Indian Country Today

About 30% of the 5.2 million Native Americans in this country live on reservations, including approximately half a million in PWNA’s service area (2010 Census). Living conditions on the reservations are often cited as “comparable to Third World countries.” It is impossible to succinctly describe the many factors that have contributed to the challenges facing Indian Country today, but here are a few of the most pressing issues that give you a glimpse of what life is like for many Native Americans.

Typically, Tribal and Federal governments are the largest employers on the reservations, and there are simply not enough jobs to go around. In our service area, 15% up to 54% of the population lives below the federal poverty line (varies by reservation)(Census, 2015-2019 American Community Survey).  Many households rely on social security, disability, or veteran income.

Often, heads of household are forced to leave the reservation to seek work, so roughly half of Native grandparents are raising their grandchildren. In order to survive, extended families pool their meager resources as a way to meet basic needs – but some needs still go unmet and these are some of the gaps that PWNA helps to fill.

The average life expectancy for Native Americans has improved yet still trails that of other Americans by about five years (2022, U.S. Congress - Joint Economic Committee). On the reservations we serve, the only healthcare provider is the federally-operated Indian Health Service (IHS) clinics. Pharmacies and doctor’s offices outside of IHS are non-existent. The IHS clinics are underfunded with high staff turnover, crisis-driven, and refer patients off-reservation for some critical care.  Per capita IHS spending is 3 times less than Medicare and more than 2 times less than Medicaid and VHA (veterans health). 

Forced relocation of tribes to reservations forced a shift away from healthy, traditional diets and fueled diabetes at epic proportions, heart disease, obesity, and cancer. Native Americans are more likely to have heart disease, and about half struggle with obesity (2018 Dept. of Health and Human Services, Office of Minority Health). Native adults are nearly three times more likely than non-Hispanic white adults to have diabetes and seven times more likely to have tuberculosis (2018 American Heart Association and 2020 CDC, respectively). Cancer-related disparities are also higher than for other Americans (2014 American Cancer Foundation). 

There is a housing crisis in Indian country, and an estimated 42,000 to 85,000 Native Americans living in Tribal areas are homeless (2017, US Dept. of Housing). About 40% of reservation housing is substandard or overcrowded with several generations living in a small home. Due to budgetary constraints, the wait time for Tribal housing assistance is three years or longer. In the meantime, most families will not turn away someone who needs a place to stay.  

The noticeable lack of utilities is another factor on the reservations. While most Americans take running water, telephones, internet, and electricity for granted, many Native Elders and families live without these luxuries. This increases overall health risk, especially in the more isolated areas.