Population Research and Policy Review 16: 147–167, 1997.
1997 Kluwer Academic Publishers. Printed in the Netherlands.
Recent health trends in the Native American population
T. KUE YOUNG
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba,
Abstract. This paper reviews the changes in the health status of Native Americans since the
mid-1950s, how the disease pattern differs from non-Natives, and regional differences within
the Native American population. Despite some limitations, data from the Indian Health Service
indicate that substantial decline in the infant mortality rate and mortality from such infectious
diseases as tuberculosis and gastroenteritis has occurred. With the exception of cardiovascular
diseases and cancer, the risk of death from most causes are higher among Native Americans
than the total US population. Geographic variation in disease rates can be demonstrated,
most notable in diabetes. The unique pattern of diseases among Native Americans reﬂect the
interaction of environmental and genetic factors. Genetic susceptibility plays a signiﬁcant role
in some diseases, such as diabetes, while for others, the generally lower socioeconomic status,
higher prevalence of certain health risk behaviors and lower utilization of preventive services
in the Native American population are important determinants.
Key words: Native Americans, Epidemiologic transition, Mortality, Indian Health Services
(IHS), Health statistics
The health of Native Americans has undergone substantial changes in the
second half of the twentieth century. In broad terms, the recent epidemiologic
history of Native American populations can be characterized by several key
features: the decline but persistence ofinfectious diseases, stabilizing at a level
still higher than that of the non-Native population; the rise in chronic diseases,
especially diabetes; and the overwhelming importance of the so-called social
pathologies–violence,unintentional injuries, andthe ill effects of alcoholand
drug abuse. The rise of chronic diseases also characterizes various indigenous
populationsaround the world that are undergoingrapid socioculturalchanges.
Such diseases collectively have also been called ‘Western’ diseases (Trowell
& Burkitt 1981).
The long-term temporal changes in the pattern of health and disease of a
population have been termed epidemiologic or health transition. One particu-
lar conception of that transition, originally proposed by Omran (1971, 1977,
1983), consists of three stages: the age of pestilence and famines, the age of