GLITEC's new report shows data for birth and death rates, HIV, flu, access to care, alcohol, immunization, and other topics. Read the report to see an overview of the current health status of Natives living in Michigan, Minnesota, and Wisconsin.
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Preface
GREAT LAKES INTER-TRIBAL EPIDEMIOLOGY CENTER
(GLITEC) has been producing community health profile reports for American Indian/Alaska Native communities in Michigan, Minnesota, and Wisconsin since 2000. One of the 7 Core Functions of the Tribal Epidemiology Centers (TECs) is to provide disease surveillance in order to pro- mote public health.1 Disease surveillance and the moni- toring of health data are critical to understanding health status. These data can highlight trends, gaps in knowledge, and progress made towards improved health outcomes.
Data can be a powerful tool that must be used respon- sibly to generate a positive effect on a community. Under- standing background and context to data is crucial to have a comprehensive understanding of that data’s implications. That is why the chapters and sections within this report include background to each topic.
Contextual considerations are critical when addressing health status in American Indian and Alaska Native popu- lations. For Americans in general, health is conceptualized as a physical state of being, with good health being a lack of illness. While Indigenous models of health are varied, most are holistic, representing a balance between physical, men- tal, emotional, and spiritual wellbeing. Due to colonization and practices of cultural genocide, Indigenous knowledge and worldviews are not held in the same regard as that of European-Americans. As a result, population-level data that appropriately convey American Indian/Alaska Natives’ health and well-being through an Indigenous framework do not exist. The data presented in this report were ob- tained using Western methods and interpreted through a Western lens. This report’s focus is on physical health; it includes few other aspects of wellness and completely lacks information relating to communities’ connection to their land, language, or relationship to animals, birds, plants, or water. Despite these limitations, the data presented may be useful for communities to advance self-determination.
GLITEC is proud to have the opportunity to work with American Indian communities throughout the three-state area and hopes to contribute to improved health data and health outcomes for American Indian people.
Executive Summary
HEALTH DATA ARE ESSENTIAL TO IMPROVING health
services and outcomes in all communities. Many health in- equities and disparities experienced by American Indian/ Alaska Natives are often directly related to ongoing colo- nization practices and resulting systemic racism. Under- standing the state of health among Indigenous communi- ties within this context while focusing on unique strengths of each community is critical to working towards good health for all.
In all three states, a larger percentage of American In- dian/Alaska Natives identified as multiracial than any oth- er race. Within the three-state area, people who identified as American Indian/Alaska Native alone or in combina- tion with one or more races accounted for 1.6 percent of the total population compared to 1.7 percent within the United States overall. A larger percentage of American In- dian/Alaska Natives were under the age of 25 years (39%) than non-Hispanic whites in the three-state area (30%). Among American Indian/Alaska Natives, one-quarter of homeowners and one-half of renters were living in unaf- fordable housing.
The leading cause of death among American Indian/ Alaska Natives in the three-state area was malignant neo- plasms (cancers). The mortality rate from cancer was 67% higher than the national mortality rate among American Indian/Alaska Natives. American Indian/Alaska Natives in this area also died from heart disease at a rate that was 1.5 times that of American Indian/Alaska Natives in the Unit- ed States overall. The rate of years of potential life lost (a measure of early death) among American Indian/Alaska Natives was significantly higher than among whites.
Pregnant American Indian/Alaska Native women living in the three-state area initiated prenatal care during later trimesters more often than their white counterparts and had fewer prenatal care visits throughout their pregnan- cy overall. The rate of Sudden Unexpected Infant Death (SUID) was four times higher among American Indian/ Alaska Native infants than white infants. The percent of children between the ages of 3 and 27 months served by Indian Health Service, Tribal, or urban Indian health facil- ities within the Bemidji Area who were up to date on their immunizations has trended downward since 2012, with 59% being up to date in 2019.
A higher percentage of American Indian/Alaska Na- tives in the three-state area have had cancer compared to American Indian/Alaska Natives in the United States. A lower percentage of American Indian/Alaska Natives in the three-state area had ever been told they had high cho- lesterol compared to whites in the three-state area. Almost one-third (32%) of American Indian/Alaska Natives liv- ing in the three-state area reported a depression diagnosis, compared to the national rate among American Indian/ Alaska Natives of 22%.
The majority (72%) of American Indian/Alaska Natives in the three states reported participating in physical activ- ity. About half of American Indian/Alaska Natives in the three-state area slept for the recommended seven or more hours per day. Slightly more than two-thirds of American Indian/Alaska Natives in the three-state area reported ever having smoked, although fewer than one-third (30%) re- ported currently smoking on a daily basis.
A higher percentage of American Indian/Alaska Natives in the three-state area had reported receiving an HIV test at some point, compared to whites. Slightly more than one-quarter (27%) of American Indian/Alaska Natives served by Indian Health Service, Tribal, or urban Indian health facilities within the Bemidji Area received their flu vaccine. However, about one-half (52%) of American Indian/Alaska Natives 65 years or older had received their flu vaccine.
When asked about overall health status, 70% of Amer- ican Indian/Alaska Natives living in the three-state area reported being in excellent, very good, or good health. The majority (88%) of American Indian/Alaska Natives reportedly had health care coverage, but 17% reported that they were unable to go to the doctor due to cost. The Indian Health Service has continued to be underfunded with the Bemidji Area only receiving 41% of the funding that was necessary.
About this Report
American Indian and Alaska Native Health in Michigan, Minnesota, and Wisconsin 2021 presents aggregate, pop- ulation-level data that provide an overview of the health status of American Indians and Alaska Natives living in Michigan, Minnesota, and Wisconsin. This report’s prima- ry purpose is to describe the current state of health of the American Indian/Alaska Native people living in the three- state area based on the most up-to-date data available at the time of writing this report. Among other things, the data presented here can be used to:
• Identify health priorities in Tribal communities
• Inform program planning, development, and resource allocation
• Guide policy-making
• Support grant applications.
The data used in this report are primarily public- ly-available and accessible at no cost. Most data are pre- sented in tables with corresponding figures to provide a visual understanding of relationships or trends. The ma- jority of the tables include data on the white race group for comparison. This is because this race group makes up the majority of the population of each of the three states and generally experiences the best health outcomes. Under- standing American Indian/Alaska Native data in the con- text of other race groups helps to highlight gaps in health services and outcomes. This report is organized into seven chapters that cover:
1. Demographics
2. Morbidity and mortality
3. Maternal and child health
4. Chronic disease
5. Behavioral health
6. Infectious disease
7. Health status and access to care.
In order to protect community privacy, no communi- ty-level data are shared in this report. All data are reported by state or as the three-state area in aggregate. However, GLITEC does provide confidential community-specific health profiles to each of the Bemidji Area communities; GLITEC is available to complete specific data requests.
When reading and using this report, keep the following issues in mind:
• Classification of people into race groups may be faulty and inaccurate.
• Individual states and the federal government may collect data differently from each other (see Appendix A for detailed information).
• Differences in rates may be due to chance, changes in data collection, or improved screening.
• Aside from confidence intervals in mortality tables (Chapters 2 and 3), there are no formal statistical tests of difference done between groups or within groups from year to year.
• The all-races population includes American Indian/Alaska Native individuals.