The health situation with regard to Native Americans is shown in numerous studies to be seriously below the standard and average of other groups in the country. This fact is underscored and emphasized in research studies such as Richardson's, The Need to Empower Indian Tribes, in which he states that,
As the nation reviews its health needs, it can look to American Indians as the ethnic group in the poorest health, with the highest rates of diabetes and tuberculosis. Recently, the Indian Health Service reported that tuberculosis rates among Native Americans exceeded all other ethnic classifications by 400%. Indians die younger than other groups, from a variety of illnesses. A 1992 report from the University of Minnesota noted that the suicide rate of Indian teens is four times greater than any other ethnic group. The accidental death rate of American Indians is 295% greater than that for the rest of the U.S. population.
(Richardson, 1994. p. 54)
The above quotation paints a general picture of the health and welfare situation of Native Americans, which is reiterated from differing perspectives in numerous other studies. One aspect that is clearly referred to in these studies is that the different health and welfare issues that affect native Americas are complex and related to other social, historical and political elements. These issues have a direct impact on the high rate of diabetes, alcohol abuse and alcoholism among Native Americans. In this regard many studies attest to the historical and cultural antecedents of these health problems.
Centuries ago, explorers introduced disease and ecological changes that took a heavy toll on the native population. Today even as tribal councils are gaining strength and taking over more government functions, poor nutrition, unsafe water supplies, inadequate waste disposal facilities, and the twin plagues of alcohol and drug addiction damage the health of many people of the Indian nations.
(Guiden & Johnson, 2000, p. 36)
Commentators and researcher point out that there is a strong correlation between health and disease issues among Native Americans and social aspects such as poverty and the access to health services. Another aspect that is mentioned is the ' cultural dislocation' of native Americans, as well as the fact that "High rates of unemployment, discrimination and cultural differences all contribute to unhealthy lifestyles and disparities in access to health care for many Indian people" (ELIMINATING HEALTH DISPARITIES IN THE AMERICAN INDIAN AND ALASKA NATIVE COMMUNITY. 2003)
These aspects are also borne out by current statistics. Among these figures are the following:
American Indians and Alaska Natives die at higher rates than other Americans from alcoholism (770%), tuberculosis (750%), diabetes (420%), accidents (280%), homicide (210%) and suicide (190%).
American Indians and Alaska Natives born today have a life expectancy that is almost 6 years less than the U.S. population (70.6 years to 76.5 years).
Infants in American Indian and Alaska Native communities die at a rate of 8 per every 1,000 live births, as compared to 7.2 per 1,000 for the U.S. population
Native American Indians also suffer from a poor health care in many communities. This is exacerbated by the fact that, while this group is most at risk for various diseases such as diabetes, they are also among the poorest in the country who cannot afford health insurance. Furthermore, they are often denied health care " ... simply because the appropriate medical services are out of geographic reach." (Rolo, 1999, p. 44)
This paper will attempt to provide an overview of the health situation with regard to diabetes and alcoholism and will also reflect on the concomitant and linked effects and problems associated with these central health issues. Remedies and proposed solutions to the problems that are encountered by Native Americans will also be explored.
2. Alcohol abuse
Statistics with regard to rates of alcoholism and alcohol related deaths are worryingly high for Native Americans. " ... age-adjusted alcoholism death rates for Indians are 440% higher than that for the general population."
Guiden & Johnson, 2000, p. 36) Another statistics is that "Rates of substance dependence and abuse among persons age 12 and older is highest among American Indians and Alaska Natives (14.1%). Rates of illicit drug use (10.1%), alcohol (44.7%) and binge alcohol use (27.9%) are among the highest in the nation. (ELIMINATING HEALTH DISPARITIES ... 2003)
This serious problem has it roots in social, historical and environmental factors. This aspect is borne out by the plethora of studies and research surveys on the subject. Data provided by the National Household Survey on Drug Abuse shows that while 50% of all adolescents in America have used alcohol, the comparable figures for Native American youths is approximately 80%. (Gale, Nancy. 1991)
This figure is also indicative of another alarming fact; namely the high incidence of alcohol abuse among younger people. This aspect is called a "tragedy" by many commentators. "The devastating effects of alcoholism have found their mark on Indian Country's youth as well. A Native teen's chance of dying from alcoholism is seventeen times higher than a teen from another race." (Rolo, 1999, p. 44)
As mentioned, the reason for this serious situation among Native Americans is partly due to historical causes. It is also related to issues of self-esteem and self -worth in the context of the larger society. Native American youths therefore face additional cultural and social pressure in addition to the normal pressures of adolescence -- which in turn often leads to the use of alcohol as a psychological 'crutch.'
The reason for alcohol abuse is deeply rooted in the psychological and social problems that are endemic to the Native American population - which also have its origins in historical circumstances.
Living up to worthy expectations can be difficult for anyone, especially in the contemporary world, where most youth are challenged to experiment with alcohol and drugs. Many Native youth, however, face additional hazards that increase their risk for alcohol and substance abuse, ... cultural conflict, post-traumatic stress, and low self-esteem.
(Gale, Nancy. 1991)
Adding to this problem is the 'cultural clash' between the norms and values of traditional cultures and the expectations and mores of modern cotemporary life. In this cultural clash native American youths are often" ... caught in a no-man's land of confusion and fuzzy self-image. Besides coping with the normal challenges of adolescence, Native youth must also deal with their identity as Indians. "(Gale, Nancy. 1991)
This aspect is also related to the history of Indian oppression and can add to feelings of inadequacy and frustration
Further research findings also shed more light on this subject. For example, it has been found that Alcoholism is multi-generational.; which means that it affects succeeding generations. Secondly it " ... often co-exists in Indian communities with certain specific other problems like depression, self-hate, cultural shame, and stress-related acting out." (Gale, Nancy. 1991) There is also evidence to suggest an important linkage between child abuse and displacement from family or home and alcohol abuse in later life. (Abused Native Americans Twice as Likely to Drink)
In summary alcohol abuse remains a very serious problem. Recent surveys of tribes in Wisconsin, Oklahoma, Oregon, Maine and Arizona reveal that "30% of the men and 18% of the women were diagnosed with some form of alcohol dependence. More than half said that they had at least one parent with alcohol problems." (Abused Native Americans Twice as Likely to Drink)
3. Diabetes and Native Americans
Diseases such as diabetes and particularly type 2 diabetes are also severe problems in Native American communities. An alarming fact is that American Indians and Alaska Natives have the highest prevalence of type 2 diabetes in the world. (ELIMINATING HEALTH DISPARITIES)
Further studies indicate that the prevalence of type 2 diabetes is rapidly increasing among American Indians and Alaska Native children and young adults when compared to other ethnic population; and is presently 2.6 times the national average. (ELIMINATING HEALTH DISPARITIES) Statistics also indicate that "... more than 107,000 Native Americans and Alaska Natives, or 14.5% of the population, receiving care from Indian Health Services (IHS) have diabetes. " (Diabetes Statistics for Native Americans)
Diabetes is the fifth deadliest disease in the Unite States with an annual cost to the country estimated to be $132 billion. (Diabetes Statistics for Native Americans) This disease can cause heart attacks and strokes as well as kidney complications and blindness. Native Americans more than any other groups are " ... 2.2 times more likely to have diagnosed diabetes as non-Hispanic whites of similar age." (Diabetes Statistics for Native Americans) This prevalence is underscored by the fact that a tribe of Native Americans situated in Arizona has the highest rate of diabetes in the world, with about 50% adults between the ages of 30 and 64 with diabetes. "Today, diabetes has reached epidemic proportions among Native Americans. Complications from diabetes are major causes of death and health problems in most Native American populations." (Diabetes Statistics for Native Americans)