Social Determinants of American Indian Health: The Interplay of History and Politics in the Origin, Evolution and Perpetuation of Health Disparities

The health of today's American Indians have been influenced by the history of oppression, repression, intergenerational anger, trauma and grief, experienced since North America was colonized by Europeans. This history of social injustice has had a profound impact on the current health status of American Indians. Relative to national population averages, American Indians experience lower health status and lower life expectancy. American Indians die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). The causes of such disparities are a complex interplay of multiple factors, including poverty, limited educational opportunities, discrimination in the delivery of health services, and power imbalances with historic precedents. In trying to account for these disparities, this presentation will examine the history and evolution of US health care policy toward American Indians and the historical experiences of American Indians linked to contemporary health problems. By making appreciable the origin and evolution of health disparities experienced by American Indians, health care providers, policymakers, and researchers will better understand how the social determinants of health – economic and social conditions in which people live – are shaped by political, social, and economic forces, and the importance of turning this knowledge into political action to eliminate disparities and provide health care justice and equity for all Americans.