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Native Americans have shorter lifespans. Better healthcare is not the only answer. • Daily Montanan

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HISLE, SD – Katherine Goodlow is only 20, but she’s been through enough to know that people around her die too young.

Goodlow, 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 including liver failure and COVID-19, she said. And she recently lost a 1-year-old nephew.

“Most Native American children and youth lose their friends at a young age,” says Goodlow, who is considering becoming a mental health therapist to help her community. “So I would say we’re actually used to it, but it hurts more and more when we lose someone.”

Native Americans generally die much earlier than white Americans. Their average age at death was 14 years younger, according to an analysis of 2018-2021 data from the Centers for Disease Control and Prevention

The inequality is even greater in Goodlow’s home state. According to state data, native South Dakotans who died between 2017 and 2021 had an average age of 58 – 22 years younger than white South Dakotans.

Donald Warne, a physician who is co-director of the Johns Hopkins Center for Indigenous Health and a member of the Oglala Sioux Tribe, can name the most common medical conditions and accidents that kill Native Americans.

But what is ultimately behind this low life expectancy, Warne and many other Indigenous health experts believe, are social and economic forces. They argue that in addition to strengthening medical care and fully funding the Indian Health Service — which provides health care to Native Americans — there should also be more investment in case management, parenting classes and home visits.

“It’s almost blasphemy for a doctor to say this,” but “the solution to addressing these issues is not hiring more doctors and nurses,” Warne said. “The answer is more community-based prevention.”

The Indian Health Service funds several types of these programs, including community health worker initiatives and efforts to increase access to fresh produce and traditional foods.

Private insurers and state Medicaid programs, including South Dakota’s, are increasingly covering such services. But insurers don’t pay for all services or reach everyone who is eligible, according to Warne and the National Academy for State Health Policy.

Warne pointed to Family Spirit, a program developed by the Johns Hopkins center to improve health outcomes for Native mothers and children.

Chelsea Randall, director of maternal and child health at the Great Plains Tribal Leaders’ Health Board, said community health workers are educating Native pregnant women and connecting them with resources during home visits.

“We can be with them through their pregnancy and support them and advocate for them,” says Randall, whose organization runs Family Spirit programs on seven reservations in the Dakotas and in Rapid City, South Dakota.

Community health workers serve families until children turn three, teaching parenting skills, family planning, substance abuse prevention and stress management. They can also integrate the tribe’s culture by, for example, using their language or birth traditions.

The health board is funding Family Spirit through a grant from the federal Health Resources and Services Administration, Randall said. Community health workers, she said, are using some of that money to provide car seats for children and to teach parents how to properly install them to combat the high number of fatalities.

Some Native American reservations have a housing shortage, while existing homes may be so crowded or dilapidated that they need to be boarded up, such as this one in Martin, South Dakota. Overcrowding and dangerous housing conditions can cause mental and physical health problems. (Photo by Arielle Zionts | KFF Health News)

Other causes of early Native American deaths include homicide, drug overdoses and chronic diseases, such as diabetes, Warne said. Native Americans also suffer disproportionate rates of infant and maternal mortality.

The crisis is evident in the obituaries of the Sioux Funeral Home, which serves primarily Lakota people from the Pine Ridge Reservation and surrounding areas. The funeral home’s Facebook page features obituaries of older adults, as well as many infants, toddlers, teens, young adults and middle-aged residents.

Misty Merrival, who works at the funeral home, blames poor living conditions. Some community members struggle to find healthy food or afford warmth in the winter, she said. They may live in houses with broken windows or that are full of relatives. Some neighborhoods are littered with trash, including intravenous needles and broken bottles.

Seeing all these premature deaths has inspired Merrival to keep herself and her teenage daughter healthy by abstaining from drugs and driving safely. They also talk about how they feel every day as a strategy to prevent suicide.

“We promised each other that we wouldn’t leave each other like that,” Merrival said.

Many Native Americans live in small towns or on poor, rural reservations. But rural areas alone do not explain the gap in life expectancy. For example, white people in rural Montana live an average of 17 years longer than Native Americans in the state, according to state data reported by Lee Enterprises newspapers.

Many Indigenous people also face racism or personal trauma due to childhood or sexual abuse and exposure to drugs or violence, Warne said. Some also face generational trauma from government programs and policies that have separated families and sought to suppress Native American culture.

Even when programs are available, they are not always accessible.

Families without strong internet connections cannot easily make video appointments. Some don’t have cars or gas money to travel to clinics, and public transportation options are limited.

Randall, the health board official, is pregnant and dealing with transportation problems of her own.

It’s a three-hour round trip between her home in the town of Pine Ridge and her prenatal appointments in Rapid City. Randall has had to cancel several appointments because family members were unable to lend out their car.

Goodlow, the 20-year-old who has lost several loved ones, lives with seven other people in her mother’s two-bedroom house down a dirt road. Their small community on the Pine Ridge Reservation has homes and farms, but no shops.

Goodlow attended several suicide prevention presentations in high school. But the programs have not stopped the deaths. A friend recently committed suicide after enduring the losses of her son, mother, best friend, and a niece and nephew.

A month later, another friend died at age 17 from a burst appendix, Goodlow said. The next day, Goodlow woke up to find that one of her grandmother’s parakeets had died. That afternoon she watched one of her dogs die after having seizures.

“I thought it was a sign,” Goodlow said. “I started crying and then I started thinking, ‘Why is this happening to me?’”

Warne said the general conditions could lead to desperation on some reservations. But those same reservations, including Pine Ridge, also include thriving arts scenes and language and cultural revitalization programs. And not all Native American communities are poor.

Warne said federal, state and tribal governments must work together to improve life expectancy. He encourages tribes to negotiate contracts that allow them to manage their own health care facilities with federal dollars, as this could open up funding streams not available to Indian Health Services.

Katrina Fuller is health director at Siċaŋġu Co, a nonprofit organization on the Rosebud Reservation in South Dakota. Fuller, a member of the Rosebud Sioux Tribe, said the organization works to promote “wicozani,” or the good way of life, which includes the physical, emotional, cultural and financial health of the community.

Siċaŋġu Co’s programs include bison restoration, youth development, a Lakota language immersion school, financial education and food sovereignty initiatives.

“Some people here who are having a hard time also have dreams. They just need the resources, the training and even the moral support,” Fuller said. “I had a person in our health coaching class who told me that they just really needed someone to believe in them, that they could do it.”

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF – an independent source of health policy research, polling and journalism.

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