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There are an estimated 4.1 million people who are classified as American Indian and Alaska Native alone or in combination with one or more other races. This racial group composes 1.5% of the total U.S. population. The leading causes of illness and death among American Indians are heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke. American Indians also have a high prevalence of obesity, chronic renal failure, alcoholism, and are at increased risk for mental health issues and suicide. In an effort to build a trusted relationship with these patients and become an active participant in their care, the health care provider must demonstrate respect for the traditions of the American Indian.
Before beginning this discussion, it is important to note that older adults prefer to be identified as American Indians (AIs), whereas younger adults prefer the term Native Americans (NAs). Identifying patient preference is an important first step in establishing an effective clinician-patient relationship.
Historical Perspective
The first people native to the Americas were the American Indians. This racial group is any and all of the original peoples of North, South, and Central America, who maintain tribal affiliation or community attachment (U.S. Department of Health and Human Services [USDHHS], The Office of Minority Health, 2006a). There are an estimated 4.1 million people who are classified as American Indian and Alaska Native (AI/AN) alone or in combination with one or more other races (Castor et al., 2006). This racial group composes 1.5% of the total U.S. population. The AIs/ANs had the right to all the land that is in the United States, but over time, were denied ownership and subsequently relocated to federal or state reservations (Kramer, 1996). Currently, more than 1.8 million AIs/ANs live on reservations or other trust lands.
Currently, there are 561 federally recognized AI/AN tribes, and more than 100 state recognized tribes. There are also tribes that are not state or federally recognized. Federally recognized tribes are provided health and educational assistance through a government agency called Indian Health Service. The federally recognized tribes can be identified by their tribal name.
Health Care Demographics
The median family income for AIs/ANs is $33,627 with more than 25% of AIs living in poverty (Castor et al., 2006; USDHHS, 2006a). Approximately 45%...