American Indian/Alaska Native

American Indians and Alaska Natives (AI/ANs) are people having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.¹ According to the 2000 U.S. Census, those who identify only as AI/AN constitute 0.9 percent of the United States population, or approximately 2.5 million individuals. The Census Bureau projects modest growth by AI/AN communities in the next few decades, topping 5 million individuals by the year 2065 and comprising 1.1 percent of the population. The greatest concentrations of AI/AN populations are in the West, Southwest, and Midwest, especially in Alaska, Arizona, Montana, New Mexico, Oklahoma, and South Dakota.²

There are 569 federally recognized AI/AN tribes, plus an unknown number of tribes that are not federally recognized. Each tribe has its own culture, beliefs, and practices. AI/ANs have a unique relationship with the federal government due to historic conflict and subsequent treaties. Tribes exist as sovereign entities, but federally recognized tribes are entitled to health and educational services provided by the federal government. Though the Indian Health Service (IHS) is charged with serving the health needs of these populations, more than half of the AI/AN population does not permanently reside on a reservation,³ and therefore have limited or no access to IHS services. Geographic isolation, economic factors, and suspicion toward traditional spiritual beliefs are some of the reasons why health among AI/ANs is poorer than other groups. Other factors that contribute to poorer health outcomes for AI/ANs include cultural barriers, geographic isolation, inadequate sewage disposal, and economic factors.⁴

Ten Leading Causes of death in the U.S. in 2001 for American Indians and Alaska Natives:

	1.	Heart disease
	2.	Cancer
	3.	Unintentional injuries
	4.	Diabetes
	5.	Stroke
	6.	Chronic liver disease and Cirrhosis
	7.	Chronic lower respiratory disease
	8.	Suicide
	9.	Influenza and Pneumonia
	10.	Nephritis, Nephrotic syndrome, and Nephrosis
Source: Health, U.S., 2003, Table 31.

In addition, American Indians and Alaska Natives have disproportionately high prevalence of the following conditions and risk factors:

	¹ Census Bureau, Census 2000 Brief: Overview of Race and Hispanic Origin, 2000.
	² Census Bureau, Census 2000.
	³ Statistical Handbook on Racial Groups in the United States by T.B. Heaton, B.A. Chadwick, and C.K. Jacobson; Phoenix: Oryx Press, 2000; Table A3.5.
	⁴ The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality. United States Commission on Civil Rights, Sept. 1999.

	Census 2000 adheres to the federal standards for collecting and presenting data on race and Hispanic origin as established by the Office of Management and Budget (OMB) in October 1997 and subsequent guidelines. One of the most important changes for Census 2000 was the revision of the questions on race and Hispanic origin to better reflect the country’s growing diversity. The federal government considers race and Hispanic origin to be two separate and distinct concepts. In addition, Asian Americans and Native Hawaiians and Other Pacific Islanders are counted as two separate and distinct racial groups. Because of these changes, the Census 2000 data on race are not directly comparable with data from the 1990 census or earlier censuses. Caution must be used when interpreting changes in the racial composition of the U.S. population over time.
	Census Bureau Glossary of Terms: Race, 2000.
	Office of Management and Budget (OMB) Provisional Guidance on the Implementation of the 1997 Standards for Federal Data on Race and Ethnicity, 2000.
	Office of Management and Budget Recommendations from the Interagency Committee for the Review of the Racial and Ethnic Standards to the Office of Management and Budget Concerning Changes to the Standards for the Classification of Federal Data on Race and Ethnicity, 1997.