Shirley Sneve
ICT
Even in death, policies and procedures are erasing American Indians and Alaska Natives, a study released by Hunter College demonstrates.
The new study, published June 16 in the JAMA Network Open found that the life expectancy of American Indian and Alaska Native individuals is significantly lower, by about three years, than official government data suggests.
The study, co-authored by Hunter College faculty members Dr. Stephanie Woolhandler and Dr. David Himmelstein, is the first in more than a decade to use self-identified race data from a nationally representative cohort to correct for pervasive racial misclassification on death certificates.
The findings reveal that American Indian and Alaska Native people die, on average, 6.5 years younger than the general U.S. population — a gap nearly three times larger than what official statistics had previously shown.
The research shows that death certificates incorrectly identify the race of more than 40 percent of American Indian and Alaska Native individuals who have died. Funeral directors usually fill-in the information on decedents’ race on the death certificate, and unless the family reports the race of the deceased, assumptions are made. This misclassification has led to years of federal underreporting, effectively concealing the true extent of Indigenous health disparities.
“This is more than just a data error — it’s a form of statistical erasure,” said Woolhandler, a distinguished professor at Hunter College and senior author of the study.
“This is an example of statistical erasure where governments make a decision to ignore a problem, to not collect data on the problem, and that they think that relieves some of the responsibility to deal with it,” Woolhandler said. “When Indigenous people’s deaths are not counted accurately, it becomes harder to mobilize the public health response they urgently need.”
The study followed more than 4 million Americans from 2008 to 2019 and found that mortality rates for American Indian and Alaska Native individuals are 42 percent higher than the national average, far exceeding the 5 percent disparity previously estimated using death certificate data.
“Policymakers have been working from flawed numbers,” said Himmelstein, a co-author and also a distinguished professor at Hunter College. “The real picture is far grimmer, and failing to see it has cost lives.”
Woolhandler hopes the study will assist in raising the bar for policy and increased funding for health care.
“Accurate information about Native American health is lagging way behind the health of other Americans,” Woolhandler said. “Federal and state governments need to be putting resources into improving the health of Native Americans. I do believe that the federal government, in particular, owes a big debt to Native Americans in terms of making treaties and then breaking them, in terms of expropriating the land of Native Americans.
“But even apart from that debt, it’s the obligation of the government to take care of the people. And if they are unaware how serious health problems are of Native Americans, then it’s easier for them to ignore those needs and fail to provide the resources that Native Americans need in order to improve their health.”
The study’s co-authors are Jacob Bor, Boston University School of Public Health; Michael Bird, Kewa Pueblo, University of California, Berkeley; Jahn Hakes, U.S. Census Bureau; and Gracie Himmelstein, University of California, Los Angeles School of Medicine.