A study published by the Journal of the American Medical Association May 8 held bad news for much of the U.S. However, the findings show that there’s both bad and good news for Indian country. The study, conducted by the Institute for Health Metrics and Evaluation, found that life expectancies in several parts of the U.S. have decreased overall between 1980 and 2014—and people residing in 13 counties can expect their lives may end up to 20 years sooner than those who live in affluent counties.
However, ever more alarming is the growth in disparity between poor and wealthy counties. The report states that “the gap between counties with the highest and lowest life expectancies is larger now than it was back in 1980… highlighting massive and growing inequality in the health of Americans.”
In particular, residents of counties in Kentucky, West Virginia, Alabama and several states along the Mississippi River have shorter life expectancies. On the other hand, a cluster of counties in Colorado had the U.S.’s highest life expectancies, with three counties topping the tiny European principality of Andorra, which boasts the world’s longest average life span. Affluent Summit County, Colorado, residents can expect to live to nearly 87 years, while Andorra’s average lifetime is almost 85 years.
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The findings for Indian country, however, were mixed. While most tribal communities actually experienced an overall rise in average life span, they still fall behind more affluent communities by as much as 20 percent.
One of those counties, Oglala Lakota County, South Dakota—a county that includes the Oglala Sioux Tribe’s reservation, headquartered in Pine Ridge—has the dubious distinction of having the lowest life expectancy in the country in 2014 at 66.8 years. This expected life span is lower than countries like Sudan (67.2), India (66.9) and Iraq (67.7). And, three other counties with tribal communities—Todd County (Rosebud Sioux Tribe) and Buffalo County, both located in South Dakota (Crow Creek Sioux Tribe) and Sioux County, North Dakota (the northern portion of the Standing Rock Sioux Tribe’s reservation)—rank in the bottom five for life expectancy.
But buried in Excel spreadsheets is some good news: life expectancies in nearly all counties with tribal communities increased from 1980 to 2014. For example, Oglala Lakota County’s average lifespan rose 5.4 years, up from just 61.3 years in 1980. But that news, although encouraging, is tempered by the fact that these increases parallel similar rises across the nation. The average South Dakotan can expect to live to age 79.5, about 12.5 years longer than a resident of the Pine Ridge Reservation.
On the other hand, one of the five counties with the highest life expectancy has a significant number of Native residents. That’s the Aleutian East Borough, which encompasses the southwestern Alaskan Peninsula and portions of the Aleutian Islands, where Alaska Natives make up about 37 percent of the population. Here, the average life expectancy for all residents is nearly 84. In fact, Alaska boroughs (the state’s term for county) account for nine of the biggest increases found in the study, and Aleutian East Borough was noted as having the largest increase in lifespans—more than 18 percent over the 34-year period.
The average lifespans for Alaska Natives across the state are somewhat less, at 70.2 years, ranging by region from 69 to 73. However, it still marks a significant rise of more than five years from 1980, echoing findings in other Native communities.
This rise can be attributed to better health care, including a decrease in premature deaths from infectious diseases such as influenza and pneumonia, said Ian Blake, health statistician with the Alaska Native Tribal Health Consortium. The consortium manages the Alaska Tribal Health System under a P.L. 93-638 compact. “Infectious disease was a major killer,” he said. The consortium also attributes better health outcomes—and longer lives—to a statewide effort to deliver care through its community health programs, including deploying community health aides. These aides, who provide basic care and prevention services, are the first line of health care in Alaska’s far-flung, remote tribal communities. But as Blake avers, “We had very low life expectancies in the 1980s—we saw these big gains because we started out so low.”
Dr. Ellen Provost, director of the health consortium’s epidemiology center, said much work remains to be done to bring average lifespans in tribal communities up to par with the rest of the U.S. “The biggest cause of premature deaths is unintentional injuries and suicides in young people,” she said. “What can be done to prevent these?”
The Indian Health Service published a study in 2014 that corroborates the Alaska consortium’s findings. This study found that deaths under 45 years of age account for 25 percent of all deaths from 2007 to 2009; that’s 312 percent higher than the U.S. overall. Just as in Alaska, unintentional injuries rank high, as do suicide and homicide, among Natives age 44 and younger.
While the institute’s report holds both promise and peril for Indian country, researchers see more peril than promise across the nation. “While the leading causes of death are similar across counties, we found massive disparities in the rates at which people are dying among causes and communities,” lead author Laura Dwyer-Lindgren wrote. “For causes of death with effective treatments, inequalities in mortality rates spotlight areas where access to essential health services and quality of care needs to be improved.”