Urban Indians face health disparities, study finds

By Lornet Turnbull
Seattle Times staff reporter

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American Indians and Alaska Natives living in urban areas suffer higher rates of chronic illness and are more likely to die from accidents and alcohol-related problems than the population overall, a new national study shows.

The percentage of teenage mothers is higher and infant-mortality rates are greater among Indians than among the general public. And the study found higher rates of poverty, lower levels of formal education and higher unemployment among Indians living away from reservations.

The findings are not particularly new: Native leaders and health-industry officials long ago sounded the alarm over the health disparities and income and education problems plaguing America's first people.

But yesterday's report by the Seattle Indian Health Board's Urban Indian Health Initiative takes the first look nationally at how these issues affect Native Americans who live in cities and counties where they should have the same access to social services as everyone else.

"The health disparities that we found are probably grossly underestimated," said Ralph Forquera, executive director of the Seattle Indian Health Board and director of the Urban Indian Health Institute. He cited racial misclassification and poor record-keeping as impediments to fully examining the problem.

"We are aware that Indian people living in cities still have significant problems with access to care for a variety of reasons," Forquera said. "And we know what some of those are: higher rates of disability, poverty and unemployment."

The report used data from the U.S. Census Bureau and the National Center for Health Statistics to examine the health, educational and economic status of Indians living in metropolitan areas served by 34 organizations that receive funding from the U.S. Indian Health Service.

It was compiled for the institute by Public Health — Seattle & King County.

In the 2000 Census, 4 million Americans described themselves as American Indian or Alaska Native. Of these, nearly 70 percent lived in urban areas and 25 percent lived in counties served by health-care agencies that receive federal funding for Indians.

The Urban Indian health study comes 10 years after the Seattle Indian Health Board first examined the status of Indians living in King County and the rest of Washington State — on and off reservations. The health disparities are as severe now as they were then, Forquera said.
 
"What we found in 1994 and with this study is that the health status on the reservation and among urban Indians is well below that of the general population," he said.

"We now know this problem is broader than just Seattle and the rest of Washington state. It's really a national crisis."

The new report serves to underscore that urban Indians face significant health and social problems that are not being adequately addressed by the federal government despite having a 2010 goal of reducing health disparities for minority populations.

Maile Taualii, program manager of the Health Institute, which was formed two years ago to address the lack of data on urban Indians, said mainstream health-care systems too often aren't a good fit for Indians. "On the reservations, people got used to a federal health-care system that may not have been 100 percent adequate for their needs," she said. "But they understood it. As they moved to cities, they didn't have the same understanding of how the system worked."

Forquera said historically there's been resistance and mistrust among native groups toward mainstream services.

"The more you can create serves that are designed with cultural sensitivity and staffed with people who are used to working with or are themselves native, the greater the probability that people will not only use those services but continue to use them and in the process take more aggressive steps to help themselves," he said.

Among the report's other key findings:

• One of four urban Indians was living in poverty in 2000.

• Seventy percent of urban Indians age 25 and older reported having a high-school diploma — compared with 80 percent of the general population.

• The unemployment rate for urban Indians was about 12 percent, compared with 6 percent for the general population.

• About 46 percent of urban Indian households were headed by a single parent, compared with 30 percent of the general population.

Lornet Turnbull: 206-464-2420 or lturnbull@seattletimes.com