We spoke with AARP’s national consultant on Native American/Alaska Native communities, Michael E. Bird, about the pressing health issues facing tribal nations.
A Santo Domingo-San Juan Pueblo Indian from New Mexico, Bird has more than 30 years of public health experience with Native American populations. Previously, he was the executive director of the National Native American AIDS Prevention Center, worked with the Indian Health Service and was the first American Indian to serve as president (2000–01) of the American Public Health Association.
Please describe your role and work with AARP.
I recently served a six-year term on the National Policy Council of AARP. Out of that came the report, "Lifelong Disparities Among Older American Indians and Alaska Natives," in the fall of 2015. I then joined the Multicultural Leadership department and helped them to develop a strategic plan to increase engagement with the native communities. We've really attempted to raise the level of visibility, engagement and outreach and to develop ongoing relationships with national [American Indian and Alaska Native] organizations.
What are the top health concerns for Native Americans at this time?
The Indian Health Service [IHS], which is under the U.S. Department of Health and Human Services, is charged with meeting the needs of tribes because of treaties with the U.S. government. [Tribes] are the only community that has that government-to-government relationship. Tribes also have some of the worst health disparities and economic conditions compared to any other minority community. One of the major issues is that the IHS is only funded at about 50 percent of the level of needs. Native Americans are facing high rates of cancer, unintentional injuries and diabetes across the board. There are 567 federally recognized tribes that IHS is responsible for ... and it has never been funded adequately to address those issues.
It is related to the concept of "social determinants of health" — we have challenging conditions, which then leads to poor health outcomes. The life expectancy is about 4.4 years less than other populations — 73.7 for Native Americans and 78.1 for everyone else. For Plains tribes, their life expectancy is much lower than 73. They are rural and deal with lack of economic opportunity, lack of safety net and lack of resources.
Environmental health also plays a role. Alaska Natives have seen the impact of global warming in their communities. Permafrost is an element where the ground stays cold and they can store food there, but it is not frozen any longer. The oceans are rising, and it is impacting not only wild life but Native villages close to the oceans, as well.
Please talk about the issue of diabetes management.
We are seeing some improvement in the area of diabetes. There was legislation that increased funding for prevention, and there has been growing awareness about the importance of proper diet and the role of exercise. More communities are embracing traditional practices to promote health, including events that promote runs and walks and going back to traditional diets. Some foods that were imposed from the outside, commodity foods, had the unintended consequence of not being very healthy. Now there is a shift to food sovereignty — people asserting their rights to traditional diets.
How can people learn more about the health issues affecting Indian Country?
The Indian Health Service is always a resource, and the National Indian Health Board advocates on behalf of tribes. The Urban Indian Health Institute works on the well-being of urban Indian communities. Due to federal policies, a significant portion [of Native Americans] live in urban areas now.
The level of knowledge [about Native Americans] is somewhat limited among non-Natives. One has to understand history to really appreciate anything. It is like coming into a movie when it is half over — if you don’t understand history, there is no way to appreciate what present-day circumstances are.