The articles in this issue cover a topic that is often forgotten today: the health of American Indians. Although there are clear indications and documentation that American Indian and Alaska Native (AI/AN) people experience more health disparities than the US population at large, limited attention has been given to this group. There are 565 federally recognized AI/AN tribes, and there are approximately 3.4 million members of this group.
The Indian Health Service (IHS), an agency within the Department of Health and Human Services, provides comprehensive care to about 2 million AI/ANs. The IHS also gathers considerable data about health and the health disparities of the population they serve. They have found that the 5 leading causes of death are diseases of the heart, malignant neoplasms, unintentional injuries, diabetes mellitus, and cerebrovascular diseases.1 These leading causes with the exception of diabetes, which ranks seventh overall in the United States, are similar to the 5 leading causes in the United States: heart disease, cancer, cerebrovascular disease, chronic lower respiratory disease, and unintentional accidents.2 As you will read in the articles in this issue, this population tends to have a shorter life expectancy and dies at much higher rates than other Americans from the following: tuberculosis (500% higher), alcoholism (514% higher), diabetes (177% higher), unintentional injuries (140% higher), homicide (92% higher), and suicide (82% higher).2
The IHS is targeting diabetes as a focal area for their attention since the rates are increasing for AI/AN youth who have both type 2 diabetes and prediabetes.3 Both diabetes and obesity are 2 significant problems for this population. Diabetes was rare in this population 60 years ago when the AI/AN group was more active and ate a more traditional versus Western diet. The IHS oversees the Special Diabetes Program for Indians, which is funded by Congress and largely run by tribal members. Nurses and physicians who work in the IHS are seeing some progress in the struggle to reduce obesity and diabetes. The wisdom of the tribal leaders in allocating funds largely to prevention is consistent with a public health approach that would advocate prevention first efforts. Similarly, the way in which the programs have been established is based on public health principles in that they are a team effort among tribal leaders and health care workers and are carried out in schools, community centers, hospitals, and clinics. Many of the programs are promoting a return to raising one's own foods and encouraging more physical activity through walking and native dancing.4 The articles in this issue are interesting and compelling descriptions of the many health needs of the people who originally inhabited our nation. They also describe the work of dedicated people trying to intervene in these problems.
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