Native American Children’s Health and Well-Being

The Annie E. Casey Foun­da­tion recent­ly report­ed the lat­est demo­graph­ic trends for Amer­i­can Indi­an and Alas­ka Native (AI/AN)* chil­dren in the Unit­ed States. This is a fol­low-up to that post, with a look at the sta­tus of their health and well-being, includ­ing the solv­able inequities they face.

Our coun­try has a long his­to­ry of vio­lence and oppres­sion of Indige­nous peo­ples, the effects of which are still appar­ent today. This sys­temic inequity con­tin­ues, with the Unit­ed States cur­rent­ly not uphold­ing many of its treaty oblig­a­tions to Native nations. The coun­try is also not ful­ly imple­ment­ing poli­cies intend­ed to sup­port their well-being.

It is crit­i­cal that we work to remove the struc­tur­al bar­ri­ers that remain for Indige­nous pop­u­la­tions. Despite past and present injus­tices, Native nations have shown lead­er­ship and strength in their con­tri­bu­tions to soci­ety. Sup­port­ing all aspects of their well-being is a key part of work­ing toward equi­ty and justice.

The Sta­tus of Native Children’s Health and Well-Being

AI/AN fam­i­lies’ resilience is evi­dent in their cul­tur­al val­ues which include a deep respect for fam­i­ly and elders, a strong sense of com­mu­ni­ty and a shared respon­si­bil­i­ty to care for chil­dren and the envi­ron­ment. Accord­ing to the KIDS COUNT Data Cen­ter, AI/AN fam­i­lies are exceed­ing the nation­al aver­age on a sig­nif­i­cant mea­sure of health: Babies born to AI/AN moth­ers are more like­ly to have a healthy birth weight, which reduces the risk of long-term health and devel­op­men­tal prob­lems. Addi­tion­al­ly, sev­er­al trends not­ed below are mov­ing in a pos­i­tive direc­tion for AI/AN fam­i­lies, such as ris­ing medi­an fam­i­ly incomes, improv­ing health insur­ance cov­er­age for kids and declin­ing rates of youth in juve­nile detention.

At the same time, his­tor­i­cal trau­ma and gen­er­a­tions of dis­crim­i­na­to­ry poli­cies have led to AI/AN chil­dren, youth and fam­i­lies hav­ing dis­pro­por­tion­ate­ly poor expe­ri­ences across many mea­sures of health and well-being com­pared to the gen­er­al pop­u­la­tion. Stud­ies have doc­u­ment­ed the adverse effects of trau­ma on the phys­i­cal and men­tal health of AI/AN pop­u­la­tions — effects that endure for gen­er­a­tions. Some of the wounds inflict­ed by U.S. poli­cies are rel­a­tive­ly recent. For instance, the government’s sanc­tioned removal of AI/AN chil­dren from their homes due to forced assim­i­la­tion poli­cies con­tin­ued in dif­fer­ent forms until 1978, when the Indi­an Child Wel­fare Act (ICWA) was passed. Oth­er his­toric and ongo­ing U.S. poli­cies and prac­tices have led to iso­la­tion, eco­nom­ic depri­va­tion, food scarci­ty and chron­i­cal­ly under-resourced health care and edu­ca­tion sys­tems for AI/AN communities. 

The fol­low­ing selec­tion of data not only elu­ci­date the dis­parate con­di­tions expe­ri­enced by AI/AN chil­dren and fam­i­lies, but also demon­strate the need to pri­or­i­tize equi­ty at all lev­els of gov­ern­ment and expand the oppor­tu­ni­ties and sup­port avail­able to AI/AN communities.

Eco­nom­ic Inequities

• In 2022, near­ly one-third (29%) of AI/AN chil­dren were liv­ing in pover­ty, almost dou­ble the nation­al rate of 16%. The AI/AN child pover­ty rate has remained well above the nation­al lev­el for decades.
• AI/AN kids are near­ly three times as like­ly to live in high-pover­ty neigh­bor­hoods com­pared to their coun­ter­parts: 22% vs. 8%, accord­ing to 2017–2021 data. This trend has held since the KIDS COUNT Data Cen­ter began track­ing this mea­sure in 2006–2010.
• Just under half (43%) of AI/AN chil­dren live in fam­i­lies where par­ents do not have secure, full-time employ­ment, com­pared to 29% on aver­age in 2021. 
• About 1 in 8 AI/AN teens ages 16–19 (12%) were not in school or work­ing in 2021, out­pac­ing the nation­wide rate of 7%.
• While the medi­an income for AI/AN fam­i­lies with chil­dren has steadi­ly increased over the last decade, it remains far below the aver­age fam­i­ly income, and the gap has widened in recent years, reach­ing $53,900 vs. $84,200, respec­tive­ly, in 2021.

Edu­ca­tion Inequities

• In 2022, about half (49%) of AI/AN fourth-grade stu­dents were con­sid­ered chron­i­cal­ly absent from school in the pre­vi­ous month, an alarm­ing jump from 31% in 2019, and well above the nation­al aver­age of 36% in 2022. For two decades, AI/AN fourth-graders have been more like­ly than their peers in oth­er racial or eth­nic groups to expe­ri­ence chron­ic absen­teeism, which can include excused absences due to health issues, trans­porta­tion prob­lems or oth­er barriers.
• In 2022, more than 8 in 10 (82%) AI/AN fourth-grade stu­dents scored below pro­fi­cient in read­ing, an increase from pre­vi­ous years and a high­er share than the nation­al aver­age (68%).
• Sim­i­lar­ly, close to 9 in 10 (89%) AI/AN eighth-grade stu­dents scored below pro­fi­cient in math in 2022, 10 per­cent­age points high­er than a decade ear­li­er and 15 per­cent­age points above the nation­al aver­age of 74%. Math pro­fi­cien­cy in eighth grade and read­ing pro­fi­cien­cy in fourth grade are bell­wether indi­ca­tors of long-term aca­d­e­m­ic suc­cess — includ­ing grad­u­at­ing from high school, which increas­es employ­ment and earn­ing poten­tial in adulthood.
• One in 4 (25%) AI/AN high school stu­dents is not grad­u­at­ing on time. This is high­er than the nation­al rate (14%) and that of all oth­er racial and eth­nic groups with data, accord­ing to 2019–2020 data.

Health and Men­tal Health Inequities

• AI/AN kids ages 0–18 are more than twice as like­ly to lack health insur­ance than oth­er chil­dren (11% vs. 5% in 2022), although the rate of unin­sured AI/AN kids improved by three per­cent­age points com­pared with 2019.
• The death rate for AI/AN chil­dren and youth ages 1 to 19 from all caus­es has remained above the U.S. rate since it has been tracked on the KIDS COUNT Data Cen­ter. In 2021, the rate was 33 vs. 30 per 100,000, respectively.
• AI/AN com­mu­ni­ties face an ongo­ing cri­sis of miss­ing and mur­dered women and girls. While the fed­er­al response to track­ing these cas­es has been woe­ful­ly lack­ing for decades, a com­pre­hen­sive data­base of cas­es for all gen­ders is being cre­at­ed thanks to Indige­nous-led work, and fed­er­al action is begin­ning to improve.
• Accord­ing to the CDC’s 2021 Youth Risk Behav­ior Sur­vey, AI/AN high school stu­dents are more like­ly to seri­ous­ly con­sid­er attempt­ing sui­cide than oth­er stu­dents: 27% vs. 22%. Trag­i­cal­ly, they are also more like­ly to attempt sui­cide, with 16% of AI/AN stu­dents report­ing at least one sui­cide attempt in the pre­vi­ous year, com­pared to 10% of all high school stu­dents. AI/AN stu­dents were the most like­ly of any racial and eth­nic group with data& to report seri­ous­ly con­sid­er­ing or attempt­ing sui­cide in 2021.
• A 2023 Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Med­i­cine report found that AI/AN pop­u­la­tions expe­ri­ence sad­ness, anx­i­ety, anger and shame relat­ed to the trau­mas they have faced — includ­ing forced migra­tion, bro­ken treaties and loss of land, fam­i­ly ties, lan­guage and cul­ture. The report also called for more data on AI/AN well-being and rec­om­mend­ed mak­ing this a fed­er­al priority.

Fam­i­ly and Com­mu­ni­ty Inequities

• Over one-third (37%) of AI/AN chil­dren have had at least two adverse child­hood expe­ri­ences (ACEs) — more than dou­ble the nation­al aver­age (17%), accord­ing to 2020–2021 data. ACEs are poten­tial­ly trau­mat­ic events such as: expo­sure to fam­i­ly or neigh­bor­hood vio­lence, parental death or incar­cer­a­tion, fre­quent eco­nom­ic hard­ship or liv­ing with some­one who has men­tal ill­ness or sub­stance abuse prob­lems. Stud­ies have doc­u­ment­ed con­nec­tions between col­o­niza­tion, trau­ma and ACEs, with inter­gen­er­a­tional effects.
• AI/AN chil­dren con­tin­ue to be over­rep­re­sent­ed in the fos­ter care sys­tem. In 2021 and pre­vi­ous years, AI/AN kids made up 2% of those in fos­ter care — dou­ble the share of the gen­er­al child pop­u­la­tion (1%). Even after the Indi­an Child Wel­fare Act was passed to pro­vide min­i­mum fed­er­al pro­tec­tions and end the forcible removal of chil­dren from their homes, the law has not been imple­ment­ed con­sis­tent­ly, and the child wel­fare sys­tem con­tin­ues to demon­strate sys­temic bias. AI/AN chil­dren remain more like­ly than their white peers to expe­ri­ence mal­treat­ment inves­ti­ga­tions and be placed in fos­ter care. 
• Among AI/AN youth tran­si­tion­ing out of fos­ter care — who also par­tic­i­pat­ed in a fol­low-up sur­vey — 43% report­ed expe­ri­enc­ing home­less­ness between ages 19 and 21, sig­nif­i­cant­ly high­er than the nation­al rate of 29%.
• AI/AN youth are also dis­pro­por­tion­ate­ly detained and incar­cer­at­ed by the jus­tice sys­tem. The lat­est Nation­al Cen­ter for Juve­nile Jus­tice data show that 181 AI/AN youth per 100,000 ages 10 to 21 were resid­ing in juve­nile deten­tion in 2021, a sub­stan­tial decline from pre­vi­ous years but well above the nation­al rate of 74 per 100,000. Deten­tion for any length of time has been shown to neg­a­tive­ly affect youth, and it does not improve pub­lic safety.

This selec­tion of find­ings is not com­pre­hen­sive but sheds light on the per­sis­tent inequities faced by AI/AN chil­dren, youth and families.

Look­ing Forward

Achiev­ing equi­ty for AI/AN com­mu­ni­ties is cer­tain­ly pos­si­ble, if pri­or­i­tized, but it will take pub­lic pol­i­cy and sys­tems change, increased resources, improved col­lab­o­ra­tion and long-term com­mit­ments, par­tic­u­lar­ly from non-Native allies. We must pro­mote aware­ness among non-Native allies about the struc­tur­al inequities that con­tin­ues to dri­ve dis­par­i­ties in AI/AN children’s health and well-being. We also must pri­or­i­tize and incor­po­rate AI/AN views and knowl­edge as we iden­ti­fy cul­tur­al­ly respon­sive solu­tions. In that spir­it, the fol­low­ing resources offer rec­om­men­da­tions from mem­bers of AI/AN com­mu­ni­ties to address sys­temic inequities:

• The Gen­er­a­tional Impact of Racism on Health: Voic­es from Amer­i­can Indi­an Communities
• Amer­i­can Indi­an and Alas­ka Native Cul­tur­al Wis­dom Dec­la­ra­tion in the Sub­stance Abuse and Men­tal Health Ser­vices Administration’s Nation­al Trib­al Behav­ioral Health Agenda
• Fed­er­al Poli­cies that Con­tribute to Racial and Eth­nic Health Inequities and Poten­tial Solu­tions for Indige­nous Chil­dren, Fam­i­lies, and Communities

These high­light the need to inte­grate well­ness approach­es for Native com­mu­ni­ties into gov­ern­ment plans to ensure that strate­gies are cul­tur­al­ly tai­lored and rel­e­vant, rec­og­niz­ing the diver­si­ty of Indige­nous com­mu­ni­ties. Rec­om­men­da­tions also include using the Cul­tur­al Wis­dom Dec­la­ra­tion above as a cross-cut­ting frame­work for all pro­grams, includ­ing health, men­tal health, edu­ca­tion, child wel­fare, juve­nile jus­tice and eco­nom­ic supports.

Along with build­ing on the wis­dom and exper­tise of the AI/AN com­mu­ni­ties, it is crit­i­cal­ly impor­tant to hon­or U.S. treaty oblig­a­tions and sup­port the sov­er­eign­ty and self-deter­mi­na­tion of Native nations in any efforts to improve the health and well-being of these chil­dren. The Indi­an Child Wel­fare Act (ICWA) pro­vides one oppor­tu­ni­ty to respect this sov­er­eign­ty and address sys­temic racism. For instance, the ICWA aims to keep AI/AN kids con­nect­ed with their fam­i­lies, cul­ture and com­mu­ni­ties by requir­ing active efforts to pre­vent children’s removal from their homes. If removal is nec­es­sary, how­ev­er, it requires place­ment with AI/AN fam­i­lies before non-AI/AN fam­i­lies. The ICWA also man­dates active efforts to sup­port fam­i­ly reuni­fi­ca­tion when pos­si­ble. Ensur­ing that states and agen­cies ful­ly com­ply with the ICWA is an essen­tial strat­e­gy to cor­rect struc­tur­al bias­es and pro­tect AI/AN families.

Addi­tion­al oppor­tu­ni­ties to strength­en the well-being of AI/AN chil­dren, youth and fam­i­lies include but are not lim­it­ed to:

• Pri­or­i­tize equi­ty through­out state and fed­er­al poli­cies, includ­ing end­ing the chron­ic under­fund­ing of health care and edu­ca­tion infra­struc­tures in Indige­nous communities.
• Rec­og­nize and sup­port Indige­nous cul­tures as a pro­tec­tive fac­tor in any pro­gram and pol­i­cy solutions.
• Ful­ly imple­ment exist­ing poli­cies intend­ed to advance equi­ty, such as the ICWA described above.
• Strength­en coor­di­na­tion across fed­er­al agen­cies and depart­ments to stream­line pro­gram deliv­ery and improve equi­table access to services. 
• Pro­mote ongo­ing efforts to elim­i­nate dis­crim­i­na­tion in the child wel­fare and juve­nile jus­tice sys­tems and pre­vent young peo­ple from enter­ing these sys­tems in the first place. Max­i­miz­ing juve­nile jus­tice diver­sion respons­es and sup­port­ing Indige­nous-led restora­tive jus­tice mod­els that focus on treat­ment, account­abil­i­ty, heal­ing and repair­ing harm to the com­mu­ni­ty are just two ways to help rather than punish.
• Pri­or­i­tize accu­rate, rep­re­sen­ta­tive data col­lec­tion for AI/AN pop­u­la­tions across all domains of health and well-being and, specif­i­cal­ly, for cas­es of mur­dered and miss­ing Indige­nous individuals.

By pri­or­i­tiz­ing actions like these, we can move toward a future in which AI/AN chil­dren, youth and fam­i­lies have equi­table oppor­tu­ni­ties to thrive in safe, healthy and sus­tain­able com­mu­ni­ties. Equal­ly impor­tant is ensur­ing that today’s AI/AN chil­dren have the oppor­tu­ni­ty to grow up in com­mu­ni­ties where their sov­er­eign­ty and self-deter­mi­na­tion are sup­port­ed, and they are ful­ly con­nect­ed to their cul­tur­al iden­ti­ty, prac­tices, lan­guage and land. Indeed, Indige­nous com­mu­ni­ties have main­tained these vital cul­tur­al assets despite gen­er­a­tions of destruc­tive U.S. poli­cies, and efforts to ful­ly restore and uplift Native cul­tures will con­tin­ue while we work toward a shared, pos­i­tive future for all.

More Resources Relat­ed to the Health and Well-Being of AI/AN Families

• A Look at the Lat­est Pop­u­la­tion Trends for Native Children
• Judge William Thorne on the His­to­ry and Heal­ing of Amer­i­can Indi­an Fam­i­lies
• All Data by Race and Eth­nic­i­ty on the KIDS COUNT Data Center
• “Heal­ing Native Youth Through Youth Jus­tice Reform,” Asso­ci­a­tion on Amer­i­can Indi­an Affairs
• Prac­tice Brief: ​“Trib­al Chil­dren and Forced Assim­i­la­tion,” Native Child Advo­ca­cy Resource Center
• Guide­lines for Imple­ment­ing the Indi­an Child Wel­fare Act, Bureau of Indi­an Affairs
• Fed­er­al Pol­i­cy to Advance Racial, Eth­nic, and Trib­al Health Equi­ty, Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Medicine
• Land Rights and Health Out­comes in Amer­i­can Indian/​Alaska Native Chil­dren, Amer­i­can Acad­e­my of Pedi­atrics Journal
• The Oth­er Side of the ACEs Pyra­mid: A Heal­ing Frame­work for Indige­nous Com­mu­ni­ties, Inter­na­tion­al Jour­nal of Envi­ron­men­tal Research and Pub­lic Health

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* As not­ed in our pre­vi­ous post, we pri­mar­i­ly use the term ​“Amer­i­can Indi­an and Alas­ka Native (AI/AN)” to be con­sis­tent with the data sources ref­er­enced. Oth­er terms com­mon­ly used to encom­pass the wide­ly het­eroge­nous orig­i­nal peo­ples of North, Cen­tral and South Amer­i­ca include: Amer­i­can Indi­an, First Nations, Native Amer­i­can, Native and Indige­nous. Nat­u­ral­ly, ter­mi­nol­o­gy is evolv­ing and per­son­al, and pref­er­ences vary on which labels to use. These broad terms are meant to refer to the many dif­fer­ent Native nations in what we now call the Unit­ed States, although using spe­cif­ic Native nation names is prefer­able when refer­ring to indi­vid­u­als or sin­gle groups.