HILE, South Dakota — Katherine Goodrow may only be 20 years old, but she's experienced enough to understand that people around her are dying young.
Goodrow, a member of the Lower Brule Sioux Tribe, said she has lost six friends and acquaintances to suicide, two to car accidents and one to appendicitis. Four of her relatives died in their 30s or 40s from causes such as liver failure and coronavirus infection. And recently, she lost her one-year-old nephew.
“Most Native American children and youth lose friends at a young age,” said Goodloe, who is considering becoming a mental health therapist to help her community. “So I think we're basically used to it, but every time we lose someone it hurts even more.”
Native Americans tend to die much earlier than white Americans.The median age of death was 14 years younger, according to an analysis of 2018-21 data from the U.S. Centers for Disease Control and Prevention.
The disparity is even greater in Goodrow's home state. The median age of Native South Dakotans who died between 2017 and 2021 was 58 years old, 22 years younger than white South Dakotans, according to state data.
Donald Warne, an internist and co-director of the Johns Hopkins Indian Health Center and a member of the Oglala Sioux Tribe, can talk in detail about the most common medical conditions and incidents that kill Native Americans.
But ultimately, social and economic forces are behind this low life expectancy, Warne and many other Indigenous health experts agree. They argue that in addition to strengthening health care and fully funding the Indian Health Service, which provides health care to Native Americans, there needs to be increased investment in case management, parenting classes, and home visits. .
“It's almost blasphemy for a doctor to say,” Warne said, but “the answer to addressing these problems is not to hire more doctors and nurses.” “The answer is to take more community-based precautions.”
The Indian Health Service funds several types of programs, including community health worker initiatives and efforts to increase access to fresh and traditional foods.
Private insurance companies and state Medicaid programs, including South Dakota's, are increasingly covering these services. But insurers don't pay for all services and aren't able to reach everyone they cover, according to Warne and the National Academy of State Health Policy.
Warne pointed to Family Spirit, a program developed by the Johns Hopkins University Center to improve the health outcomes of Native American mothers and children.
Chelsea Randall, director of maternal and child health for the Great Plains Tribal Leadership Health Council, said community health workers are educating pregnant Native American women and providing resources during home visits.
“We're able to be with them throughout their pregnancy, support them and be their advocate,” said the family spirit program on seven reservations in the Dakotas and Rapid City, South Dakota. Randall, the organization that runs it, said.
Community health workers support families until children are three years old, teaching them parenting skills, family planning, substance abuse prevention, and stress management. Tribal cultures can also be integrated, such as through the use of language and birth traditions.
Randall said the Board of Health is funding Family Spirit through a grant from the federal Health Resources and Services Administration. She said local health workers are using some of the money to provide car seats and teach parents how to properly install them to combat the high rate of fatalities.
Warne said other causes of premature death among Native Americans include homicide, drug overdoses and chronic diseases such as diabetes. Native Americans also suffer disproportionate numbers of infant and maternal deaths.
This crisis is also evident in obituaries from Sue Funeral Home, which primarily serves the Lakota Nation on the Pine Ridge Reservation and surrounding areas. The funeral home's Facebook page also posts obituaries for its many infants, toddlers, teens, young adults and middle-aged residents, as well as the elderly.
Misty Merival, who works at a funeral parlor, blames poor living conditions. Some local residents say they struggle to find healthy food or afford heat in the winter. They may live in a house with broken windows or a house full of relatives. Some areas are littered with trash, including IV needles and broken bottles.
Faced with all these untimely deaths, Merivale decided to keep herself and her teenage daughter healthy by abstaining from drugs and driving safely. They also talk about their feelings daily as a suicide prevention measure.
“We made a promise to each other not to part ways like that,” Merivale said.
Many Native Americans live in small towns or rural, impoverished reservations. However, rurality alone does not explain differences in life expectancy. For example, white people living in rural Montana live an average of 17 years longer than Native Americans in the state, according to state data reported by the Lee Enterprise newspaper.
Many Indigenous people also face personal trauma from racism, child abuse, sexual abuse, exposure to drugs and violence, Warne said. Others deal with intergenerational trauma caused by government programs and policies that tore families apart and suppressed Native American culture.
Even if a program is available, it may not always be accessible.
Families without a strong internet connection cannot easily make video appointments. Some people lack the money for a car or gas to get to the clinic, and public transportation options are limited.
Randall, a health board employee, is pregnant and faces challenges with her own transportation.
It's a three-hour round trip between her home in the town of Pine Ridge and her prenatal appointment in Rapid City. Randall said her family could not lend her a car and she had to cancel several of her appointments.
Goodrow, 20, who has lost several loved ones, lives with seven other people in her mother's two-bedroom house on a gravel road. Their small community on the Pine Ridge Reservation has a home and a ranch, but no store.
Goodloe attended several suicide prevention presentations during her high school years. But the program hasn't stopped the deaths. A friend recently committed suicide after enduring the loss of his son, mother, best friend, niece and nephew.
A month later, another friend died of a ruptured appendix at age 17, Goodloe said. The next day, Goodloe woke up to find one of his grandmother's parakeets dead. That afternoon, she watched one of her dogs suffer a seizure and die.
“I thought it was some kind of sign,” Goodloe said. “I started crying and then I started thinking, 'Why is this happening to me?'”
Warne said the overall situation on some reservations can create hopelessness. But the same reservation that includes Pine Ridge also includes a thriving arts scene and language and cultural revitalization programs. And not all Native American communities are poor.
Warn said federal, state and tribal governments need to work together to increase life expectancy. He is encouraging tribes to negotiate contracts that allow them to manage their own health facilities with federal funding. Doing so could open up funding streams unavailable to India's health services.
Katrina Fuller is the health director for Siashtu, a nonprofit organization on the Rosebud Reservation in South Dakota. Fuller, a member of the Rosebud Sioux Tribe, said the organization works toward “wikozani,” or a good way of life, encompassing the physical, emotional, cultural and economic health of the community. Ta.
Siċaŋġu Co's programs include bison restoration, youth development, Lakota language immersion schools, financial education, and food sovereignty initiatives.
“Some of the people who are struggling here have dreams. All they need is resources, training and even emotional support,” Fuller said. “One of the students in our health coaching class said that she really needed someone to believe that she could do it, that she could do it.”
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