There’s No Prescription to Cure Native Healthcare

Published February 11, 2026    By Joshua Arce

On the Rosebud Sioux Reservation in South Dakota, accessing health care often depends on something as basic, and often as unreliable, as a ride.

For Marvine D., who works with Elders through the Rosebud Sioux Tribe’s Elderly Caregivers Program, this reality shows up every day.

“It’s really hard for them if they don’t have transportation to get to (their appointments). The people who have Medicare and Medicaid, a lot of them are able to access the clinic in Mission, but there’s only one problem there. They have to have their own transportation to get there.

If they’re going to Rosebud, a Community Health Representative can help with rides. Some of them don’t have phones, though, so they have to get someone to call for them. It’s not easy for a lot of them, especially the homeless …”

Marvine’s experience reflects a reality shared across Indian Country, where access to health care is shaped not only by medical need, but by geography, infrastructure, and long-standing gaps in services.

Many reservation communities are located far from hospitals, specialty providers, and even primary care clinics. For Native Americans living in rural areas, a routine appointment can require traveling hundreds of miles. Public transportation is often nonexistent, and many households lack reliable vehicles or consistent cell service. These barriers disproportionately affect Elders, people with disabilities, and those experiencing housing insecurity.

Even when care is technically available, access is not guaranteed. Indian Health Service (IHS) facilities have long been underfunded. For patients who rely on Medicare or Medicaid alongside IHS, navigating where to go, how to get there, and who can provide transportation becomes an added layer of complexity, one that can delay or prevent treatment altogether.

National Health Disparities in Native American Communities

The barriers Marvine describes — long distances to care, limited transportation, and geographic isolation—are part of a broader pattern reflected in national health data. Native American and Alaska Native people experience significantly worse health outcomes than other populations in the United States, shaped by structural inequalities developed over generations.

According to federal health data, American Indians and Alaska Natives have the lowest life expectancy of any major racial group in the country. In 2023, average life expectancy at birth for non-Hispanic American Indians and Alaska Natives was about 70.1 years, compared with 78.4 years for all races combined.

Chronic disease is a major factor in this gap. Native adults are almost three times more likely to have type 2 diabetes than their White peers, and deaths from diabetes in Native communities occur at nearly twice the rate of the general population. These disparities are not the result of individual choices alone, but of systemic barriers to consistent, preventive, and culturally appropriate health care.

Tribal-Led Initiatives are working to close the healthcare gap

Across Indian Country, Tribal Nations are addressing healthcare gaps through community-based models designed to meet people where they are geographically, culturally, and relationally. One of the most critical of these models is the Community Health Representative (CHR) program, which serves as a frontline connection between Native households and formal healthcare systems.

CHRs provide health education, help patients navigate IHS and other providers, coordinate transportation, and follow up on care plans, often in communities where clinics are hours away and communication barriers are common.

Public Health Nurses (PHNs) play a similarly vital role. They deliver preventive care, conduct screenings, and make referrals to specialty services, while monitoring chronic conditions such as diabetes, heart disease, and respiratory illness. Together, CHRs and PHNs address not only medical needs, but the broader realities shaping health in reservation communities, including limited transportation, housing instability, food insecurity, and social isolation among Elders.

This work is deeply relational. Building trust takes time, particularly in communities shaped by generations of underfunded and inconsistent healthcare access. Many households are more willing to engage in health services when care is delivered by familiar faces who understand local history, family dynamics, and community context. Relationship-building often comes first, before education, referrals, or treatment can take place.

Partnership With Native Americans^® (PWNA) works alongside Tribal healthcare providers, including CHRs and PHNs, to support this relationship-centered approach. By supplying practical incentives such as household supplies, hygiene items, and other essentials, PWNA helps reduce immediate barriers that prevent families from engaging in health education and follow-up care. These resources reinforce healthcare providers’ work, making it easier for households to prioritize appointments, screenings, and preventive services amid competing daily needs.

Beyond CHR and PHN programs, Tribal Nations are advancing additional Native-specific health initiatives. These include mobile clinics, expanded telehealth access in rural areas, chronic disease prevention programs, and culturally grounded wellness efforts that integrate traditional knowledge with modern care. In fact, Medicare has expanded coverage for traditional healing services in four states, acknowledging the cultural and therapeutic value of these practices.

Improving Native health outcomes requires more than clinics alone. It requires community leadership, trust, and sustained partnership. These approaches reflect broader efforts by Tribal Nations and partners to ensure that health care is not only physically accessible, but also culturally relevant and respectful of Indigenous worldviews.

What You Can Do to Support Health Access in Native Communities

Health disparities in Native American communities are the result of long-standing policy decisions, underinvestment, and systemic barriers. While no single individual can solve these challenges alone, there are meaningful ways to contribute to healthier futures for Native communities.

• Support organizations that work in partnership with Tribal Nations. Nonprofit organizations that collaborate directly with Tribal governments and community-based programs play a critical role in strengthening health access, particularly in remote areas where resources are limited.
• Learn and share accurate information. Understanding why health disparities exist helps counter harmful myths and oversimplified narratives about Native health. Listening to Native voices, following Native-led journalism, and amplifying stories from Tribal communities all help raise awareness of both challenges and solutions.
• Advocate for equitable healthcare systems. Policies that support funding for Indian Health Service, Tribal health programs, rural infrastructure, and community-based healthcare workers like CHRs and PHNs are essential. Staying informed and engaged as a voter and community member helps keep these issues visible.
• Practice and promote healthy living in your own community. Health equity is interconnected. Prioritizing preventive care, nutrition, mental health, and physical well-being, while encouraging others to do the same, strengthens communities everywhere.

Improving health access for Native Americans requires honoring Tribal sovereignty, supporting community-led solutions, and committing to long-term change. By staying informed, supporting trusted partners, and valuing health in our own lives, each of us can play a role in closing the healthcare gap—one relationship, one policy, and one community at a time.