Health Problems in American Indian/Alaska Native Women

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What health problems affect a lot of American Indian/Alaska Native women?
What types of health care coverage exist? How do I find out about them?

See also…

• Diabetes
• Fetal Alcohol Syndrome
• Heart and Cardiovascular Disease
• Heart Healthy Eating
• High Blood Pressure
• High Cholesterol
• Lung Cancer
• Prenatal Care
• Smoking
• Stroke

What health problems affect a lot of American Indian/Alaska Native women?

(For detailed information on each of the health problems listed below, refer to the other NWHIC FAQs listed at the top of this FAQ):

Obesity and Overweight
Being overweight or obese increases your risk of heart disease, type 2 diabetes, high blood pressure, stroke, breathing problems, arthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), osteoarthritis and some cancers. Obesity is measured with a Body Mass Index (BMI). BMI shows the relationship of weight to height. Women with a BMI of 25 to 29.9 are considered overweight, while women with a BMI of 30 or more are considered obese. All adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability from being overweight or obese. These health risks increase as the BMI rises. Your health care provider can help you figure out your body mass or go to www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm. Not only are health care providers concerned about how much fat a person has, but also where the fat is located on the body. Women with a "pear" shape tend to store fat in their hips and buttocks. Women with an "apple" shape store fat around their waists. For most women, carrying extra weight around their waists or middle (with a waist larger than 35 inches) raises health risks (like heart disease, diabetes, or cancer) more than carrying extra weight around their hips or thighs. In one specific population in Arizona, a study found that 80% of American Indians were overweight. If you are overweight or obese, losing weight can lower your risk for many diseases. And physical activity is an important part of weight loss treatment. Try to be active (30 minutes most days of the week is best) and eat better to help prevent and treat obesity.

Diabetes
You can get diabetes if your body does not make or use insulin right. Insulin is what is in your body that changes the sugars in food into energy. With diabetes, glucose builds up in the blood, flows into the urine, and is carried out of the body instead of being used by the cells for energy. Type 1 diabetes happens when your body destroys its own cells that make insulin. Type 2 diabetes occurs when the pancreas doesn't make enough insulin.

Diabetes is a serious and common problem among American Indians and Alaska Natives. Most people have type 2 diabetes. For American Indians/Alaska Natives (AI/AN), both women and men, the number of new cases of type 2 (or adult) diabetes has reached epidemic proportions. Diabetes contributes to several of the leading causes of death in AI/AN, including heart disease, stroke, pneumonia, and influenza. Specific tribes have much higher rates. For example, 50% of Pima Indians in Arizona who are between the ages of 30 and 64 have type 2 diabetes.

Pregnant AI/AN women with type 2 diabetes are at an increased risk of having babies born with birth defects. Diabetes that shows up in pregnancy is called gestational diabetes. This form of diabetes is high among certain AI/AN. Gestational diabetes increases the baby's risk for problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar). Although the blood glucose levels of women with gestational diabetes usually return to normal after childbirth, these women have an increased risk of developing gestational diabetes in future pregnancies. In addition, studies show that many women with gestational diabetes will develop type 2 diabetes later in life.

Serious complications of diabetes are increasing. The most concerning are kidney (or renal) failure, heart disease, amputations, and blindness. Infections, including tuberculosis (TB), are of particular concern to both American Indians and Alaska Natives who have diabetes. Tuberculosis is a disease caused by a bacteria. If TB is in the lungs, it can cause a bad cough, chest pain, fatigue, weight loss, chills, and fever. A study of Sioux Indians showed that their rate of developing tuberculosis is higher if they had diabetes than if they did not.

People with diabetes have a higher chance of having problems with their skin, mouth, kidneys, heart, nerves, eyes, and feet. Although type 1 diabetes cannot be prevented, there are steps you can take to prevent and control type 2 diabetes:

• See your health care providers regularly. Don't forget about the dentist and eye doctor!
• Don't smoke.
• Control your blood sugar and cholesterol levels, your blood pressure, and weight.
• Exercise (30 minutes most days of the week is best).
• Check your feet everyday for blisters, red spots, swelling, or cuts.
• Stay aware of how you feel-if you notice a problem, call your health care provider right away.

Smoking
Women who smoke put their health at risk. Smoking during pregnancy increases the risk of miscarriage, stillbirth, preterm delivery, and low birth weight. Smoking increases the risk for a lot of diseases, including cancer, heart attacks, oral diseases, and lung problems. In fact, lung cancer is the largest single cause of cancer deaths in the U.S. For years, men were at higher risk for lung cancer because of their higher smoking rates. However, with the rising number of women who smoke, lung cancer surpassed breast cancer in 1987 as the leading cause of cancer deaths among women. It is the leading cause of cancer death among American Indians and Alaska Natives. American Indians and Alaska Natives have the highest smoking rates and use of smokeless tobacco (chewing tobacco or snuff) of any group in the United States. More people smoke in Alaska and North Plains than in the Southwest, where smoking rates are the lowest. If you smoke, try to quit. At just a few days, your health will begin to improve. There are many organizations to help you quit. Contact the American Cancer Society (1-800-ACS-2345 or www.cancer.org) for help.

Alcoholism
According to the National Institutes of Health, alcoholism is a disease with these symptoms:

• craving: a strong need to drink
• loss of control: can't limit one's drinking
• physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety that happens when you stop drinking alcohol after a period of heavy drinking
• tolerance: drink greater amounts of alcohol in order to "get high"

American Indians and Alaska Natives are five times more likely to die of alcohol-related causes than Whites and face high rates of chronic liver disease and cirrhosis. In addition, American Indians and Alaska Natives have a high rate of drinking and driving and alcohol-related fatal crashes compared to the general population.

Prevent problems related to alcohol. If you drink, the National Institutes of Health advises a safe level of drinking: for most adults, moderate alcohol use--up to two drinks per day for men and one drink per day for women and older people. However, some people should NOT drink at all:

• women who are pregnant or trying to become pregnant
• people who plan to drive or engage in other activities that require alertness and skill (such as using high-speed machinery)
• people taking certain over-the-counter or prescription medications
• people with medical conditions that can be made worse by drinking
• recovering alcoholics
• people younger than age 21

Suicide
Suicide, or the taking of one's own life, is a tragic problem. Suicide is a leading cause of death in the U.S. In some segments of the American Indian and Alaska Native populations, there have been high rates of suicide. Between 1979 and 1992, the U.S. Surgeon General reported that overall, these groups have a higher rate of suicide, compared to the rest of the American population. Also, the age of suicide for American Indians is quite unlike that for the general population, because of the high rates among young adults and lower rates among the elderly. Of all women, American Indian/Alaska Native women ages 25-44 had the highest suicide rate in 2000. Many American Indian people who commit suicide haven't seen mental health providers; suicide often results from missed opportunities to treat such problems as depression, alcoholism, child abuse, and domestic violence. You can help prevent suicide. You can call 911, 1-800-SUICIDE, or the number of a suicide crisis center (you can find the number in your phone book) if you feel suicidal or know someone who talks about it. It is important to talk with someone right away.

Sudden Infant Death Syndrome (SIDS)
SIDS is the sudden and unexplained death of a baby under 1 year old. More American Indian infants die from SIDS than infants born to other women in the United States. Reduce the risk for SIDS by taking these steps:

• Don't smoke, use drugs, or drink alcohol while you're pregnant.
• Place your baby on his/her back to sleep.
• Be sure your baby sleeps on a firm mattress.
• Remove soft, fluffy, loose blankets, pillows, stuffed toys, and other bedding from your baby's sleep area.
• Keep your baby at a temperature that feels comfortable to you. Babies should be kept warm, but not too warm.
• Don't let anyone smoke around your baby.
• Keep covers away from your baby's head and face during sleep.

Infant Deaths
Understanding infant death is difficult and can bring anger, pain, sadness, and confusion. Causes of infant deaths vary, but could include SIDS, birth defects, pre-term/low birthweight, problems from pregnancy, accidents, or respiratory distress syndrome. American Indian and Alaska Natives have the second highest number of infant deaths in the U.S. These health problems are prevented in different ways. However, you can improve your chances of having a healthy baby by taking these steps:

• Visit your health care provider as soon as you find out you're pregnant. Continue to go during your pregnancy.
• Talk to your health care provider about taking a vitamin with folic acid and iron.
• Talk to your health care provider about how much weight you should gain.
• Drink lots of fluids and eat foods high in protein and fiber such as whole wheat breads, whole-grain cereals, fruits (apples, pears, strawberries), nuts, seeds, and beans. Avoid high-fat and fried foods.
• Talk to your health care provider to make sure you've had all the vaccines (shots) you need.
• Talk to your health care provider about what exercises will help you.
• Don't touch cat litter or eat undercooked meat.
• Avoid hot tubs, saunas, and steam rooms.
• Tell your health care provider about medicines you take, both prescriptions and over-the counter medicines.
• Don't use recreational drugs, smoke, or drink alcohol.
• Avoid insecticides and products that have lead, mercury, or solvents (such as paint thinner).

Gallstones
Gallstones are pieces of solid matter that form in the gallbladder, a part of the digestive system that stores bile, which helps your body digest food. Gallstones form when parts of the bile form hard crystals. There are 2 types of gallstones: pigment (bilirubin) and cholesterol. Most people have cholesterol gallstones. They sometimes form as lots of small stones or may form as one big stone. A lot of times, gallstones don't cause any symptoms. When they do, some common symptoms include:

• a severe pain in the upper abdomen or right side that sometimes lasts for several hours
• pain in the right shoulder or between your shoulder blades
• nausea or throwing up
• sweating
• indigestion or stomach bloating after a fatty meal

Some factors that put you more at risk for gallstones include:

• obesity
• too much estrogen
• gender (female)
• age (over 60)
• taking drugs that lower cholesterol
• diabetes
• rapid weight loss
• fasting

Because of high levels of cholesterol in their bile, more American Indians have gallstones than other women in the United States. Among the Pima Indians of Arizona, 70% of women have gallstones by age 30.

Cardiovascular Disease
Heart disease and stroke affect all racial and ethnic groups in the U.S. Cardiovascular disease, including heart disease and stroke, is the leading cause of death for American Indians and Alaska Natives.

Coronary heart disease, the most common form of heart disease, affects the blood vessels (or coronary arteries) of the heart. It causes angina and heart attacks. Angina is a pain in the chest that happens when a part of the heart does not get enough blood. A heart attack can cause chest pressure, fullness, squeezing, or pain in the center of the chest that lasts longer than a few minutes, or comes and goes, spreading pain to one or both arms, back, jaw, or stomach, or cold sweats and nausea. Some women don't have these symptoms but may have other symptoms, such as an upset stomach, a burning feeling in the upper abdomen, and lightheadedness. A heart attack can cause permanent damage to the heart and maybe even death. If you have any of these symptoms, call 911 or see your health care provider right away.

There are two types of stroke. An ischemic (iss-kee-mik) stroke happens when a blood vessel that goes to the brain is blocked, and blood can’t get to the brain. A hemorrhagic (heh-muh-ra-jik) stroke happens when a blood vessel breaks and blood goes into the brain. Sometimes a person can have a “mini stroke,” or transient ischemic attack (TIA). A TIA is a stroke that happens when a blood vessel to the brain is blocked for a short time and less blood reaches the brain. A stroke could cause problems that may affect speech, language, movement, vision, balance, hearing, breathing, and swallowing. A stroke could also cause death. Diabetes, high blood pressure, high cholesterol, not exercising, and smoking all put women at risk for heart disease and stroke.

To avoid heart attack and stroke, the American Heart Association advises people to take the following steps:

• Don't smoke.
• Control your blood pressure. Ask your health care provider what a healthy number is for you and how often you need your blood pressure checked.
• Eat healthy.
• Lower your cholesterol (fatty substance in your blood) to the right level, based on your personal risk. Talk to your health care provider about a healthy level for you.
• Get at least 30 minutes of exercise on most days of the week.
• Maintain a healthy weight. Ask your health care provider what a healthy weight is for you.
• Have a normal fasting blood glucose level (below 110 mg/dL). Ask your health care provider when you should be tested.

Getting Health Care
Although this isn't a problem with the health of women, it can lead to health problems because many women can't get the right health services, medicines, and supplies when they need them. Some reasons include:

• They can't pay for it and don't have health insurance.
• They have no way to get to a doctor.
• They have physical limitations that make it hard to get to a doctor.
• They don't understand the language.

Because they believe ill health is part of the normal aging process, American Indians/Alaska Natives may be less likely than others to get care for problems that can be treated. They have faced racism and have been denied medical care in the past, which are also barriers for some people to get care later in their lives. In fact, one study found that older American Indians fear non-Indian health professionals and do not expect to be treated fairly by them.

Another barrier is not having medical care close by. Even though the U.S. Department of Health and Human Services' Indian Health Service (IHS) offers health care services for American Indians and Alaska Natives, many do not have a health care provider to see for preventive health services or medical care. Only 1 in 5 American Indian or Alaska Native uses health care from the Indian Health Service. IHS services clinics are mainly located at reservations. So, American Indians and Alaska Natives who live in urban areas can't use it.

What types of health care coverage exist? How do I find out about them?

Finding health insurance often requires good research and finding answers to lots of questions. There are a number of different kinds of health care coverage:

Private Insurance

• Employer sponsored -- fully or partly paid by an employer, includes health maintenance organizations, preferred provider organizations, and point of service plans. Contact your employer for information on plans available to you.

• Individual insurance -- private health insurance that a person buys through an insurance company. You may want to talk to an insurance broker, who can tell you more about the health care plans that are available for individuals. Some states also provide insurance for very small groups or people who are self-employed. You may also want to go to the Quality Interagency Coordination Task Force Web site on health care quality at http://www.consumer.gov/qualityhealth/ for information on selecting a health plan. If you do not have access to the Internet, or don't know how to use a computer, call 1-800-994-WOMAN (1-800-994-9662).

Public Insurance

• Medicare -- federal government health insurance program for people 65 and older, or who are disabled, or who have permanent kidney failure. You can call the Social Security Administration at 1-800-772-1213 or contact your local Social Security Office for more information.

• Medicaid -- federal and state health insurance program run by states for low-income or disabled people of all ages. Click on http://cms.hhs.gov/medicaid/tollfree.asp for a list of Medicaid toll-free lines in each state. If you do not have access to the Internet, or don't know how to use a computer, call 1-800-994-WOMAN (1-800-994-9662).

• Indian Health Service - The U.S. Department of Health and Human Services' Indian Health Service (IHS) offers health care services for American Indians and Alaska Natives who belong to a federally recognized tribe. For more information, go to http://www.ihs.gov or call 1-301-443-2694 to begin research on whether you're eligible for coverage. You may be referred to another source for more information.

For more information on health insurance, contact these organizations:

Agency for Healthcare Research and Quality
Phone: (800) 358-9295
Internet Address: http://www.ahrq.gov

Bureau of Primary Health Care
Phone: (800) 400-2742
Internet Address: http://www.bphc.hrsa.gov/

Centers for Medicare & Medicaid Services (CMS)
Phone: 877-267-2323
Internet Address: http://www.cms.hhs.gov

Health Insurance Association of America
Phone: 202-824-1600
Internet Address: http://www.aahp.org/template.cfm

For More Information...

You can find out more about health problems in American Indian/Alaska Native women by contacting the National Women's Health Information Center at 800-994-WOMAN (9662), visiting the NWHIC Minority Women's section (http://www.4woman.gov/minority/index.htm), and contacting the following organizations:

Office of Minority Health
Phone: (301) 443-5224, (301) 589-0951 (Publications)
TDD line: (800) 444-6472
Internet address: http://www.omhrc.gov

Office of Minority and Women's Health
Phone: (301) 594-4490
Internet address: http://bphc.hrsa.gov/OMWH/home.HTM

All material contained in the FAQs is free of copyright restrictions and may be copied, reproduced, or duplicated without permission from the Office on Women's Health in the U.S. Department of Health and Human Services. Citation of source is appreciated.

May 2003