Closing the health disparity gap

Carole Anne Heart

Untold epidemics wiped out 95 percent of North and South America's Native
population after 1492, as described by Henry Dobyns and others. This had
more than a devastating impact on the tribes. Why is this fact important to
remember? Centuries later, tribes continue to struggle for survival.

The near-extinction, in the 1800s, of the North American bison has been
compared to the near-extinction of the American Indian population of the
United States at the same time. This analogy supports the stories, handed
down for generations, about the survival of the American Indian in North

In the 1871 Annual Report of the Commissioner, the number submitted for the
American Indian and Alaska Native population was 300,000 and diminishing.
This is a good starting point to begin a discussion on the present state of
American Indian health.

The 2000 Census Report listed approximately 4 million self-reporting
American Indian and Alaska Natives. The birth rate as a marker of the
wellness of a people, balanced with the death rate, details the status of
American Indians. While American Indians have a high birth rate, the real
question is what is their health status?

The IHS, in its publication "Trends in Indian Health," tells a consistently
reliable statistical story. When compared to the general population, of the
12 areas designated under the Indian Health system, Aberdeen Area
(consisting of the tribes residing in the states of North Dakota, South
Dakota, Nebraska and Iowa) exhibited the highest birth rate, 29.5 per 1,000
for the years 1996 - '98; however, they exhibited the greatest health
disparities when compared to the general population of the United States.

A people's quality of life is compressed between the high birth rate and
the high death rate. What is the quality of life experienced by American
Indian people residing in Aberdeen Area? The unemployment rate is as high
as 80 percent on Pine Ridge Reservation in South Dakota and as low as 42
percent for Spirit Lake Reservation in North Dakota. The unemployment rate
for the state of South Dakota is 4.3 percent; when that rate creeps a
percentage point higher, it is sign of something amiss in the economic

According to the 1990 U.S. Census, the median household income in the
Aberdeen Area was $19,897 while the figure for all U.S. households was

It has been reported that many families residing on Pine Ridge survive on
as little as $5,900 per year. Healthy People 2010 stated: "In general,
population groups that suffer the worst health status also are those that
have the highest poverty rates and the least education ... Higher incomes
permit increased access to medical care, enable people to afford better
housing and live in safer neighborhoods, and increase the opportunity to
engage in health-promoting behaviors."

Why are Indian reservations allowed to exist as Third World countries in a
country with a seemingly inexhaustible supply of resources, wealth and
unrivaled political power? This question is foremost on the minds of
American Indian leaders as they prepare for the annual budgetary battle
with the federal government to plead for health funding before
congressional committees.

The budget request submitted by the administration for 2007 has proposed
eliminating new hospital construction for tribes. At a time when tribes are
making a population comeback - when tribes are making progress in tackling
chronic diseases such as diabetes, cardiovascular disease, substance abuse
and cancer - this elimination of program funding as well as the failure to
increase critical line items will present a serious setback to the progress

Tribes have developed long-range goals and have been diligently working
toward economic self-sufficiency; however, that vision is blurred when
viewed through government-issued glasses. Tribal infrastructures need "a
certain amount of humanitarian assistance and repair" also. The real chance
that tribes have for economic self-sufficiency is to reach out and develop
alternative, innovative and productive partnerships with states and the
private sector.

The obligations agreed to within the treaties and affirmed through numerous
court decisions and acts of Congress reiterate the legal and moral
responsibility to tribes. In closing, a quote by President Bush is
appropriate: "The true mark of civilization is that the strong help the

Carole Anne Heart is the executive director of the Aberdeen Area Tribal
Chairmen's Health Board. She can be reached at (605) 721-1922 or Visit for more information.

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