Discrimination in the United States: Experiences of Native Americans

Abstract

Objective: To examine reported racial discrimination and harassment against Native Americans, which broadly contribute to poor health outcomes.

Data source and study design: Data come from a nationally representative, probability-based telephone survey including 342 Native American and 902 white US adults, conducted January-April 2017.

Methods: We calculated the percent of Native Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Native American-white difference in odds of discrimination and conducted exploratory analyses among Native Americans only to examine variation by socioeconomic and geographic/neighborhood characteristics.

Principal findings: More than one in five Native Americans (23 percent) reported experiencing discrimination in clinical encounters, while 15 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Native Americans also reported they or family members have experienced violence (38 percent) or have been threatened or harassed (34 percent). In adjusted models, Native Americans had higher odds than whites of reporting discrimination across several domains, including health care and interactions with the police/courts. In exploratory analyses, the association between geographic/neighborhood characteristics and discrimination among Native Americans was mixed.

Conclusions: Discrimination and harassment are widely reported by Native Americans across multiple domains of their lives, regardless of geographic or neighborhood context. Native Americans report major disparities compared to whites in fair treatment by institutions, particularly with health care and police/courts. Results suggest modern forms of discrimination and harassment against Native Americans are systemic and untreated problems.

Keywords: American Indian and Alaska Natives; Native Americans; discrimination; racial/ethnic disparities in health and health care; racism; social determinants of health; survey research.

Figure 1

Adjusted odds of experiencing discrimination among Native American adults compared to whites (reference group). OR, odds ratio, with 95% confidence interval bars. Nationally representative sample of Native American and non‐Hispanic white adults ages 18+. Full model results available in Appendices S2 and S3. *Statistical significance at P < .05. Don't know/refused responses coded as missing. Odds ratios report the odds that Native American adults reported experiencing discrimination for each outcome (whites were the reference group). These estimates control for sex, age (18‐49 vs 50+), education (<college vs college graduate or more), household income (<$25 k vs $25 k+), living in a neighborhood that is predominantly one's own race, household location (urban, suburban, rural), and region (Northeast, Midwest, South, West). ^aEqual pay question only asked among respondents who have ever been employed for pay. ^bJobs question only asked among respondents who have ever applied for a job. ^cCollege application/attendance was only asked among respondents who have ever applied for college or attended college for any amount of time. ^dIncludes discrimination against you or a family member because you are Native American or white. ^eHousing question only asked among respondents who have ever tried to rent a room or apartment, or to apply for a mortgage or buy a home. ^fMicroaggressions indicate that someone made negative assumptions or insensitive or offensive comments about you because you are Native American or white. ^gRacial/ethnic slurs indicate that someone referred to you or your racial group using a slur or other negative word because you are Native American or white. ^hRacial/ethnic fear indicates that people acted as if they were afraid of you because you are Native American or white