The life expectancy of Native Americans in some states is 20 years shorter than the national average.
There are many reasons why.
Among them, health programs for American Indians are chronically underfunded by Congress. And, about a quarter of Native Americans reported experiencing discrimination when going to a doctor or health clinic, according to findings of a poll by NPR, the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health.
Margaret Moss, a member of the Hidatsa tribe, has worked as a nurse for the Indian Health Service and in other systems. She now teaches nursing at the University of Buffalo.
She says she has seen racism toward Native Americans in health care facilities where she's worked, and as a mom trying to get proper care for her son.
Once, when she was on a health policy fellowship with a U.S. Senate committee, Moss' son had a broken arm improperly set at a non-IHS health facility in Washington, D.C.
She asked the physician about options to correct it, but he told her it was fine, she said. "Even when I, as an educated person using the right words, was saying what needed to happen, [he] didn't want to do anything for us, even though we had a [health insurance] card."
Moss then reluctantly pulled out a business card with the Senate logo, she recalled, and was instantly transformed in the doctor's eyes from "this American Indian woman with my obviously minority son" to someone he could not afford to dismiss.
"It wasn't until the person ... felt they could get in trouble for this ... then the person did something," said Moss. "I felt like it was racism. Not everybody has a card they can just whip out."
She says she feels discrimination is more overt, "in areas where American Indians are known about," like the Dakotas and parts of the American Southwest, but also exists in places without big tribal populations.
In the NPR poll, Native Americans who live in areas where they are in the majority reported experiencing prejudice at rates far higher than in areas where they constituted a minority.
In places where there are few American Indians, Moss says, "people don't expect to see American Indians; they think they are from days gone by, and so you are misidentified. And that's another form of discrimination."
Health care systems outside the Indian Health Service generally see very few Native American patients, because it's so hard for American Indians to access care in the private sector. A lot of that has to do with high poverty and uninsured rates among American Indians, who also often live in rural areas with few health care providers.
"The strikes against people trying to get care are huge: geographic, transportation, monetary," Moss says.
A persistent myth inside and outside Indian Country is that Native Americans get free health care from the federal government.
A persistent myth inside and outside Indian Country is that Native Americans get free health care from the federal government.
Anna Whiting Sorrell, a health care administrator for her tribes, says she is optimistic that the Affordable Care Act will make a big difference for Native Americans. It gives lower-income people access to affordable insurance coverage outside the IHS. Many Natives Americans who weren't eligible for Medicaid before the ACA now are, too.
Moss is more skeptical that the ACA will make a big difference, in part because of entrenched institutional discrimination toward Native Americans in healthcare.
"Until attitudes change," Moss says, "we're still going to be in a sad situation."
For Natives Americans, In Indian Health Service And Outside It : Shots - Health News : NPR
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