November marks National American Heritage Month, when the US recognizes the cultures, heritage, and contributions of Indigenous peoples including those from American Indian, Alaskan Native, Native Hawaiian, and Pacific Island communities. As the world celebrates Indigenous knowledge and culture, it is important to recognize that Indigenous people face many socioeconomic and health disparities that limit their overall health and well-being.
In the US, there are more than 8.6 million people who identify as American Indian and Alaskan Native (AIAN) alone or in combination with another race/ethnicity and nearly 700,000 people who identify as Native Hawaiian and Other Pacific Islander (NHOPI) alone or in combination with another the group. Of these groups 1.7 million people identify only as AIAN and 550,000 people identify as NHOPI only. The combined population of AIAN and NHOPI has grown by 45% over the past decade, from 6.4 million in 2010 to nearly 9.3 million in 2021.
The US is responsible for providing certain rights, protections, and services to AIAN people, including health care. However, the Indian Health Service has been underfunded to meet the health needs of the AIAN population and they face other social and economic challenges that contribute to poor health outcomes. NHOPI people also face systemic challenges in health. Older AIAN and NHOPI adults are more likely to be uninsured than their White counterparts and younger AIAN and NHOPI adults are also more likely to delay or stop seeking health care than their White counterparts due to cost being a barrier. Additionally, AIAN and NHOPI households are less likely to be full-time workers and more likely to be poor compared to White households.
Reflecting these and other challenges, AIANs do worse than their White counterparts across a range of health measures, including being more likely to report fair or poor health (24% AIAN vs. 12% NHOPI vs. 12% White) and having chronic conditions. such as asthma and diabetes. NHOPI individuals fare less well than their White counterparts on some of these measures, but this may mask differences within this diverse population and/or more limited access to providers to diagnose chronic diseases. It may also reflect limitations in the ability to reliably capture their experiences in survey data due to their small population size. AIANs also face mental health challenges, including high rates of suicide and drug overdose deaths, which have risen in the past few years amid the epidemic. Separate data for the NHOPI population were not available for these measures. In addition, COVID-19 caused a disproportionate increase in AIAN and NHOPI populations, where they experienced higher age-adjusted rates of cases and deaths compared to Whites.
Addressing the health and social challenges faced by Indigenous peoples will be critical to fulfilling the nation’s duties and responsibilities, improving the health and well-being of this diverse and growing population, and supporting improved health and prosperity in the US As part of these efforts. , it will be important to resolve the ongoing gaps and limitations found in the data to understand their health and health care experiences. The Biden Administration has recently invested heavily to address the COVID-19 pandemic and improve infrastructure in Native communities. A continued focus on addressing their health and healthcare needs will be critical going forward.
KFF Analysis of the 2021 American Community Survey, 1-year Estimates; 2021 Behavioral Risk Factor Surveillance Program Data; Centers for Disease Control and Prevention, COVID-19 Response, COVID-19 Case Surveillance Use Case Data, released October 6, 2022; and National Center for Health Statistics, Interim Mortality from COVID-19 by HHS Region, Race, and Age, as of October 26, 2022.