It is well known that colonization has incredibly detrimental effects on Indigenous populations. Often people are displaced from their traditional homes and food sources, exposed to new and possibly deadly disease agents, introduced to harmful substances such as alcohol and tobacco and forced to redesign their social norms to fit into the legal and financial frameworks imposed by colonizers. All of these factors have negative and direct health outcomes, which can be passed down through the generations as people are forced further and further from their traditional way of life, but also not fully embraced within the new colonial culture. AI/AN peoples experience the direct consequences of these factors through both social and health outcomes. They have very high rates of poverty, unemployment, substance use and low levels of education when compared to other segments of the population. These social factors have direct health outcomes such as lower life expectancy, high rates of teen pregnancy, suicide in young people, infant mortality rates and disproportionate burden of disease, largely due to preventable conditions such as heart disease, unintentional injury, diabetes and chronic liver disease and lung cancer.
These health outcomes are not just a product of historic social discrepancies, but are being fed by modern structures, which continue to widen the gap between AI/AN peoples and the rest of the population. While these tribes exist as sovereign entities within the U.S., they are entitled to health services from the federal government, which are provided on reservations through the Indian Health Service (IHS). The IHS provides medical care for approximately 2.2 million AI/AN individuals, however the U.S. census estimates that there are approximately 5 million AI/AN individuals in the US with more than half living outside of reservations and therefore unable to receive the benefit of the IHS program. Along with approximately half of all AI/AN peoples not having access to the IHS, it is estimated that almost 27% of all indigenous people in the United States lack health insurance. This leaves AI/AN individuals who choose to live outside of reservations with little choice in relation to access to health care.
In an era where we see a national push for expanded access to health and it is important that we do not leave AI/AN peoples behind, but instead meaningfully engage them in a disserted effort to bridge the social and health chasm in ways that are effective and culturally appropriate.