Health of Native Americans in the United States

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Native Americans are affected by noncommunicable illnesses related to social changes and contemporary eating habits. Increasing rates of obesity, poor nutrition, sedentary lifestyle, and social isolation affect many Americans. While subject to the same illnesses, Native Americans have higher morbidity and mortality to diabetes and cardiovascular disease as well as certain forms of cancer. Social and historical factors tend to promote unhealthy behaviors including suicide and alcohol dependence. Reduced access to health care in Native American communities means that these diseases as well as infections affect more people for longer periods of time. [1]

Contents

Life expectancy

In October 2019, American Indian and Alaska Natives had a life expectancy of 73 years, compared to the 78.5 years for the general American population. [2]

Noncommunicable diseases

The leading causes of death by percentage for Native Americans and Alaska Natives in 2005. Heart disease accounted for 25% of deaths, cancer 22%, accidents 19%, diabetes 7%, liver disease 6%, suicide 6%, respiratory diseases 6%, stroke 4%, homicide 3%, and influenza and pneumonia 3%. Leading Causes AIAN.pdf
The leading causes of death by percentage for Native Americans and Alaska Natives in 2005. Heart disease accounted for 25% of deaths, cancer 22%, accidents 19%, diabetes 7%, liver disease 6%, suicide 6%, respiratory diseases 6%, stroke 4%, homicide 3%, and influenza and pneumonia 3%.

Native Americans share many of the same health concerns as their non-Native American, United States citizen counterparts. In 2010, Native Americans' leading causes of death include "heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke". Other health concerns include "high prevalence and risk factors for mental health and suicide, obesity, substance use disorder, sudden infant death syndrome (SIDS), teenage pregnancy, liver disease, and hepatitis." The leading causes of death for Native Americans include the following: heart disease, cancer, diabetes, and chronic liver disease / cirrhosis. [3] [4]

Though these diseases are also prevalent among non-Native Americans, some present a much greater threat to Native Americans' health. [5] In 2013, American Indians and Alaska Natives died at greater rates from: chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases. [6] These discrepancies in disease patterns vary significantly among diseases, but have a significant effect on the population.[ citation needed ]

The genetic composition of Native Americans and clans can have an influence on many diseases and their continuing presence.[ dubious – discuss ] The commonly lower socioeconomic status limits the ability of many to receive adequate health care and make use of preventive measures. Also, certain behaviors that take place commonly in the Native American culture can increase risk of disease. [7] When the period of tribal termination in the 20th century occurred, some tribes that were terminated could no longer afford to keep their hospitals open. [8]

In 2005, Native Americans had higher rates of tobacco use than white, Asian, or black communities. Native American men are about as likely to be moderate to heavy drinkers as white men, but about 5–15% more likely to be moderate to heavy drinkers than black or Asian men. Native Americans are 10% less likely to be at a healthy weight than white adults, and 30% less likely to be at a healthy weight than Asian adults. On a similar note, they have far greater rates of obesity, and were less likely to engage in regular physical activity than white adults. [9]

Data collected by means of secondary sources, such as the US Census Bureau and the Centers for Disease Control and Prevention's National Center for Health Statistics, showed that from 1999 to 2009, Alaska Natives and Native Americans had high mortality rates from infectious diseases when compared to the mortality rate of white Americans. Alaska natives from the age groups 0–19 and 20–49 had death rates 4 to 5 times higher than compared to whites. Native Americans from the 20–49 age group in the Northern Plains were 4 to 5 times more likely to die to infectious diseases than whites. Native American and Alaska Natives were 13 times more likely to contract tuberculosis than whites.[ citation needed ]

In 2005, Native Americans were at least twice as likely to have unmet medical needs due to cost. They were much less likely to have seen a dentist within the last five years compared with white or Asian adults, putting them at risk for gingivitis and other oral diseases. Native American/ Alaska Natives face high rates of health disparity compared to other ethnic groups. [10]

Heart disease

The leading cause of death of Native Americans is heart disease. In 2005, 2,659 Native Americans died of this cause. Heart disease occurs in Native American populations at a rate 20 percent greater than all other United States races. The demographic of Native Americans who die from heart disease is younger than other United States races, with 36% dying of heart disease before age 65. [11] The highest heart disease death rates are located primarily in South Dakota and North Dakota, Wisconsin, and Michigan. [12]

Heart disease among Native Americans is due not only to diabetic complications, but also to higher rates of hypertension. Native American populations have been documented as being more likely to have high blood pressure than other groups, such as white European Americans. [13] Some studies associate the exposure to stress and trauma to an increased rate of heart disease. It has been documented in Native American populations that adverse childhood experiences, which are significantly more common in the Native American demographic, have a positively linear relationship with heart disease, as well an increasing influence on symptoms of heart disease. [14]

Cancer

Cancer is documented among Native Americans. The rates of certain types of cancer exceed that of the general population of the United States. For instance, in 2001–05 Native American males were twice as likely to have liver cancer than in white males. Women are 2.4 times as likely to contract and die from liver cancer as their white counterparts. Rates of alcohol use disorder of Native Americans are greater than in the general population. [5]

In 2012, Stomach cancer was 1.8 times more common in Native American males than white males, and was twice as likely to be fatal. Other cancers, such as kidney cancer, are more common among Native American populations. But overall cancer rates are lower among Native Americans than among the white population of the United States. For cancers that are more prevalent in Native Americans than the white United States population, death rates are higher. [5]

Diabetes

The rates of death by diabetes for each race and ethnicity in the United States in 2005 Diabetes 2005 graph.png
The rates of death by diabetes for each race and ethnicity in the United States in 2005

Diabetes has posed a significant health risk to Native Americans. Type I diabetes is rare among Native Americans. Type II diabetes is a much more significant problem; it is the type of diabetes discussed in the remainder of this section. Diabetes began to occur at higher rates among Native Americans in the middle of the twentieth century and has increased into what is called an epidemic. This time frame relates to generations having grown up on reservations, and, in some cases, adopting mainstream food and cultural patterns. They were largely prevented from following their traditional patterns of hunting and gathering, and they changed their traditional eating patterns. [15] About 16.3% of Native American adults have been diagnosed with diabetes. [16] Type two diabetes and its complications have become chronic illnesses within Native American and Alaska Native communities. Native Americans and Alaska Natives have high rates of end-stage renal disease, which is mainly driven by, and directly correlates with, the increase in diabetes within their communities. [17]

Native Americans are about 2.8 times more likely to have Type II diabetes than whites of comparable age.[ citation needed ] The rates of diabetes among Native Americans continue to rise. from 1990 to 1998, the rate of diabetes increased 65% among the Native American population. This is very significant growth, and this growth continues in the present day. [18]

The highest rates of diabetes in the world are found among a Native American tribe. The Pima tribe of Arizona took part in a research study on diabetes which documented diabetes rates within the tribe. This study found that the Pimas had diabetes rates 13 times that of population of Rochester, Minnesota, which is predominately European American in ethnicity. Diabetes was documented in over one third of the Pima from ages 35–44, and in over sixty percent of those over 45 years of age. [19]

There are multiple factors contributing to the prevalence of diabetes among Native Americans:

Genetic predisposition
Native Americans with the "least genetic admixture with other groups" [18] have been found to be at a higher risk of developing diabetes. the genetic makeup of the American Indian allowed their bodies to store energy for use in times of famine. When food was plentiful, their bodies stored excess carbohydrates through an exaggerated secretion of insulin called hypersulinemia, and were able to use this stored energy when food was scarce. When feast or famine was no longer an issue, and food was always plentiful, with modern, high caloric foods, their bodies may not have been able to handle the excess fat and calories, resulting in type II diabetes. [20]
Obesity
Obesity is a significant health problem for Native Americans, as they are 1.6 times more likely to be obese than white Americans. [5] Native Americans are as likely as black adults to be obese. [10] Obesity is known as a general causative factor of diabetes, and is related to the changes if diet as noted above.
Low birth weight
The correlation between low birth weight and increased risk of diabetes has been documented in Native American populations. [18]
Diet
Changes in Native American diets have been associated with the increase in diabetes, as more high calorie and high fat foods are consumed, replacing the traditionally agriculturally driven diet. [21] Some tribes have begun programs to encourage their people to return to traditional ways to include growing, preparing, and eating traditional foods.

Several federal agencies are also trying to help. The Centers for Disease Control and Prevention (CDC) has also encouraged this approach; in 2013, it produced a public service announcement (PSA), in which Cherokee actors discussed diabetes, and the significance of diet on their increased risk. [22] In the early 21st century, such agencies as the IHS (part of the U.S. Public Health Svc.) & the Division of Diabetes Treatment and Prevention (DDTP) have offered 19 diabetes programs, 12 control officers, and 399 grant programs such as SDPI (Special Diabetes program for Indians), aimed at aiding Native Americans to abolish diabetes for good. [23]

Diabetes' effects

The prevalence of diabetes has resulted in related health complications, such as end-stage renal disease. [17] Each of these is more prevalent in the Native American population. [24] Diabetes has increased the rate of premature death of Native Americans by vascular disease, especially among those diagnosed with diabetes later in life. It has been reported among the Pima Tribe to cause elevated urinary albumin excretion. Native Americans with diabetes have a significantly higher rate of heart disease than those without diabetes. Cardiovascular disease is the "leading underlying cause of death in diabetic adults" in Native Americans. [21]

Diabetes can cause nephropathy, leading to renal function deterioration, failure, and disease. Prior to the increase in cardiovascular disease among diabetic Native Americans, renal disease was the leading cause of death for this population. Another complication documented in diabetic Native Americans, as well as other diabetic populations, is retinopathy, causing the loss of sight. [21]

Because of vascular and nerve damage from diabetes, Native Americans have a higher rate of lower extremity amputations than European Americans. In studies of the Pima tribes, those with diabetes were also found to have much higher prevalence of periodontal disease, and higher rates of bacterial and fungal infection. For instance, "diabetic Sioux (Lakota people) Tribes were four times as likely to have tuberculosis as those without diabetes." [21]

Native Americans with diabetes have a death rate three times higher than those in the non-Native population. Diabetes can shorten a person's life by approximately 15 years. [16] As of 2012, diabetes was not the leading cause of death for Native Americans but contributed significantly to the top leading causes of death. [3]

The barriers for Native Americans and Alaskan Natives to receive proper health care include the isolated locations of some tribes, and social isolation related to poverty. Travel to health facilities can be too difficult, given distance, hazardous roads, high rates of poverty, and too few staff in hospitals near reservations. Diabetes is the primary cause of end-stage renal disease. Dialysis treatments and kidney transplants remain the most effective methods of treatment, but distance limits access to the first, as noted above. In addition, Native people are documented as having to wait longer for organ transplants than white people. [17]

Stroke

Stroke is the sixth-leading cause of death in the Native American population. Native Americans are sixty percent more likely than white adults in the United States to have a stroke. Native American women have double the rate of stroke of white women. About 3.6% of Native American and Alaska Native men and women over 18 have a stroke. [25] The stroke death rate of Native Americans and Alaska Natives is 14 percent greater than among all races. [26]

Psychosocial problems

About 70% of American Indian and Alaska Native men and 60% of the women met the criteria for at least one lifetime DSM IV disorder. American Indian and Alaskan Native men and women have a higher prevalence of any substance use, mood, and personality disorder, compared to non-Hispanic Whites. [27]

Mental Health Disorders in Native American Women

The lifestyle prevalence of mood disorders in Native American women is 44%, with 81% of the women with mood disorders suffering from major depression. A third of the cases of depression were moderate or severe. Anxiety disorders were the most common mental disorders, particularly specific phobias and post-traumatic stress disorder. Comorbid anxiety and depression is also common, with 82% of Native American women who have a lifetime diagnosis of depression reporting anxiety, and 54% of those with a lifetime diagnosis of anxiety experiencing depression. [28]

Suicide

Native Americans face issues of depression and the highest rate suicide rate of any ethnic group in the United States. In 2009 suicide was the leading cause of death among Native Americans and Native Alaskans between the ages of 10 and 34. [29] 75% of deaths among Native Americans and Native Alaskans over the age of 10 are due to unintentional injury, homicide, and suicide. [29] Suicide rates among Native American youths are significantly higher than among white youths. [29] The head of the IHS, Mary L. Smith, says[ when? ] that her agency is focusing on mental health issues in Native American communities. Because of numerous suicides among teens on the Pine Ridge Indian Reservation, it has been designated as a Promise Zone and the government is sending extra help. [30]

A British Columbia study, published in 2007, reported an inverse correlation between Indigenous youth suicide and use of their heritage language. Language use is considered a cultural continuity factor, and it was more highly correlated to youth suicide than six other such cultural factors. Those bands that had higher rates of indigenous language use had lower rates of suicide. Since the late 20th century, numerous tribes have undertaken language revitalization programs in order to maintain their cultures. This study indicates such language use can also have positive effects on teens' mental health. The study recorded suicides among bands with higher use and those with lower use of indigenous languages. Communities with lesser language knowledge estimated 96.59 suicides per 100,000 individuals; the bands with greater language knowledge estimated 13 suicides per 100,000 people. Indigenous youths' mental health can be affected by the community's use of Indigenous language. [31]

Alcohol use disorder

Another significant concern in Native American health is alcohol use disorder. From 2006 to 2010, alcohol-attributed deaths accounted for 11.7 percent of all Native American deaths, more than twice the rates of the general U.S. population. The median alcohol-attributed death rate for Native Americans (60.6 per 100,000) was twice as high as the rate for any other racial or ethnic group. [32] Alcohol use disorder is often approached using the disease model of addiction, with biological, neurological, genetic, and environmental sources of origin. [33] The influence of trauma has been supported by research showing that Native American behavior is frequently affected by trauma resulting from domestic violence, racial discrimination, poverty, homelessness, historical trauma, disenfranchised grief, and internalized oppression. [34] Statistically, the incidence of alcohol use disorder among survivors of trauma is significantly elevated, with survivors of physical, emotional and sexual abuse in childhood having the highest rates of alcohol use disorder. [35] [36]

However, at least one recent study refutes the belief that Native Americans drink more than white Americans. Analysis of data from the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013 revealed that Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined. The survey included responses from 171,858 whites compared to 4,201 Native Americans. The majority (59.9%) of Native Americans abstained from drinking alcohol, whereas less than half (43.1%) of the white population surveyed abstained. Approximately 14.5% of Native Americans were light/moderate-only drinkers, versus 32.7% of whites. Native American and white binge drinking (5+ drinks on an occasion 1–4 days during the past month) estimates were similar: 17.3% and 16.7%, respectively. The two populations' heavy drinking (5+ drinks on an occasion 5+ days in the past month) estimates were also similar: 8.3% and 7.5%, respectively. [37] Nonetheless, Native Americans may be more vulnerable to the health risks associated with drinking because of lack of access to health care, safe housing and clean water. [38]

After colonial contact, white drunkenness was interpreted by whites as the misbehavior of an individual. Native drunkenness was interpreted in terms of the inferiority of a race. What emerged was a set of beliefs known as "firewater myths" that misrepresented the history, nature, sources and potential solutions to Native alcohol problems. [39] [40] These myths claim that:

Scientific literature has debunked many of these myths by documenting the wide variability of alcohol problems across and within Native tribes and the very different response that certain individuals have to alcohol as opposed to others. [41] [42]

The 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III) found that 19.2% of Native Americans surveyed had had an alcohol use disorder during the previous twelve months, and 43.4% had had an alcohol use disorder at some time during their lives (compared to 14.0% and 32.6% of whites, respectively). [43] This contrasts sharply with the 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services, which surveyed adolescents and adults receiving treatment and found that 9.7% of Native Americans surveyed had had an alcohol use disorder during the previous twelve months (compared to 6.1% of whites). [44] An analysis of surveys conducted between 2002 and 2016 determined that 34.4% of Native American adults used alcohol in 2016 (down from 44.7% in 2002). [45]

Native American tribes with a higher level of traditional social integration and less pressure to modernize appear to have fewer alcohol-related problems. Tribes in which social interactions and family structure are disrupted by modernization and acculturative stress (i.e. young people leaving the community to find work) have higher rates of alcohol use and misuse. Native Americans living in urban areas have higher rates of alcohol use than those living in rural areas or on reservations, and more Native Americans living on reservations (where cultural cohesion tends to be stronger) abstain altogether from alcohol. [46] Alaska Natives who follow a more traditional lifestyle have reported greater happiness and less frequent alcohol use for coping with stress. [47]

HIV/AIDS

HIV and AIDS are growing concerns for the Native American population. The overall percentage of Native Americans diagnosed with either HIV or AIDS within the entire United States population is relatively small. Native American AIDS cases make up approximately 0.5% of the nation's cases, while they account for about 1.5% of the total population. [5]

Native Americans and Alaska Natives rank third in the United States in the rate of new HIV infections. [48] Native Americans, when counted with Alaskan Natives, have a 40% higher rate of AIDS than white individuals. Also, Native American and Alaskan Native women have double the rate of AIDS of white women. [5]

These statistics have multiple suggested causes:

Sexual behaviors
Previous studies of high rates of sexually transmitted diseases among Native Americans lead to the conclusion that the sexual tendencies of Native Americans lead to greater transmission [49]
Illicit drug use
The use of illicit drugs is documented to be very high among Native Americans, and not only does the involvement of individuals with illicit drugs correlate with greater rates of sexually transmitted disease, but it can facilitate the spread of diseases
Socio-economic status
Due to the poverty and lower rates of education, the risk of getting AIDS or any other sexually transmitted disease can be increased indirectly or directly
Testing and data collection
Native Americans may have limited access to testing for HIV/AIDS due to location away from certain health facilities; data collected on Native American sexually transmitted diseases may be limited for this same reason as well as for under-reporting and the Native American race being misclassified [49]
Culture and tradition
Native American culture is not always welcoming of open discussion of sexually transmitted diseases [48]

Combating disease and epidemics

Many initiatives have been put in place to combat Native American disease and improve the overall health of this demographic. One primary example of such initiative by the government is the Indian Health Service which works "to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to Native American and Alaska Native people". [50] There are many other governmental divisions and funding for health care programs relating to Native American diseases. Additionally, there is a multitude of health provision and disease prevention programs administered by tribes themselves. [51]

Government agencies

Healthcare for Native Americans were provided through the Department of War (throughout the 1800s) until it became a focus of the Office of Indian Affairs in the late 1800s. It again switched government agencies in the early 1950s, going under the supervision of the Department of Health, Education, and Welfare's Public Health Service (PHS). In 1955, the Indian Health Service division was created, which still enacts the majority of Native American specific healthcare. [52]

The Snyder Act of 1921 (23 U.S.C. 13) was one of the first formal legislative pieces to allow healthcare to be provided to Native Americans. [52] [53]

In the 1970s, more legislation began passing to expand the healthcare access for Native Americans.[ citation needed ]

Diabetes programs

Eagle books are a book series produced by the CDC to inform Native American children about healthy lifestyles to prevent diabetes. Eaglebooks.jpg
Eagle books are a book series produced by the CDC to inform Native American children about healthy lifestyles to prevent diabetes.

As diabetes is one of the utmost concerns of the Native American population, many programs have been initiated to combat this disease.

Governmental programs

One such initiative has been developed by the Centers for Disease Control and Prevention (CDC). Termed the "Native Diabetes Wellness Program", this program began in 2004 with the vision of an "Indian Country free of the devastation of diabetes". [54] To realize this vision, the program works with Native American communities, governmental health institutions, other divisions of the CDC, and additional outside partners. Together they develop health programs and community efforts to combat health inequalities and in turn prevent diabetes. The four main goals of the Native Diabetes Wellness Program are to promote general health in Native communities (physical activity, traditional foods), spread narratives of traditional health and survival in all aspects of life, utilize and evaluate health programs and education, and promote productive interaction with the state and federal governments. [54]

Funding for these efforts is provided by the Balanced Budget Act of 1997, Public Law 105–33, and the Indian Health Service. One successful aim of this program is the Eagle Books series, which are books using animals as characters to depict a healthy lifestyle that prevents diabetes, including embracing physical activity and healthy food. These books were written by Georgia Perez, who worked with the University of New Mexico's Native American Diabetes Project. [55] Other successful efforts include Diabetes Talking Circles to address diabetes and share a healthy living message and education in schools. The Native Diabetes Wellness Program also has worked with tribes to establish food programs that support the "use of traditional foods and sustainable ecological approaches" [54] to prevent diabetes.

The Indian Health Service has also worked to control the diabetes prevalence among Native Americans. The IHS National Diabetes Program was created in 1979 to combat the escalating diabetes epidemic. [56] The current head of the IHS, Mary L. Smith, Cherokee, took the position in March 2016 and had pledged to improve the IHS and focus on comprehensive health care for all the tribes and people covered by the department. [30] A sector of the service is the Division of Diabetes Treatment and Prevention, which "is responsible for developing, documenting, and sustaining clinical and public health efforts to treat and prevent diabetes in Native Americans and Alaska Natives". [56]

This division contains the Special Diabetes Program for Indians, as created by 1997 Congressional legislation. This program receives $150 million a year in order to work on "Community-Directed Diabetes Programs, Demonstration Projects, and strengthening the diabetes data infrastructure". [56] The Community-Directed Diabetes Programs are programs designed specifically for Native American community needs to intervene in order to prevent and treat diabetes. Demonstration Projects "use the latest scientific findings and demonstrate new approaches to address diabetes prevention and cardiovascular risk reduction". [56] Strengthening the diabetes data infrastructure is an effort to attain a greater base of health information, specifically for the IHS electronic health record. [56]

In addition to the Special Diabetes Program for Native Americans, the IHS combats diabetes with Model Diabetes Programs and the Integrated Diabetes Education Recognition Program. There are 19 Model Diabetes Programs which work to "develop effective approaches to diabetes care, provide diabetes education, and translate and develop new approaches to diabetes control". [56] The Integrated Diabetes Education Recognition Program is an IHS program that works towards high-quality diabetes education programs by utilizing a three-staged accreditation scale. Native American programs in healthcare facilities can receive accreditation and guidance to effectively educate the community concerning diabetes self-management. [56]

Tribal programs

Many tribes themselves have begun programs to address the diabetes epidemic, which can be specifically designed to address the concerns of the specific tribe. The Te-Moak Tribe of Western Shoshone have created their diabetes program. With this program, they hope to promote healthy lifestyles with exercise and modified eating and behavior. The means of achieving these ends including "a Walking Club, 5 a Day Fruits and Vegetable, Nutrition teaching, Exercise focusing, 28 day to Diabetes Control, and Children's Cookbook". [57] Additionally, the Te-Moak tribe has constructed facilities to promote healthy lifestyles, such as a center to house the diabetes program and a park with a playground to promote active living. [57]

The Meskwaki Tribe of the Mississippi has also formed diabetes program to provide for the tribe's people. The Meskwaki Tribe facilitates their program to eliminate diabetes as a health concern through prevention and control of complications. The program has a team mentality, as community, education and clinical services are all involved as well as community organizations and members. [58]

There are many facets of this diabetes program, which include the distribution of diabetes information. This is achieved through bi-weekly articles in the Meskwaki Times educating the population about diabetes prevention and happenings in the program and additional educational materials available about diabetes topics. Other educational is spread through nutrition and diabetes classes, such as the Diabetes Prevention Intensive Lifestyle Curriculum Classes, and events like health fairs and walks. Medical care is also available. This includes bi-weekly diabetes clinics, screenings for diabetes and related health concerns and basic supplied. [58]

HIV-AIDS programs

Official seal of the National Native HIV/AIDS Awareness Day National Native AIDS Awareness.jpg
Official seal of the National Native HIV/AIDS Awareness Day

Multiple programs exist to address the HIV and AIDS concerns for Native Americans. Within the Indian Health Service, an HIV/AIDS Principal Consultant heads an HIV/AIDS program. This program involves many different areas to address "treatment, prevention, policy, advocacy, monitoring, evaluation, and research". [59] They work through many social outputs to prevent the masses from the epidemic and enlist the help of many facilities to spread this message. [59]

The Indian Health Service also works with Minority AIDS Initiative to use funding to establish AIDS projects. This funding has been used to create testing, chronic care, and quality care initiatives as well as training and camps. [60] The Minority AIDS Initiative operates through the Ryan White HIV/AIDS Program, under the Public Health Service Act. This is in recognition of the disproportionate impact of HIV/AIDS on racial and ethnic minorities. [61]

There has also been a National Native HIV/AIDS Awareness Day held on March 20 for Native Americans, Alaska Natives, and Native Hawaiians, with 2009 marking its third year. This day is held to:

  1. encourage Native people to get educated and to learn more about HIV/AIDS and its impact in their community;
  2. work together to encourage testing options and HIV counseling in Native communities; and
  3. help decrease the stigma associated with HIV/AIDS. [62]

This day takes place across the United States with many groups working in coordination, groups like the CDC and the National Native Capacity Building Assistance Network. By putting out press releases, displaying posters, and holding community events, these groups hope to raise awareness of the HIV/AIDS epidemic. [62]

Heart disease and stroke programs

The Centers for Disease Control and Prevention contain a Division for Heart Disease and Stroke Prevention, which collects data and specifically releases information to form policy for Native Americans. They have identified many areas in which lifestyles of Native Americans need to be changed in order to greatly decrease the prevalence of heart disease and stroke. [26] One major concern to prevent is diabetes, which directly relates to the presence of heart disease. Many general health concerns also need to be addressed, according to the CDC's observations, including moderating alcohol use, eliminating tobacco use, maintaining health body weight, regularizing physical activity, diet, and nutrition, preventing and controlling high blood cholesterol, and preventing and controlling high blood pressure. [26]

The Indian Health Service works in collaboration with the University of Arizona College of Medicine to maintain the Native American Cardiology Program. This is a program that acknowledges the changes in lifestyle and economics in the recent past which have ultimately increased the prevalence of heart attacks, coronary disease, and cardiac deaths. The Native American Cardiology Program prides itself in its cultural understanding, which allows it to tailor health care for its patients. [63]

The program has many bases but has placed an emphasis on providing care to remote, rural areas in order for more people to be cared for. The Native American Cardiology Program's telemedicine component allows for health care to be made more accessible to Native Americans. This includes interpreting medical tests, offering specialist input and providing triage over the phone. The Native American Cardiology Program also has educational programs, such as lectures on cardiovascular disease and its impact, and outreach programs. [63]

Alcohol treatment and prevention programs

SAMHSA's Office of Tribal Affairs and Policy

The Office of Tribal Affairs and Policy (OTAP) serves as primary point of contact between the Substance Abuse and Mental Health Services Administration (SAMHSA) and tribal governments, tribal organizations, and federal agencies on behavioral health issues that impact tribal communities. [64] OTAP supports SAMHSA's efforts to implement the Tribal Law and Order Act (TLOA) of 2010 and the National Tribal Behavioral Health Agenda. [65] The Office of Indian Alcohol and Substance Abuse (OIASA), an organizational component of OTAP, coordinates federal partners and provides tribes with technical assistance and resources to develop and enhance prevention and treatment programs for substance use disorders, including alcohol. [66]

Indian Health Services

The Alcohol and Substance Abuse Program (ASAP) is a program for American Indian and Alaska Native individuals to reduce the incidence and prevalence of alcohol and substance use disorders. These programs are administered in tribal communities, including emergency, inpatient and outpatient treatment and rehabilitation services for individuals covered under Indian Health Services. [67] It addresses and treats alcohol use disorder from a disease model perspective.

Tribal Action Plan

The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 [68] was updated in 2010 to make requirements that the Office of Indian Alcohol and Substance Abuse (OIASA), a subdivision of SAMHSA, is to work with federal agencies to assist Native American communities in developing a Tribal Action Plan (TAP). The TAP coordinates resources and funding required to help mitigate levels of alcohol and substance abuse among the Native American population, as specified in the Indian Alcohol and Substance Abuse Memorandum of Agreement of August 2011, and executed by OIASA. [69]

See also

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<span class="mw-page-title-main">Substance abuse prevention</span> Measures to prevent the consumption of licit and illicit drugs

Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults — especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.

<span class="mw-page-title-main">Health in Bangladesh</span>

Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.

<span class="mw-page-title-main">Modern social statistics of Native Americans</span>

Modern social statistics of Native Americans serve as defining characteristics of Native American life, and can be compared to the average United States citizens’ social statistics. Areas from their demographics and economy to health standards, drug and alcohol use, and land use and ownership all lead to a better understanding of Native American life. Health standards for Native Americans have notable disparities from that of all United States racial and ethnic groups. They have higher rates of disease, higher death rates, and a lack of medical coverage.

Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.

<span class="mw-page-title-main">Yvette Roubideaux</span> American physician

Yvette Roubideaux is an American doctor and public health administrator. She is a member of the Rosebud Sioux Tribe of South Dakota.

The Northwest Portland Area Indian Health Board (NPAIHB) is a non-profit tribal advisory organization in Portland, Oregon, run and organized by participating tribes. It was established in 1972 to focus on four areas as they pertain to the health of Native people: health promotion and disease prevention, legislative and policy analysis, training and technical assistance, and surveillance and research. It serves 43 federally recognized tribes in Oregon, Washington and Idaho, with each tribe appointing a delegate to the board that oversees the NPAIHB. The board meets quarterly to discuss current projects and issues.

<span class="mw-page-title-main">Native Americans and reservation inequality</span> Social issue in the U.S.

Native American reservation inequality underlies a range of societal issues that affect the lives of Native American populations residing on reservations in the United States. About one third of the Native American population, about 700,000 people, lives on an Indian Reservation in the United States. Reservation poverty and other discriminatory factors have led to persisting social inequality on Native American reservations. Disparities between many aspects of life at the national level and at the reservation level, such as quality of education, quality of healthcare, substance use disorders, teenage pregnancy, violence, and suicide rates are significant in demonstrating the inequality of opportunities and situations between reservations and the rest of the country.

Contemporary Native American issues in the United States are topics arising in the late 20th century and early 21st century which affect Native Americans in the United States. Many issues stem from the subjugation of Native Americans in society, including societal discrimination, racism, cultural appropriation through sports mascots, and depictions in art. Native Americans have also been subject to substantial historical and intergenerational trauma that have resulted in significant public health issues like alcohol use disorder and risk of suicide.

<span class="mw-page-title-main">Alcohol and Native Americans</span> Use of alcoholic beverages by Native Americans

Many Native Americans in the United States have been harmed by, or become addicted to, drinking alcohol. Among contemporary Native Americans and Alaska Natives, 11.7% of all deaths are related to alcohol. By comparison, about 5.9% of global deaths are attributable to alcohol consumption. Because of negative stereotypes and biases based on race and social class, generalizations and myths abound around the topic of Native American alcohol misuse.

In the 1960s and 1970s, the Indian Health Service (IHS) and collaborating physicians sustained a practice of performing sterilizations on Native American women, in many cases without the free and informed consent of their patients. In some cases, women were misled into believing that the sterilization procedure was reversible. In other cases, sterilization was performed without the adequate understanding and consent of the patient, including cases in which the procedure was performed on minors as young as 11 years old. A compounding factor was the tendency of doctors to recommend sterilization to poor and minority women in cases where they would not have done so to a wealthier white patient. Other cases of abuse have been documented as well, including when health providers did not tell women they were going to be sterilized, or other forms of coercion including threatening to take away their welfare or healthcare.

Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected, become unintentionally pregnant, or make a partner pregnant. It can mean two similar things: the behavior itself, and the description of the partner's behavior.

Suicide among Native Americans in the United States, both attempted and completed, is more prevalent than in any other racial or ethnic group in the United States. Among American youths specifically, Native American youths also show higher rates of suicide than American youths of other races. Despite making up only 0.9% of the total United States population, American Indians and Alaska Natives (AIANs) are a significantly heterogeneous group, with 560 federally recognized tribes, more than 200 non-federally recognized tribes, more than 300 languages spoken, and one half or more of them living in urban areas. Suicide rates are likewise variable within AIAN communities.

Discrimination against people with substance use disorders is a form of discrimination against people with this disease. In the United States, people with substance use disorders are often blamed for their disease, which is often seen as a moral failing, due to a lack of public understanding about substance use disorders being diseases of the brain with 40-60% heritability. People with substance use disorders are likely to be stigmatized, whether in society or healthcare.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on Native American tribes and tribal communities</span> Effects of the viral outbreak on tribal communities

The impact of the COVID-19 pandemic on Native American tribes and tribal communities has been severe and has emphasized underlying inequalities in Native American communities compared to the majority of the American population. The pandemic exacerbated existing healthcare and other economic and social disparities between Native Americans and other racial and ethnic groups in the United States. Along with black Americans, Latinos, and Pacific Islanders, the death rate in Native Americans due to COVID-19 was twice that of white and Asian Americans, with Native Americans having the highest mortality rate of all racial and ethnic groups nationwide. As of January 5, 2021, the mortality impact in Native American populations from COVID-19 was 1 in 595 or 168.4 deaths in 100,000, compared to 1 in 1,030 for white Americans and 1 in 1,670 for Asian Americans. Prior to the pandemic, Native Americans were already at a higher risk for infectious disease and mortality than any other group in the United States.

References

  1. ↑ Mary Smith, "Native Americans: A Crisis in Health Equity," Human Rights Magazine, Vol. 43, No. 3: The State of Healthcare in the United States; 1 Aug 2018.
  2. ↑ US Census Bureau. "About Race". www.census.gov. Archived from the original on 2020-12-29. Retrieved 2019-04-08.
  3. 1 2 "Native American & Alaska Native (AI/AN) Populations". Office of Minority Health and Health Disparities, Centers for Disease Control and Prevention. November 30, 2010. Archived from the original on 2013-11-22. Retrieved December 4, 2013.
  4. ↑ Barnes, P.M., P.F. Adams, and E. Powell-Griner. (2010). Health Characteristics of the Native American or Alaska Native Adult Population: United States, 2004–2008. Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
  5. 1 2 3 4 5 6 "Cancer and Native Americans/Alaska Natives". United States Department of Health and Human Services: Office of Minority Health. June 13, 2012. Archived from the original on 2012-09-13. Retrieved September 7, 2012.
  6. ↑ Indian Health Service (January 2013). "Disparities". Newsroom. Retrieved June 10, 2017.
  7. ↑ Young, T. Kue (1997). "Recent Health Trends in the Native Americans' Population". Population Research and Policy Review. 16: 147–67. doi:10.1023/A:1005793131260. S2CID   67979174.
  8. ↑ Deloria, Vine (1988). Custer Died For Your Sins, An Indian Manifesto. New York: University of Oklahoma Press. p. 55. ISBN   978-0-8061-2129-1.
  9. ↑ Barnes, Patricia M. (2005). Vital and Health Statistics: Health Characteristics of the Native American and Alaska Native Adult Population (356th ed.). Centers for Disease Control and Prevention.
  10. 1 2 2005. Health Characteristics of the Native Americans and Alaska Native Adult Population: U.S., 19992003: Advance Data: From Vital and Health Statistics of the Centers for Disease Control and Prevention/National Center for Health Statistics;2005 ASI 41468.357;PHS 20051250, No. 356. n.p.:
  11. ↑ "Division for Heart Disease and Stroke Prevention – AIAN Fact Sheet". Centers for Disease Control and Prevention. October 9, 2009. Archived from the original on 2010-09-21. Retrieved 2017-09-10.
  12. ↑ American Indian and Alaska Native Heart Disease and Stroke Fact Sheet, CDC and U.S. Department of Health and Human Services
  13. ↑ Duyff, Roberta Larson (2006). American Dietetic Association Complete Food and Nutrition Guide. New York: Wiley.
  14. ↑ Bullock, Ann; Ronny A. Bell (2005). "Stress, trauma and coronary heart disease among Native Americans". American Journal of Public Health. 95 (12): 2122–b–2123. doi:10.2105/AJPH.2005.072645. PMC   1449491 . PMID   16257937.
  15. ↑ Edwards, Karethy; Patchell, Beverly (2009). "State of the science: a cultural view of Native Americans and diabetes prevention". Journal of Cultural Diversity. 16 (1): 32–35. PMC   2905172 . PMID   20640191.
  16. 1 2 "Division of Diabetes Treatment and Prevention". Indian Health Service. Retrieved October 8, 2009.
  17. 1 2 3 Narva, Andrew S (2002). "Kidney Disease in Native Americans". Journal of the National Medical Association. 94 (8): 738–42. PMC   2594281 . PMID   12152933.
  18. 1 2 3 Joslin, Elliott P. (2005). Joslin's diabetes mellitus. Philadelphia: Lippincott Williams & Willkins.
  19. ↑ Mogensen, Carl Erik (2000). The Kidney and Hypertension in Diabetes Mellitus. New York: Springer.
  20. ↑ "Type II Diabetes, the Modern Epidemic of American Indians in the United States". anthropology.ua.edu. Retrieved 2018-05-11.
  21. 1 2 3 4 Ekoé, Jean-Marie; Zimmet, Paul; Williams, Rhys, eds. (2001). The Epidemiology of Diabetes Mellitus: An International Perspective. New York: Wiley. doi:10.1002/0470846429. ISBN   978-0-471-97448-2. S2CID   58513280.
  22. ↑ Centers for Disease Control and Prevention (CDC) (2013-02-27), OUR CULTURES ARE OUR SOURCE OF HEALTH , retrieved May 6, 2016
  23. ↑ McLaughlin, Sue (2010-10-02). "Traditions and Diabetes Prevention: A Healthy Path for Native Americans". Diabetes Spectrum. 23 (4): 272–277. doi: 10.2337/diaspect.23.4.272 . ISSN   1040-9165.
  24. ↑ Sandefur, Gary D (1996). Changing numbers, Changing needs: Native American demography and public health. National Academy Press. ISBN   978-0-309-17529-6.
  25. ↑ "Stroke and Native Americans/Alaska Natives". Office of Minority Health. Archived from the original on 2009-11-16. Retrieved October 11, 2009.
  26. 1 2 3 "Division for Heart Disease and Stroke Prevention – AIAN Fact Sheet". Centers for Disease Control and Prevention. Archived from the original on 2009-10-20. Retrieved October 11, 2009.
  27. ↑ Brave Heart, Maria Yellow Horse; Lewis-Fernández, Roberto; Beals, Janette; Hasin, Deborah S.; Sugaya, Luisa; Wang, Shuai; Grant, Bridget F.; Blanco, Carlos (July 2016). "Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions". Social Psychiatry and Psychiatric Epidemiology. 51 (7): 1033–1046. doi:10.1007/s00127-016-1225-4. PMC   4947559 . PMID   27138948.
  28. ↑ Duran, Bonnie; Sanders, Margaret; Skipper, Betty; Waitzkin, Howard; Malcoe, Lorraine Halinka; Paine, Susan; Yager, Joel (January 2004). "Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care". American Journal of Public Health. 94 (1): 71–77. doi:10.2105/ajph.94.1.71. PMC   1449829 . PMID   14713701.
  29. 1 2 3 "Mental Health – The Office of Minority Health". minorityhealth.hhs.gov. Archived from the original on 2016-05-09. Retrieved May 5, 2016.
  30. 1 2 kpolisse (April 25, 2016). "New IHS Head Focused on Quality, Accountability". Indian Country Today Media Network.com. Retrieved May 5, 2016.
  31. ↑ Hallett, Darcy; Chandler, Michael; Lalonde, Christopher (2007). "Aboriginal language knowledge and youth suicide" (PDF). Cognitive Development. 22 (3): 392–399. doi:10.1016/j.cogdev.2007.02.001 . Retrieved 7 November 2019.
  32. ↑ Gonzales, K.; Roeber, J.; Kanny, D.; Tran, A.; Saiki, C.; Johnson, H.; Yeoman, K.; Safranek, T.; Creppage, K.; Lepp, A.; Miller, T.; Tarkhashvili, N.; Lynch, K. E.; Watson, J. R.; Henderson, D.; Christenson, M.; Geiger, S. D.; Centers for Disease Control and Prevention (CDC) (2014). "Alcohol-Attributable Deaths and Years of Potential Life Lost — 11 States, 2006–2010". MMWR. Morbidity and Mortality Weekly Report. 63 (10): 213–216. PMC   5779340 . PMID   24622285.
  33. ↑ Matamonasa-Bennett, A. (2015). ""The Poison That Ruined the Nation": Native American Men—Alcohol, Identity, and Traditional Healing". American Journal of Men's Health. 11 (4): 1142–1154. doi:10.1177/1557988315576937. PMC   5675341 . PMID   25812975.
  34. 1 2 Dunbar-Ortiz, Roxanne; Gilio-Whitaker, Dina (2016). "All the Real Indians Died Off": And 20 Other Myths about Native Americans. Beacon Press: Boston, 2016. ISBN   978-0-8070-6265-4.
  35. ↑ Buchwald, D.; Tomita, S.; Hartman, S.; Furman, R.; Dudden, M.; Manson, S. M. (2000). "Physical Abuse of Urban Native Americans". Journal of General Internal Medicine. 15 (8): 562–564. doi:10.1046/j.1525-1497.2000.02359.x. PMC   1495579 . PMID   10940148.
  36. ↑ Amanda Lechner, Michael Cavanaugh, Crystal Blyler. "Addressing Trauma in American Indian and Alaska Native Youth," Research paper developed for the Dept. of Health & Human Services by Mathematica Policy Research, Washington, DC August 24, 2016.
  37. ↑ Cunningham, James K.; Solomon, Teshia A.; Muramoto, Myra L. (2016). "Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief". Drug and Alcohol Dependence. 160: 65–75. doi:10.1016/j.drugalcdep.2015.12.015. PMID   26868862.
  38. ↑ "Broken Promises: Continuing Federal Funding Shortfall for Native Americans | U.S. Commission on Civil Rights". www.usccr.gov. Retrieved 2024-01-24.
  39. ↑ Gonzalez, V. M.; Skewes, M. C. (2016). "Association of the Firewater Myth with Drinking Behavior Among American Indian and Alaska Native College Students". Psychology of Addictive Behaviors. 30 (8): 838–849. doi:10.1037/adb0000226. PMC   5222774 . PMID   27736147.
  40. ↑ Gonzalez, Vivian M.; Bravo, Adrian J.; Crouch, Maria C.; Protective Strategies Study, Team (2019). "Endorsement of the "firewater myth" affects the use of protective behavioral strategies among American Indian and Alaska Native students". Addictive Behaviors. 93: 78–85. doi:10.1016/j.addbeh.2019.01.027. PMC   6488417 . PMID   30703666.
  41. ↑ Coyhis, D.; White, W. (2002). "Addiction and Recovery in Native America: Lost History, Enduring Lessons" (PDF). Counselor. 3 (5): 16–20. Archived from the original (PDF) on 2012-04-18.
  42. ↑ Coyhis, D.; Simonelli, R. (2008). "The Native American Healing Experience". Substance Use & Misuse. 43 (12–13): 1927–1949. doi:10.1080/10826080802292584. PMID   19016172. S2CID   20769339.
  43. ↑ Grant, B. F.; Goldstein, R. B.; Saha, T. D.; Chou, S. P.; Jung, J.; Zhang, H.; Pickering, R. P.; Ruan, W. J.; Smith, S. M.; Huang, B.; Hasin, D. S. (2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–766. doi:10.1001/jamapsychiatry.2015.0584. PMC   5240584 . PMID   26039070.
  44. ↑ "Behavioral Health Barometer: United States, Volume 4: Indicators, as measured through the 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services. Substance Abuse and Mental Health Services Administration." HHS Publication No. SMA–17–BaroUS–16. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.
  45. ↑ Table 50: Use of selected substances in the past month among persons aged 12 and over, by age, sex, race, and Hispanic origin: United States, selected years 2002–2016. 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services.
  46. ↑ Philip A., May (1996). "Overview of Alcohol Abuse Epidemiology for American Indian Populations". In Sandefur, Gary D.; Rindfuss, Ronald R.; Cohen, Barney (eds.). Changing Numbers, Changing Needs: American Indian Demography and Public Health. National Academies Press. pp. 235–261. ISBN   978-0-309-05548-2. PMID   25121291.
  47. ↑ Borowsky, Iris Wagman; Resnick, Michael D.; Ireland, Marjorie; Blum, Robert W. (1999). "Suicide Attempts Among American Indian and Alaska Native Youth". Archives of Pediatrics & Adolescent Medicine. 153 (6): 573–580. doi:10.1001/archpedi.153.6.573. PMID   10357296.
  48. 1 2 "The Indian Health Service Fact Sheets" . Retrieved October 11, 2009.
  49. 1 2 "HIV/AIDS among Native Americans and Alaska Natives — Factsheets". Centers for Disease Control and Prevention. Archived from the original on 2009-10-17. Retrieved October 6, 2009.
  50. ↑ "Introduction to IHS by Dr Yvette Roubideaux". Indian Health Service. Archived from the original on 2009-05-09. Retrieved October 9, 2009.
  51. ↑ "What the Future Holds: The Changing Landscape of Federal Indian Policy". Harvard Law Review. Retrieved 2024-01-24.
  52. 1 2 Champagne, Duane (2001). The Native North American ALmanac. Farmingtom Hills, MI: Gale Group. pp. 943–945. ISBN   978-0-7876-1655-7.
  53. ↑ "Legislation | About IHS". About IHS. Retrieved 2018-11-04.
  54. 1 2 3 "National Diabetes Wellness Program". Centers for Disease Control and Prevention. Retrieved October 9, 2009.
  55. ↑ "Eagle Books | Native Diabetes Wellness Program". www.cdc.gov. Retrieved May 6, 2016.
  56. 1 2 3 4 5 6 7 "Division of Diabetes Treatment and Prevention". Indian Health Service . Retrieved October 9, 2009.
  57. 1 2 "Special Diabetes Program". Te-Moak Tribe of Western Shoshone . Retrieved October 13, 2009.
  58. 1 2 "Sac & Fox Tribe – Diabetes & Wellness Program". Official Site of the Meskwaki Nation. Archived from the original on 2009-06-30. Retrieved October 13, 2009.
  59. 1 2 "IHS HIV/AIDS Program". Indian Health Service. Archived from the original on 2009-08-25. Retrieved October 11, 2009.
  60. ↑ "IHS HIV/AIDS Program Minority AIDS Initiative". Indian Health Service. Archived from the original on 2009-08-25. Retrieved October 11, 2009.
  61. ↑ "HRSA – Part F Minority AIDS Initiative". Health Resources and Services Administration. Retrieved October 11, 2009.
  62. 1 2 "2009 National Native HIV/AIDS Awareness Day". National Native American AIDS Prevention Center. Archived from the original on 2011-07-27. Retrieved October 11, 2009.
  63. 1 2 "Native American Cardiology Program at UMC". University Medical Center Tucson, Arizona. Archived from the original on 2010-12-01. Retrieved October 14, 2009.
  64. ↑ "SAMHSA's Office of Tribal Affairs". 28 April 2014. Archived from the original on 2020-07-01. Retrieved 2020-07-02.
  65. ↑ "The National Tribal Behavioral Health Agenda". Archived from the original on 2019-08-16. Retrieved 2020-07-02.
  66. ↑ "Office of Indian Alcohol and Substance Abuse". 5 May 2014. Archived from the original on 2020-06-30. Retrieved 2020-07-02.
  67. ↑ "Alcohol and Substance Abuse Program: Treatment". Archived from the original on 2020-04-22. Retrieved 2020-07-02.
  68. ↑ "The Indian Alcohol and Substance Abuse Prevention and Treatment Act". Archived from the original on 2019-01-02. Retrieved 2020-07-02.
  69. ↑ ""Tribal Action Plan," Indian Health Service". 9 September 2014. Archived from the original on 2020-04-01. Retrieved 2020-07-02.


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