American Indian Health Status 2001

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American Indian Health Status 2001

• January 9, 2001
• Washington State

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Presentation Overview

• American Indians and Alaska Natives
• Trust Obligation of the United States
• Indian Health Service
• Indian Health Status
• Overview of the Northwest Portland Area Indian
  Health Board

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Who are the American Indians and the Alaska
Natives?
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American Indians and Alaska Natives
Approximately 558 sovereign Tribes, each..
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American Indians and Alaska Natives
. with (a) distinct
tradition
language
migratory history
geographic distribution
population size
gene flow, and
culture
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American Indians and Alaska Natives

• Scientists and others have long questioned the
  origins, affinities, and adaptations of the first
  Americans
• New evolutionary theories are proposed or
  existing predominant theories revisited
• It remains unknown
• whether there was
• one migration or more

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American Indians and Alaska Natives

• If more than one migration, the exact number of
  migrations remains unknown
• The timing of the migration(s) and the
  relationship among and between the migrants are
  unknown
• At minimum, we know the
• ancestors of present-day
• American Indians have inhabited
• North American for 12,000 years

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American Indians and Alaska Natives

• The top 10 states ranked by Native percentage
• Alaska 16.4 Arizona 5.5
• New Mexico 9.5 N. Dakota 4.8
• S. Dakota 8.2 Wyoming 2.3
• Oklahoma 7.8 Washington 1.8
• Montana 6.5 Nevada 1.8
• Population Estimates Program, Population
  Division, US Census Bureau (August 2000)
• For more information http//www.census.gov

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American Indians and Alaska Natives

• The top 10 states ranked by Native population
• California 313,642 Alaska 101,352
• Oklahoma 262,581 N. Carolina 99,277
• Arizona 261,168 Texas 97,412
• New Mexico 165,444 New York 76,755
• Washington 104,819 Florida 60,358
• Population Estimates Program, Population
  Division, US Census Bureau (August 2000)
• For more information http//www.census.gov

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Trust Obligation of the United States
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Foundations for Federal Health Obligations and
Responsibilities

• Treaties
• More than 800 ratified treaties
• Many more unratified treaties
• Direct Government to Government relationships
  (not subordinate to state governments)
• United States Constitution, Article I, Section 8
  Congress regulates commerce among states and
  with Indian Tribes
• Tribal Consultation with Departments at the
  Secretarial level, including the Executive Office
  of the President

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Legislation that mandates the provision of health
care to American Indians and Alaska Natives

• Snyder Act of 1921 (provides Congress authority
  to fund)
• Transfer Act (transferred responsibility from BIA
  to IHS)

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Indian Health Service
an agency within the Department of Health and
Human Services, is responsible for providing
federal health services to American Indians and
Alaska Natives. The provision of health services
to members of federally-recognized tribes grew
out of the special government-to-government
relationship between the federal government and
Indian tribes. This relationship, established in
1787, is based on Article I, Section 8 of the
Constitution, and has been given form and
substance by numerous treaties, laws, Supreme
Court decisions, and Executive Orders. The IHS is
the principal federal health care provider and
health advocate for Indian people, and its goal
is to raise their health status to the highest
possible level. The IHS currently provides health
services to approximately 1.5 million American
Indians and Alaska Natives who belong to more
than 557 federally recognized tribes in 35
states.
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Indian Health Service
Mission... to raise the physical, mental, social,
and spiritual health of American Indians and
Alaska Natives to the highest level. Goal... to
assure that comprehensive, culturally acceptable
personal and public health services are available
and accessible to American Indian and Alaska
Native people. Foundation... to uphold the
Federal Government's obligation to promote
healthy American Indian and Alaska Native people,
communities, and cultures and to honor and
protect the inherent sovereign rights of Tribes.
For more information, http//www.ihs.gov
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(No Transcript)
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Legislation that mandates the provision of health
care to American Indians and Alaska Natives

• Snyder Act of 1921 (provides Congress
• authority to fund)
• Transfer Act (transferred responsibility from
• BIA to IHS)

• Indian Self-Determination and Education
  Assistance Act of 1975 (ISDEAA)
• The 1988 and 1994 Amendments to the ISDEAA
• Indian Health Care Improvement Act (Reauthorized
  2001)

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Indian Health Status
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Indian Health Status
Population Numbers and Figures

• The AI/AN population is increasing at a rate of
  about 1.8 per year
• 33 of the population is younger than 15 years of
  age and 6 of the population is older than 64
  years of age compared to the US All Races ages of
  22 years and 13 years, respectively
• 17 of AI/AN males are under age 15 and 16 of
  AI/AN females are under age 15 compared to US All
  Races of 11
• 65.3 of AI/AN aged 25 years or older are high
  school graduates or higher compared to 75.2 for
  US All Races
• 8.9 of AI/AN aged 25 years or older hold
  Bachelor degrees compared to 20.3 for US All
  Races

US Census Bureau
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Indian Health Status
Select Infant Numbers and Figures

• The birthrate for 1994-1996 of 24.1 births per
  1,000 population was 63 greater than the US All
  Races rate of 14.8 (1995) and 70 greater than
  the US White rate of 14.2 (1995)
• 6.0 of live births, 1994-1996, were of low birth
  weight, compared to 7.3 for US All Races (1995)
• 12.7 of live births, 1994-1996, were of high
  birth weight, compared to 10.3 for US All Races
  (1995)
• Maternal mortality decreased from 27.7 (rate per
  100,000 live births) in 1972-1974 to 6.1 in
  1994-1996, a decrease of 78
• Infant mortality decreased from 22.2 (rate per
  100,000 live births) in 1972-1974 to 9.3 in
  1994-1996, a decrease of 58

IHS, Trends in Indian Health (2000)
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Indian Health Status
Infant Mortality

• Leading Causes of Infant Deaths, American
  Indians and Alaska Natives, 1994-1996
• 
  
• AI/AN
  US All US
• Cause of Death
  RACES WHITE
• ---------------------------------------------
  ------------------
• Sudden Infant Death Syndrome 2.0
  0.9 0.7
• Congenital Anomalies 2.0 1.7
  1.6
• Low Birth Weight 0.6 1.0
  0.7
• Accidents 0.4 0.2 0.2
• Pneumonia and Influenza 0.4 0.1 0.1
• ---------------------------------------------
  ------------------
• Rate per 1,000 live births
• IHS, Trends in Indian Health (2000)

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Indian Health Status
Infant Mortality
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Indian Health Status
Infant Mortality

• Number of sudden infant death syndrome (SIDS)
  and non-SIDS cases and SIDS rate among American
  Indians and Alaska Natives, by year--Idaho,
  Oregon, and Washington, 1985-1996
• 
  
• 1985-
  1989- 1993-
• Characteristic 1988
  1993 1996
• ---------------------------------------------
  ------------------
• No. live-born infants 9,410
  10,775 10,350
• No. SIDS cases 84
  71 31
• No. Non-SIDS cases 104
  115 49
• SIDS rate 8.9
  6.6 3.0
• Non-SIDS rate 11.1
  10.7 4.7
• ---------------------------------------------
  ------------------
• Per 1000 live-born infants.
• Robertson, et al., MMWR, Vol. 48, No.9 (1999)

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Indian Health Status
Patient Care Numbers and Figures

• Hospital admissions peaked in FY1978 with 112,000
  admissions, in 1997 there were approximately
  85,000 admissions
• For AI/AN males, the leading hospital admissions
  were for respiratory illness (18), digestive
  diseases (14.1), and injury and poisonings
  (13.5)
• For AI/AN females, the leading hospital
  admissions were for obstetric deliveries (29.4),
  respiratory diseases (12.1), and digestive
  diseases (11.9)
• In 1997, there were approximately 7,307,697
  ambulatory visits
• The three leading ambulatory visits were for
  respiratory system, nervous system, and
  endocrine, nutritional, and metabolic disorders

IHS, Trends in Indian Health (2000)
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Indian Health Status

• Alcoholism is 627 percent greater
• Tuberculosis is 533 percent greater
• Diabetes mellitus is 249 percent greater
• Accidents are 204 percent greater
• Suicide is 72 percent greater
• Homicide is 63 percent greater
• HIV is 60 percent greater
• Indian Health Service, Trends in Indian
  Health(2000)

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Indian Health Status

• Risk factors high prevalence of smoking,
  obesity, diabetes, and sedentary lifestyle
• The age-adjusted prevalence of diseases higher
  than the US General Population
• The prevalence of disease in younger populations
  is increasing
• The rate of complications is higher

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Northwest Portland Area Indian Health Board
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Northwest Portland Area Indian Health Board

• Founded in 1972 as a non-profit organization that
  conducts
• Health Research
• Policy Analysis
• - Program Development and Assessment
• - National, Regional, and State Meeting Planning
• Training and Technical Assistance
• Recognized as a tribal organization under P.L.
  93-638
• 42 member tribes (delegates are often elected
  tribal leaders or health administrators)

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Portland Area (Washington, Oregon, and Idaho)
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Northwest Portland Area Indian Health Board

• Mission. To assist member tribes in their
  delivery of culturally competent health services,
  to improve health status and quality of life

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Northwest Tribal Epidemiology Center

• Founded in June 1997
• Mission. to collaborate with Northwest American
  Indian Tribes to provide health-related research,
  surveillance and training to improve the quality
  of life of American Indians.
• Goal to provide accurate and timely health data
  to member tribes

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Northwest Tribal Registry Project

• Ascertain levels of racial misclassification in
  non-IHS health registries
• Preliminary analysis suggests racial
  misclassification to be a significant problem in
  these registries

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Northwest Tribal Registry Project
Washington State Death Files (1989-1997)
Overall misclassification 15
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Northwest Tribal Registry Project
Idaho State Cancer Registry
Overall misclassification 50.3
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Northwest Tribal Registry Project
Oregon State Cancer Registry
Overall misclassification 68
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accurate and timely data

• Community Health Profile Project (broad-based
  community health indicators)
• 2001 Northwest Tribal BRFSS Project (health risk
  behavior)
• Tribal Elder Diet and Nutrition Project (focus
  groups, 24-hr recalls, FFQ)

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accurate and timely data

• Stop Chlamydia! Project
• Western Tribal Diabetes Project
• Project Red Talon (HIV/AIDS)
• RPMS Cancer Assessment Project
• Fetal Alcohol Syndrome Project
• Infant Mortality Project

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accurate and timely data

• Native American Research Centers for Health
• -e.g. Obesity and Caries Prevention
• Project
• Thank you!

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For more information Francine C.
RomeroEpidemiologist

• Telephone [phone]
• E-mail fromero_at_npaihb.org