Native American-White Differences in Adult Health

Shu-chuan Wang, University of Texas at Austin

Over time, the health status for all races in the U.S. has improved, but the gap between races remains. For example, the life expectancy for Whites rose to 76.5 in 1992 from 72.2 in 1973 and that for Native Americans increased from 63.5 in 1973 to 73.2 in 1992 (Indian Health Service, 1997). That is, Native Americans¡¦ longevity lags behind that of Whites by about two decades. The gap had narrowed appreciably by the 1980s, but there was no further improvement by the 1990s. Nevertheless, the major reduction in health among Native Americans in the 1980s should be interpreted carefully because the Native American population has changed over time. Notice, for example, the large increase in the size of this population group in the 1970s and 1980s. Those who claimed to be Native Americans in the 1980s and 1990s, but not in the earlier years, may improve the health status of the population as a whole because many are Native Americans with relatively better socioeconomic status living in metropolitan areas (Snipp, 1997; Eschbach et. al, 1998). Therefore, these ¡§new¡¨ Native Americans might mask the more disadvantaged health status and survival chances of reservation Native Americans. That is, the health of reservation Native Americans with relatively disadvantaged socioeconomic status might not have improved as much as indicated. Hence, it is important to examine the health differences of reservation and non-reservation Native Americans or, at least, to examine the health status of Native Americans who live in metropolitan and non-metropolitan areas respectively. The aims of this work are to investigate what the health differences are and why the differences exist between Native American and White adults. The health outcomes to be examined include self-report health, limitation of activity, days in bed, and doctor visits from National Health Interview Survey (NHIS). The NHIS from 1986 to 1994 (See note 1) are pooled so as to obtain a sample size of Native Americans as large as possible. Note that the content and the sampling frame of the NHIS are consistent from 1986 through 1994. Only adults aged 18 and over are used for this analysis. Based on the literature and associated rationale, I expect the following: 1) Native Americans will have poorer self-reported health than Whites. 2) Native Americans will have more doctor visits per year than Whites. 3) Native Americans will have more activity limitations than Whites. 4) Native Americans spend more days in bed than Whites due to illness. 5) The racial gap in health between Native Americans and Whites narrows with age. That is, the gap is wider in younger ages and narrower in old ages as a result of selection. 6) Native Americans living in metropolitan areas will have better health outcomes than Native Americans living in non-metropolitan areas. That is, metropolitan Native Americans will have better self-reported health, fewer doctor visits, fewer activity-limited days, and fewer days staying in bed than non-metropolitan Native Americans. Furthermore, the racial differential in health between Native Americans and Whites in metropolitan areas in health will be smaller than that in non-metropolitan areas. 7) Socioeconomic status plays an important role in health differentials between Native Americans and Whites. The racial gap will be smaller or disappear between Native Americans and Whites after controlling SES. Note: 1 Instead of NHIS 1986-1994, NHIS 1995-2000 may be used depending on the importance of the explanatory variables in 1886-1994 but not available in 1995-2000 such as ownership of telephone. Reference: Eschbach, K. (1993). ¡§Changing Identification among American Indians and Alaska Natives.¡¨ Demography 30(4): 635-652. Indian Health Service (1997). Trend in Indian Health. Rockville, MD: Indian Health Service, U.S. Department of Health and Human Services. Snipp, C. Matthew (1997). ¡§The Size and Distribution of the American Indian Population: Fertility, Mortality, Migration, and Residence.¡¨ Population Research and Policy Review. 16(1-2): 61-93.