This brings up several questions before we can begin a discussion of “Indian Country.” Who is the American Indian? What is the educational and health status of this group? There are more than 566 federally and state-recognized tribes with 200 different dialects. Each tribe practices its own spiritual ways, some of these being similar across tribes. Enrollment into a tribe varies, quite often by blood quantum (degree of tribal blood). This enrollment criteria is set by tribes themselves, the U.S. Department of Education sets its own definition, and the U.S. Census Bureau uses self-identification. Indian identity can’t necessarily be confused with blood quantum. This is a common mistake made by many non-Natives, asking the Indian individual, “How much Indian are you?” As if to pretend to know how much blood makes an Indian an Indian.
Being recognized as a tribal member does not bring with it an automatic check from the federal government, nor does it provide health care off the reservation. The U.S. government has gone down in the history of the world for breaking more treaties than any other country.
Education has changed in the underlying philosophy, from “kill the Indian/save the child” to a philosophy of bicultural education. Bicultural education can be seen as including both Indian and mainstream subjects. The Two Eagle River School on the Flathead Reservation in Montana can be seen as an example of this, requiring both the Salish language to be learned, as well as well as cultural practices of food- and root-gathering in home economic classes.
Health care is another treaty-obligated service provided by the federal government to Indian people on reservations, although the budget for health care has not increased proportionally as the population has increased. However, the funding base has been increased by the Patient Protection and Affordable Care Act passed under the Obama administration. Health issues facing American Indians vary, but the leading causes of death involve the health status of Indians/Natives sorely lagging behind all other ethnic groups in the United States. Mortality rates for this group are high. The top 10 leading causes of death include: tuberculosis; chronic liver disease and cirrhosis; accidents (unintentional injuries); diabetes; stroke; chronic lower respiratory diseases like pneumonia and influenza; suicide; homicide; cancer; and heart disease.
The U.S. government has gone down in the history of the world for breaking more treaties than any other country.
Upon examination, one can surmise that economic conditions (unemployment, lack of economic opportunities, availability and access to appropriate health care, etc.) strongly influence health status. This, combined with geographic isolation, limited access to medical care, cost and other barriers, creates invisible boundaries that stand between Native peoples and appropriate health care. In addition, American Indians/Alaskan Natives have disproportionately high prevalence of mental health issues; obesity, substance abuse and Sudden Infant Death Syndrome (SIDS) (CDC, 2002).
The boundaries that impede access to health care are obvious when examining the lack of appropriate diagnosis. Recent research (CDC, April 2005) strongly indicates American Indians/Alaskan Natives are under-diagnosed in comparison to whites. Natives are nearly three times more likely not to be diagnosed for diabetes compared to whites. American Indians were less likely to be informed of having hypertension and were more likely than all other groups to experience a migraine, pain in the neck, and/or lower back pain or pain below the knee. This study also found they were more likely than other groups to report difficulty hearing or deafness, and were more likely than other groups to have activity limitations (CDC, April 2005).
Other health disparities include: • Indian men were twice as likely to be diagnosed with stomach or liver cancers as white men.
• Indian/Native women were 20 percent more likely to die from cervical cancer compared to white women.
• Adult males were 2.3 times as likely to be diagnosed with diabetes as their white peers.
• Indian/Native adults are at greater risk of developing heart trouble.
• Education and health disparities among this group consistently are at a greater gap than any other minority group in the U.S.
Given all of the ills that are rampant in Indian country, patriotism runs strong. Per capita, Indians enlist in the military in greater numbers than any one group in America. Post-traumatic stress lends itself to the fabric of each reservation. This contributes to what has been termed historical trauma.
Many American Indians of today have forgiven, but not forgotten, the history of their forbearers and tribal histories as well as those familial stories of more recent time.
These stories are still handed down from generation to generation in an oral tradition.
Gatherings like those during the Fourth of July provide an opportunity to have ceremonies, share stories, and to strengthen one’s identity as an American Indian, as well as a citizen of the United States of America.
Dr. John Peregoy is a descendent of the Flathead Nation of Montana in private practice as a psychotherapist in Louisville. He can be reached at firstname.lastname@example.org.