The Rate of Heart Disease among Native Americans - Research Paper Example

Health Disparities American Indians, as well as Alaska Native (AI/ANs), in the Northwest and in the entire US experience some of the greatest disease rates and demonstrate the poorest health among ethnic groups in the US. In the US census conducted in 2000, approximately 4.1 million Americans termed themselves as either fully or partly AI/ANs (Kunitz 161). This figure essentially represents at least 1.5% of the US population while, in the Northwestern states, AI/ANs constitute approximately 3.7% of the entire population. Throughout the initial half of the 20th century, AI/ANs had a shorter life expectancy than the general population and constantly suffered from increased prevalence of disease such as rheumatic fever and tuberculosis (US Public Health Service 17). This paper will examine health disparities among AI/ANs, discussing the degree to which current health care system are meeting the health needs of this underserved population. Following advances in public health and medical care systems over the last half century, the AI/AN population has also transitioned with the rest of the population from a period of pandemics primarily of infectious diseases to one of degenerative, as well as lifestyle diseases. This progression has enhanced the recognition of health disparities encountered by the AI/AN communities from conditions such as cardiovascular diseases, diabetes, drug abuse and cancer, which are essentially noninfectious. While epidemiological information regarding the AI/AN population is largely incomplete or prone to inaccuracies chiefly due to racial misclassification in official records, a vast majority of the comparisons with non-Native populations are extremely dramatic. For example, among AI/AN adults who utilized Indian Health Service (IHS) facilities in 2002, the age-adjusted incidence of diabetes was approximately 15.3%. This is significantly greater than the 7.3% incidence among all American adults (Kunitz 163). The rate of heart disease has traditionally been lower among Native Americans than among the white population. However, this trend is rapidly reversing since heart disease is currently the leading cause of death among the AI/AN population. In addition, deaths from violence and unintentional injuries are a substantive problem among native communities. Between 1996 and 1998, the age-adjusted death prevalence among AI/ANs across the US was nearly twice that of the population of other races in the US. The death rate for unintentional injuries, on the other hand, was at least thrice that of the rest of the US races. Notably, the incidence of cancer and mortality is relatively lower among AI/ANs nationally than for the general US population. However, in the Northern Plains (Wyoming and Montana) and Alaska, AI/ANs have a relatively higher rate of mortality from all cancers than race rates in the entire US. Conversely, AI/ANs nationally have increased death rates from liver, renal and stomach cancers. Lifestyle factors coupled with low socioeconomic status undoubtedly play a significant role in a majority of the higher disease burdens among AI/AN populations. Cardiovascular risk factors are the highest amongst native communities than other ethnic groups (Kunitz 1465). For instance, a REACH Risk Factor Survey found that obesity, hypertension, current smoking, hyperlipdemia and diabetes rates are each noticeably higher amongst AI/ANs than amongst groups such as Asians, blacks and Latinos (Kunitz 164). Additionally, AI/ANs are more prone than non-AI/ANs to take part in heavy alcohol intake and binge drinking. This may account, partly for the nationally age-adjusted death rate from alcohol-related complications among AI/ANs, which in 1998 was at least seven times greater than that of all race populations in the US. In spite of a federal responsibility to provide quality health care for AI/ANs, inadequacies relating to social and health care services contribute significantly to the poor status of health in the AI/AN communities. The federal obligation to offer health care to AI/AN people emerged from the unique relation between the US government and sovereign Indian tribes. Many Indian tribes entered into an agreement, which guaranteed that quality health care that included the construction of clinics and hospitals, would be offered to the tribe. The agreements also dictated that the US would be responsible for the health wellbeing of tribal members. For most AI/ANs, this federal trust obligation is the foundation of a deeply held belief that health care is not necessarily provided to them freely, albeit in exchange for the massive portions of land ceded to the US government (Goldsmith 1786). With regard to the health care delivery system, the Indian Health Service, which is an operational division of the US Department of Health and Human Services, is the federal agency responsible for the provision of health care to all registered members of the approximately 550 federally documented Indian tribes, Alaska Native villages and bands within the US. AI/ANs’ health care delivery system encompasses at least 594 health care facilities in the US, including 49 hospitals, 545 ambulatory facilities, which include 231 health centers, five school-centered health centers, 176 village clinics for Alaska natives and 133 health stations (Kunitz 167). Evidently, these health care facilities fall into three broad groups; those managed under IHS, those offering services to urban AI/ANs and those managed by the tribes via the Tribal Health Authority (THA) through an agreement with IHS. In addition to ambulatory primary care services, facilities also offer inpatient care, traditional healing practices, medical specialties, mental health care, dental care, eye care and programs for substance abuse treatment. Most AI/AN tribes are also attended by community health services, which include childhood immunizations and home visits, and environmental health including injury prevention and sanitation programs that can be administered either by THA or IHS. Most specialty services and forms of medical care, which are not offered at given facilities are mostly purchased from health care providers within the private sector via the program dubbed the contract health services (CHS). However, AI/AN communities encounter immense difficulties in accessing quality health care since the THA and IHSs apply extremely rigorous eligibility criteria to select patients who quality for funding under CHS. Furthermore, the significantly inadequate funding of CHS also means that a vast majority of CHS programs essentially curtail reimbursement to most therapeutic and diagnostic services, which are vital to the prevention of immediate fatalities or severe impairments of patients’ health. In most instances, this results in limited accessibility to essential health care services such as screening services (Foard 12). This contributes rather significantly to the increased mortality of cancer; for instance, accessibility to breast cancer screening is a prominent problem among Native American women. In 2000, only about 52% of Native women reported undergoing a mammogram examination in the recent years. Core funding of a vast array of health services derive from IHS although most programs primarily depend on grant funding, third-party payers such as state Medicaid programs to sustain financial viability. Approximately 36% of AI/AN families, which constitute less than 200% of the federal poverty level do not have adequate health insurance. This percentile is second only to statistics among Latinos (Kunitz 157). While the health care systems that serve the AI/AN population appear relatively comprehensive, health care provision is significantly hampered by extreme underfunding by the US Congress of IHS. The funding inadequacy to CHS programs, as well as direct health services offered by tribal facilities and IHS means that comprehensive access to care for AI/ANs is essential unavailable. In conclusion, health disparities among AI/ANs have been in existence for more than five centuries. These disparities among AI/ANs include preventable health conditions such as cancer, injuries, diabetes and bronchiolitis. The rate of these health conditions is significantly higher among AI/AN population than in other races in the US (Stephenson 1784). However, certain health disparities place AI/AN populations at a lower risk of death from conditions such as cancer than other races in the country. Although public health efforts are underway to address the health disparities of American Indians and Alaska Natives, the efforts have been mostly inadequate because of inadequate funding despite partnerships among federal, state and tribal public health institutions. Works Cited Foard, F. T. “Health Services for the North American Indians.” Medical Woman’s Journal 57.1 (1950): 12. Print. Goldsmith, M. F. “First Americans Face Their Latest Challenge: Indian Health Care Meets State Medicaid Reform.” Journal of the American Medical Association 275 (1996): 1786-1788. Print. Kunitz, S. J. “The Evolution of Disease and the Devolution of Health Care for American Indians,” The Changing Face of Disease: Implications for Society. Ed. Mascie-Taylor, N., Peters, J., and McGarvey, S.T. New York: CRC Press, 2004. 153–169. Print. Kunitz, S. J. “The History and Politics of US Health Care Policy for American Indians and Alaskan Natives.” American Journal of Public Health 86 (1996): 1465. Print. Stephenson, J. “For Some American Indians, Casino Profits Are a Good Bet for Improving Health Care.” Journal of the American Medical Association 275 (1996): 1783–1785. Print. US Public Health Service. Indian Health Service: A Comprehensive Health Care Program for American Indians and Alaska Natives. Washington DC: US Department of Health and Human Services, 1989. Print. Read More