This paper investigates the ongoing health crisis affecting Native American communities in the United States, tracing its roots to historical trauma including forced removal, assimilation policies, and broken government promises. The paper argues that the Indian Health Service, established in 1955 to serve Native Americans, remains chronically underfunded and inadequate to meet community needs. Beyond fiscal constraints, the paper highlights how healthcare providers' lack of cultural understanding—particularly regarding holistic, spiritually-centered approaches to health—exacerbates the delivery of mental health services. The paper documents alarming statistics on suicide, alcoholism, and poverty on reservations and concludes that addressing both funding and cultural competency is essential to improve health outcomes and honor the trust between Native American tribes and the federal government.
Social injustice is not a new issue in our world. But for the Native American tribes who have lived in the United States for generations, it seems to be the never-ending story of their culture. Their lives were torn apart centuries ago by newcomers who took their land, leaving them with nothing to live off. To this day, their needs—specifically their physical and mental health needs—are still being neglected. High rates of suicide, alcoholism, and unemployment are carryover effects of underfunded health facilities that cannot properly serve Native American citizens. The very institutions that took their land and promised to help them are now turning their backs on them. The Native American community is in a state of health crisis, and attention must be brought to their situation.
To understand the current state of Native Americans, we must understand how they arrived there. During the 19th century, Native Americans became increasingly wary of the United States government and its desire for the expansion of America—expansion that came at their cost. The Indian Removal Act of 1830 encouraged reluctant tribe leaders to reconsider signing treaties with the American government in exchange for their homelands. Native Americans were convinced, being told it was Manifest Destiny—a belief among whites that expansion was not only good but inevitable and certain. For Native Americans, Manifest Destiny was simply a way to justify the removal of their land and their forced relocation. Removing them from their land also removed them from their culture. The Indian Removal Act paved the way for the migration of tens of thousands of American Indians to the West, an event known as the "Trail of Tears," a resettlement of the Native population to reservations where they could be more easily separated from traditional life and pushed into European-American society.
After a series of violent Indian wars in the late 19th century, the United States began the assimilation process of Native children by establishing boarding schools where they were pushed toward European cultures and forbidden from practicing their Native language and beliefs. They were also severely mistreated and abused. It was not until 1924 that the United States government signed the Indian Citizenship Act, granting citizenship to all Native Americans. Once granted citizenship, Native Americans began to reclaim their power. Approximately 44,000 Native American men served in the United States Army during World War II. Tribes began building their own schools and college institutions in hopes of preserving and reviving their culture. Most importantly, the granting of citizenship entitled Native Americans to receive health services provided by the government. The Indian Health Service (IHS) was established in 1955 by the United States Health Services with the goal of providing health services to tribe members living on reservations.
Established by the United States with the intent to provide health care to any registered Native American, the Indian Health Service has repeatedly suffered from inadequate support by the very hand that created it. In the past, severe underfunding has affected the IHS and the services it is able to provide to tribe members. Between 1993 and 1998, "IHS appropriations increased by 8%, while medical inflation increased by 20.6%. As a result, when both the rate of medical inflation and increases in the Native American populations were considered, there was, in reality, a decrease of 18% in the per capita appropriations for IHS during this period" (Warne). This trend has not abated. In 2013, the Indian Health Service was hit again with funding cuts of approximately 800 million dollars, representing a substantial percentage of its budget (Belluck).
These money shortages, along with distance from facilities, can delay treatment of serious conditions for months or years. For one tribe member named Joanna Quotskuyva, she chose to have a mastectomy even though her breast cancer did not require it because radiation would have meant months of driving five hours round-trip from her home on the Hopi reservation in Kykotsmovi, Arizona to the nearest radiation facility (Belluck). Another significant problem with the IHS is that tribal health care facilities serve only their tribal members, with other qualified Indians and Alaska Natives being offered care only on a space-available basis (Belluck). This policy makes it difficult for any tribe member who leaves their tribal home for education or employment to receive health care services to which they are legally entitled.
Economic barriers compound these structural problems. Although some Native Americans have private insurance, usually through their employers or businesses like casinos, a third are uninsured and a quarter live in poverty (Belluck). Lack of funding, strict policy rules, and few resources make a health care act created to help Native Americans increasingly difficult for them to access.
Beyond government shortages, there is a serious lack of understanding of Native American culture by those hired to provide health services. A study led by Yurkovich in 2008 attempted to help medical health providers better understand and communicate with reservation patients. The researchers interviewed patients suffering from persistent mental illness to better understand how they deal with and describe being healthy or unhealthy. Yurkovich's research revealed very insightful findings.
Tribe members view health as a process of gaining a sense of personal well-being at any moment in time within one's established boundaries and context. Rural dwellers define health as the "ability to work." Native American culture holds spirituality as the highest fundamental to one's health. It is important to realize that in their culture, "the physical, mental (cognitive), emotional, and spiritual dimensions of a person are always perceived as one, and largely considered inseparable; the mind-body split of western thought is not present" (Yurkovich). Through her series of interviews with 44 Native Americans suffering from persistent mental illnesses, Yurkovich learned of their cultural viewpoint on health and stated their collective thoughts as "all illness is an illness of the spirit that manifests itself in the body, mind and emotions, and we all carry within our souls the capacity to heal ourselves." This research revealed Native American culture as very holistic in nature.
This research is critical to note in the delivery of mental health services, where cultural issues and communication between provider and patient are essential parts of treatment. These findings remind us how imperative it is that health care providers understand the perceptions of health held by the individuals with persistent mental illness that they are trying to care for. From the findings of this study, it is also clear that the environment influences the development of mental illness and the person's ability to maintain a healthy state. Lack of understanding how Native Americans perceive health is a critical point that must be understood to better help the people of their culture.
The lack of understanding of Native American culture and their view on health, combined with underfunded facilities, may be contributing factors to the deteriorating state of health on reservations nationwide. Chronic depression, high suicide rates, and widespread alcoholism are all social behaviors prevalent on many tribal reservations. However, these problems are rooted in long histories that extend back to when Native Americans first met white settlers who wanted their land. White settlers purposely introduced alcohol to Native Americans because it was a very profitable trade good. This drive to make them dependent on alcohol succeeded; the 1992–1994 alcohol-related mortality rate for Native Americans was approximately six times the 1993 rate for the whole United States population (Frank). One-fourth of children in tribes suffer from fetal alcohol syndrome or related issues due to their parents' alcoholism (Gosh). High alcoholism rates continue to affect communities, with the rate of alcoholism among Native Americans six times the United States national average according to the IHS (Gosh).
These alarming rates of alcohol abuse are affecting other aspects of reservation life. According to the Census Bureau, the poverty rate at Standing Rock Reservation in North Dakota is 43.2%, nearly triple the national average. The reservation has a population of 8,956, and one in four lives in poverty (Krogstad). Native American teens graduate high school at a rate 17% lower than the national average. Their substance abuse rates are higher. They have a 2.3% higher rate of exposure to trauma. They are twice as likely as any other race to die before the age of 24 (Horwitz).
The exposure to trauma and abuse stems from high rates of domestic abuse on reservations, where stigma and lack of mental health facilities discourage those with depression from seeking help. Those most affected by these statistics are children being raised on these troubled reservations. Teen suicide rates for reservation youth are more than three times the national average, and up to 10 times on some reservations (Horwitz). In the past, youth suicide was unheard of in tribes. Traditional beliefs and child-rearing practices provided a system of child protection—a sort of community safety net. However, these practices were lost when the federal government attempted to assimilate Native people and placed children in boarding schools. Those children are now the parents and grandparents of today's vulnerable youth. Although these children have more resources to escape their reservation life than their ancestors did, their likelihood of doing so does not seem to be receiving national attention. These long-ingrained social and mental health problems must be addressed as a culture if older generations are to help prevent their youth from following a dangerous path of destruction.
"Integrated solutions, tribal relationships, national responsibility"
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