In 1985, a government report for the first time documented disparities in health and mortality between black and other minority groups in the U.S. and whites. Thirty years later, we remain a nation of serious inequities when it comes to health and health care, according to a new report.
The Centers for Disease Control and Prevention’s National Center for Health Statistics has published a 461-page analysis, “Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities,” detailing the progress we have (and have not) made in addressing health discrimination.
About 42 percent of the American Indian and Alaska Native (AIAN) population gets its healthcare through the Indian Health Service. The National Congress of American Indians in its analysis of the FY2017 budget request for the IHS pointed out that the agency’s per capita spending is only $3,107, compared to $8,097 per person for health care spending nationally in 2014.
If Congress were to increase IHS funding by $2 billion a year, in 10 years, “the increase would fully fund the IHS at the $29.96 billion amount required for Native peoples to achieve health care parity with the rest of the American population,” according to NCAI. The Health and Human Services 2017 budget request for IHS is $5.185 billion, $377.4 million above the FY 2016 enacted level of $4.808 billion.
A new Government Accountability Office report finds that one of the deficiencies at IHS facilities—many of which can be attributed to inadequate funding—is that patients do not always receive primary care in a timely manner—some people wait as much as 3 to 4 months for an initial appointment, which can have serious implications for health status and outcomes.
Average life expectancy in the U.S. has increased by 2 years since 2000 and is now at 76.4 years for men and 81.2 years for women. Life expectancy for the AIAN population was not given in this report, but the Indian Health Service says American Indians and Alaska Natives have a life expectancy that is 4.4 years less than the life expectancy for all races.
Heart disease remains the leading cause of death for most groups, but its incidence has been reduced from a rate of 257.6 per 100,000 in 2000 to 167.0 per 100,000 in 2014, with cancer a close second at a rate of 161.2 per 100,000 in 2014.
The leading causes of death for AIAN males is unintentional injuries, followed by heart disease, cancer and liver disease. The leading causes of death for AIAN women are heart disease, cancer, unintentional injuries and liver disease.
Deaths caused by opioids and heroin have quadrupled since 1999 overall. Numbers are not available here for AIAN persons.
AIAN death rates from motor vehicle related injuries fell from 78.9 per 100,000 in 1980 to 23.4 per 100,000 in 2014. Homicide death rates for AIAN males fell from 23.3 per 100,000 in 1980 to 9.1 per 100,000 in 2014.
The suicide death rate increased 21 percent between 2004 and 2014. Deaths from heroin increased fivefold, with the highest rate in 2014 among people ages 28 to 34.
The suicide rate for AIAN males has fallen from 19.3 per 100,000 overall in 1980 to 16.4 percent per 100,000 in 2014, according to this report. The rate remains highest among 15-24 year olds (23.5 per 100,000) and 25-44 year olds (26.2 per 100,000). On the other hand, suicide death rates for AIAN females has risen from 4.7 per 100,000 in 1980 to 5.5 per 100,000 in 2014. The rate is highest for 14-24 year olds (9.6 per 100,000) and 25-44 year olds (9.7 per 100,000).
Cigarette smoking is a high-risk behavior in terms of health, says the report. “Smokers are more likely to develop heart disease, stroke, and cancer. Smoking also increases the risk for diabetes, cataracts, rheumatoid arthritis, and stillbirth.”
AIAN adults 18 and over had the second highest rates of cigarette smoking of all groups in 2012-2014, 28 percent for men and 24 percent for women. Rates for people of 2 or more races were slightly higher, while the lowest rates were for Asians (14.8 percent for men, 5 percent for women).
For whites, the rates were 21.3 percent for men and 18.7 percent for women. The percentage of male AIAN smokers declined only slightly from 1999-2001 and 2012-2014, but rates for women, while still relatively high, saw a substantial decline from 36.3 percent in 1999-2001 to 24 percent in 2012-2014.
Obesity and Diabetes
The report puts the overall rate of obesity for U.S. adults 20 and over at 36.5 percent (2011-2014). For 2 to 5 year olds, the rate is 8.9 percent. The report does not give figures for AIAN people.
The U.S. Health and Human Services’ Office of Minority Health says 30.8 percent of AIAN adults over 18 are overweight but not obese and 40.8 percent of AIAN adults over 18 are obese, based on 2012 data from the Centers for Disease Control and Prevention.
A 2015 report from the Trust for America’s Health and the Robert Wood Johnson Foundation puts the rate of obesity for AIAN children ages 2 to 4 at 21.1 percent, up from 16.3 percent in 1998; 31 percent of AIAN 6 to 11 years olds are obese and 49 percent are overweight or obese. For 12 to 19 year old AIAN children, the rate of obesity is 31 percent and the rate of overweight or obese AIAN teens is 51 percent.
For all races, the rate of diabetes increased by about 25 percent between 2000 and 2014. The report does not give stats for AIAN diabetes. Data from NCAI’s Center for Diabetes Research and Policy Research Center indicates that one out of every two AIAN children can be expected to develop Type 2 diabetes, with some being diagnosed as early as age 4.
In 2013, only about two-thirds of women over 40 had had mammograms within the past 2 years. The number was pretty consistent across racial/ethnic groups. Only a slightly higher percentage had had Pap smears within the past 3 years.
AIAN mothers experienced the lowest percentage of low-risk Caesarean section births in 2014.
AIAN mothers experienced the second-highest rate of preterm births of less than 37 weeks, 9.0 percent, compared with 11 percent for black or African American women and 6.9 percent for whites.
Rates of teen pregnancy (maternal age 15-19) have decreased over the past 10 years for all ethnic and racial groups. For AIAN teens, the rate decreased by 51 percent for AIAN teenagers ages 15 to 17 and by 39 percent for ages 18-19.
Between 1983 and 2013, infant deaths have been nearly cut in half for all groups, but the rates for AIAN and black or African American babies remain higher than average.
In 2013 about half of all adults between the ages of 50 and 75 had been screened for colorectal cancer. For AIAN people, the percentage jumped from 26.7 to 46.7 between 2008 and 2010. Under the Affordable Care Act, colorectal cancer screening tests are among the free services provided for preventive care by insurance policies instituted after September 23, 2010.
Affordable Care Act
Passage of the Affordable Care Act in 2010 seems to have cut the number of people who report not receiving needed medical care, prescription drugs or dental care by about 25 percent between 2010 and 2014, reversing an upward trend that had been in place since the late 1990s. However, in 2014, almost twice as many AIAN people as whites reported they did not get the prescription drugs they needed because of cost. The percentage of AIAN people who did not receive needed dental care increased between 1999-2001 and 2009-2011, then fell back to 1999-2001 levels in 2012-2014.
In 2014, 35.5 percent of AIAN persons were covered by Medicaid, the highest percentage ever. Also in 2014, 28.3 percent of AIAN people had no health insurance. People who had only IHS coverage were considered uninsured. IHS provides health care for 2.2 million AIAN people.
Doing the Numbers
It is important to realize that in this report racial and ethnic groups include only people who identify as just one race or ethnicity. All persons identifying as more than one race or ethnicity are grouped together into one category, which means there is no retrievable information in the report about AIAN mixed-race persons.
According to the U.S. Census Bureau, in 2010, 5.2 million people in the U.S. identified as American Indian and Alaska Native, either alone or in combination with one or more other races. Of that total, 2.9 million people identified as AIAN alone, while 2.3 million identified as being AIAN in combination with one or more other races.