As is true with any ethnic group, Native Americans are highly diverse. Native Americans in the United States belong to more than 500 different tribes, each with a distinct language and culture. Around 20% live in rural areas, 20% on res- ervations or other trust lands, and 60% in suburbs or cities.
Life expectancy among Native Americans has increased steadily since the 1950s. However, it is still considerably lower than among other Americans, espe- cially when we look only at those who live on or near tribal lands. (Statistics that include individuals who live away from tribal lands can be misleading because many who identify as Native American have few genetic or cultural ties to Native American peoples.) Similarly, Native Americans are con- siderably more likely than other Americans to live with disabilities and to report unmet health care needs.
Infant mortality is a particularly crucial marker of the health problems faced by Native Americans. Compared to non-Hispanic whites, rates of infant mortality are 60% higher among Native Americans overall and 240% higher among those living on South Dakota’s large and exceptionally poor Pine Ridge Reservation.
These differences in infant mortality grow even starker when we separate neonatal infant mortality (deaths occurring during the first 27 days after birth) from postneonatal infant mortality (deaths occurring between 28 days and 11 months after birth). Neonatal infant mortality rates are essentially the same among Native Americans and whites, but postneonatal infant mortality is more than twice as high among Native Americans. Most postneo- natal deaths stem from poverty, malnutrition, maternal tobacco use, poor living conditions, and lack of health care for ill infants.
For Native Americans who survive past infancy, heavy alcohol use stands out as an especially serious health risk. Although alcohol-related deaths among Native Americans have decreased in recent years, deaths from liver disease, suicide, and accidents (often caused by alcohol use) remain strikingly common.
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