Six and a half years.
This is the decline in life expectancy caused by the COVID-19 pandemic on American Indians and Alaska Natives, based on an August 2022 report from the National Center for Health Statistics.
This surprising figure results in an overall decrease in average life years from 71.8 years in 2019 to 65.2 at the end of 2021.
Although the pandemic is the main reason for this decline, it is not the whole story. Even before the advent of COVID-19, life expectancy for Native Americans was five years lower than that of non-Hispanic whites in the United States.
The grim reality
As a Native American physician and board-certified MD, I am very familiar with the health challenges that Native Americans face.
Growing up in remote rural Alaska as a member of the Koyukon Athabascan tribe, I heard stories of infectious diseases like flu, smallpox and tuberculosis threatening their survival. My cultural group comes from three families that survived the 1918 flu pandemic.
This history inspired me to become a traditional healer. Along with training in Western medicine, I also studied plant-based medicine and earth science, taught by elders – practitioners who passed down thousands of years of accumulated knowledge to me.
Through medical and traditional practices, I know there are many reasons for reduced life expectancy and the divide between Indigenous and non-Indigenous health outcomes. But this gap – if the government and the medical system will act – can be shortened.
Poverty, unemployment and lack of health care
American Indians and Alaska Natives die from diabetes at more than twice the rate of the non-native population. A report from the Centers for Disease Control and Prevention shows that Native Americans have lower rates of obesity, high blood pressure, cancer and other general health conditions than other Americans. Suicide rates in Indigenous communities are approximately 43% higher than in non-Indigenous communities. And Native American women experience sexual violence more often than non-Hispanic white women.
There are many reasons for these disparities. For starters: Native Americans have the highest poverty rate of all minority groups, perhaps as high as 25%.
Unemployment among American Indians and Alaska Natives in November 2022 was 6.2%, compared to 3.7% in the general population. Many Indigenous people, who work only seasonally, are also unemployed.
American Indians and Alaska Natives are also underserved in the US health care system. The Indian Health Service — the federal agency that provides medical care to Native Americans — is funded about $6 billion a year. That translates to just $4,078 per person in 2021.
As a result, there are fewer doctors, nurses and therapists seeing Indigenous patients, especially those living in rural areas. Those providing treatment have less technology, such as MRI and ultrasound machines, to help diagnose and treat disease earlier. These shortages mean less access to primary or emergency care, leading to lower life expectancy.
Historical trauma
A shaky health care system is only part of the problem. Adverse childhood experiences, social marginalization and toxic and relentless stress also contribute to shorter lives.
Then there are the unresolved effects of historical trauma – the cumulative emotional and psychological trauma in a particular group that spans generations.
This kind of collective trauma cannot be underestimated. A growing body of evidence documents its effects on Indigenous peoples. Historical trauma can cause physiological stress, affecting not only the individual, but the entire family. There is new evidence showing that the body’s stress response causes epigenetic changes – meaning changes in gene expression caused by the environment – in Native Americans that can affect their health before birth.
To this day, the U.S. government has consistently enacted policies that sanction inequality—actions that may perpetuate historical trauma and present-day health disparities. American Indian and Alaska Native communities have suffered from disease, war, internment and starvation for centuries.
Not only are Native people being displaced from the land that was once our home, the US government has even banned us from practicing these traditions. Throughout the 20th century, the US government placed Indigenous children in boarding schools that separated them from their families.
Break the cycle
It is clear that Indigenous communities need new or improved hospitals and clinics, better diagnostic technology, more specialized services in dental care, obstetrics, pediatrics and oncology, and more alcohol and substance abuse treatment programs.
There is some good news: the Biden administration’s 2022 infrastructure bill makes $13 billion available to address some of these needs for Native American tribes. And the additional $20 billion in COVID-19 relief will also provide assistance for some of the most immediate challenges.
But even with this help, there is still a funding gap. The National Indian Health Council, a nonprofit advocacy group representing federally recognized tribes, is recommending a $48 billion commitment for fiscal year 2024 to fund the health needs of Indigenous peoples. The current budget, $9.3 billion, is less than a fifth of that.
The recent funding increase is certainly a step in the right direction. But the factors that contributed to the shorter lives of Native Americans began many generations ago, and are still present among the youngest today.
Both from a professional point of view – as well as a very personal one for me and my predecessor – more work in this area cannot come soon enough.
Allison Kelliher is an assistant professor in the Department of Family & Community Medicine at the University of North Dakota
Learn how to navigate and strengthen trust in your business with The Trust Factor, a weekly newsletter that examines what leaders need to succeed. Log in here.