The persistence of American Indian health disparities

Abstract

Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes. American Indians joined these debates, often suggesting different explanations. Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians. Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued. Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities. Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them.

Figure 1

A House-call on the Navajo Reservation. As part of its effort to improve health services for American Indians in the 1950s, the Public Health Service funded a series of innovative health care projects. In one project, based at Many Farms, Arizona, physicians, nurses, anthropologists, and Navajo health workers attempted to bring modern medicine into Navajo homes and lives. Source. New York Weill Cornell Medical Center Archives, Photograph Collection, Navajo Project, #2310.

Figure 2

Accomack [Plymouth Harbor] before the Plague. When Samuel de Champlain explored the coast of Massachusetts in 1613, he found thriving Indian communities, such as Accomack, with its wigwams and fields of corn. Three years later an epidemic devastated the Massachusett and Wampanog tribes. When English colonists arrived in 1620, they found Accomack abandoned. They built their first settlement, Plymouth, on its ruins. Source. Sameul de Champlain, Les Voyages du Sieur de Champlain Xaintongeois (Paris: 1613). By permission of the Houghton Library, Harvard University.

Figure 3

Ration Day on a Sioux Reservation. Between the 1830s and the 1870s, the federal government confined most American Indian groups onto reservations. The Sioux encountered terrible conditions as the government tried to transform them from nomadic hunters to settled agriculturalists. Many depended completely on government rations for subsistence. These reservations provided ideal conditions for tuberculosis. Source. By permission of the National Anthropological Archives, Smithsonian Institution, 56 630.

Figure 4

The Satellite Clinic near Many Farms. Walsh McDermott’s team of clinicians and researchers struggled to make best use of the limited resources provided for Indian health. When their initial clinic at Many Farms became overcrowded, they opened up a satellite clinic in the settlement at Rough Rock, 22 miles away. They used a converted refrigerator car, donated by the Santa Fe Railroad: the car, which cooled off at night, remained cool during the hot Arizona days. Source. Courtesy of New York Weill Cornell Medical Center Archives, Photograph Collection, Navajo Project, #2302.