Sudden Unexpected Infant Death

Sudden unexpected infant death (SUID) is the death of an infant less than 1 year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. Most SUIDs are reported as one of three types: sudden infant death syndrome (SIDS), unknown cause, or accidental suffocation and strangulation in bed. From 2011-2014 SUID rates for AI/AN infants were more than twice of those for non-Hispanic white infants.

• Health care providers and researchers don’t know the exact cause of SIDS. However, parents and caregivers can take actions, like placing their baby on his or her back to sleep, to reduce the chance of SIDS and other sleep-related infant deaths.
• The 1,000 Grandmothers project is a culturally appropriate approach to reduce SUID rates within the Native American population. This CDC-funded project created opportunities for tribal elders (especially grandmothers) to mentor and educate young Native parents on safe sleep practices for infants. Learn more about The 1,000 Grandmothers Project.

Diabetes

Diabetes is a chronic (long-lasting) disease that affects how the body turns food into energy. AI/AN people have a greater chance of having diabetes than any other US racial group, and are twice as likely as whites to have diabetes.

• Learn more about who is at risk for diabetes and the importance of getting tested.
• Visit the Native Diabetes Wellness Program, part of CDC’s Division of Diabetes Translation. The program aims to share messages through youth-focused Eagle Books about traditional ways of health that are remembered, retold, and talked about where people live, work, and play. The program also supports sustainable ecological approaches and health practices to promote traditional foods, physical activity, and social support.

Tribal Road Safety

Motor vehicle crashes are a leading cause of unintentional injury death for AI/AN. Among infants less than one year of age, the motor vehicle traffic death rate among AI/AN is 8 times as high as that of non-Hispanic whites.

• The major risk factors for motor vehicle injuries and deaths among AI/AN are low seat belt use, low child safety seat use, and high rates of alcohol-impaired driving.
• CDC’s Roadway to Safer Tribal Communities Toolkit includes fact sheets, posters, and a video with tips on increasing child safety seat use, increasing seat belt use and decreasing alcohol-impaired driving
• The Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide 2016 provides a summary of the burden of motor vehicle injury and death in AI/AN communities. It offers recommended strategies with examples from Indian Country and outlines important components of successful tribal road safety programs, lessons learned, case examples, resources, and calls to action for TMVIP programs.

Clinical trials are research studies involving human volunteers to evaluate medical products like medications, vaccines, or devices for safety and effectiveness. These studies may also show which medical products or therapies work best for people with certain illnesses or for certain groups of people. Ensuring people from diverse backgrounds join clinical trials is key to advancing health equity.

5 things you should know about clinical trials

1. Clinical trials are research studies conducted with people—they are designed to answer specific research questions about medical products or therapies.
2. Participation is always voluntary—you can leave a study whenever you want.
3. Clinical trials often need healthy volunteers to help answer research questions.
4. Your safety is a priority. Researchers must follow detailed protocols and the FDA’s safety requirements to make each trial as safe as possible.
5. The study will be explained to you in an informed consent process before you agree to join.

The importance of diverse participation in clinical trials

Participants in clinical trials should represent the patients that will use the medical products. This is often not the case—people from racial and ethnic minority and other diverse groups are underrepresented in clinical research. This is a concern because people of different ages, races, and ethnicities may react differently to medical products. To achieve health equity so all can benefit from clinical trials, we are committed to taking steps to change this.

Joining a clinical trial might be a good choice for you if:

• You and your health care provider believe a clinical trial may provide another option when standard treatments have failed.
• You want to help test new medical products or therapies in the diverse patients likely to use them.
• You want to help researchers find better ways to fight diseases.

Non-Hispanic American Indian and Alaska Native people have higher rates of getting certain kinds of cancer than non-Hispanic White people. They have been the subject of centuries of systemic racism, which have often resulted in less access to health care, healthy food, and educational and employment opportunities.

These types of inequities have contributed to many health disparities, including higher cancer rates, across American Indian and Alaska Native tribes and between American Indian and Alaska Native people and people of other races and ethnicities. Eliminating these inequities can improve health outcomes for these populations.

Cancer Rates

Tribal groups have unique cancer patterns. The rates of getting and dying from certain kinds of cancer can vary widely among American Indian and Alaska Native people in different areas of the United States. For example—

• Lung cancer is the most common cancer among non-Hispanic American Indian and Alaska Native populations in five of the six Indian Health Service (IHS) regions in the United States. But in the Southwest region, lung cancer is the fourth most common cancer, after colorectal, kidney, and liver cancer.
• Stomach cancer is the fourth most common cancer among non-Hispanic American Indian and Alaska Native people in Alaska but the sixth most common cancer among this population in the Southwest region. Stomach cancer is not among the top 10 most common cancers in other regions.
• The overall rate of getting cancer is more than twice as high among non-Hispanic American Indian and Alaska Native people in the Southern Plains region (612 per 100,000 people) compared to the Southwest region (294 per 100,000 people).

Compared to non-Hispanic White people, non-Hispanic American Indian and Alaska Native people have different rates of getting some kinds of cancer. For example—

• Non-Hispanic American Indian and Alaska Native women have higher rates of getting cervical cancer than non-Hispanic White women in all regions except the East region.
• Non-Hispanic American Indian and Alaska Native males and females have higher rates of getting colorectal, kidney, and stomach cancers than non-Hispanic White males and females in almost all regions.
• Non-Hispanic American Indian and Alaska Native people in the East and Southwest regions have lower rates of getting lung cancer than non-Hispanic White people. Lung cancer rates are higher among non-Hispanic American Indian and Alaska Native people compared to non-Hispanic White people in the other four regions.
• In all regions, non-Hispanic American Indian and Alaska Native people have higher rates of getting liver cancer than non-Hispanic White people.
• Non-Hispanic American Indian and Alaska Native women have higher rates of getting cervical cancer than non-Hispanic White women in all regions except the East region.
• Non-Hispanic American Indian and Alaska Native men have lower rates of getting prostate cancer than non-Hispanic White men in all regions except the Northern Plains and the Southern Plains.

Data source: United States Cancer Statistics: Data Visualizations. Data are restricted to non-Hispanic American Indian and Alaska Native people living in IHS purchased/referred care delivery area counties.

Risk Factors

Many cancers can be prevented. Staying away from commercial tobacco smoke, keeping a healthy weight, drinking little or no alcohol, and getting human papillomavirus (HPV) vaccinations on time can lower a person’s risk of getting cancer. Screening tests can prevent some cancers or find them early, when treatment works best.

A risk factor is something that may increase a person’s chances of getting cancer. American Indian and Alaska Native people in the United States have a higher prevalence of some risk factors compared to White people. For example—

• Obesity is more prevalent among non-Hispanic American Indian and Alaska Native adults than non-Hispanic White adults.
• On average, American Indian and Alaska Native people are more likely to smoke cigarettes than members of other racial or ethnic groups in the United States.
• American Indian and Alaska Native people have the highest rate of getting chronic hepatitis C, which can lead to liver cancer.
• The prevalence of Helicobacter pylori (H. pylori)—a type of bacteria that can lead to stomach cancer—is particularly high among Alaska Native people.
• Non-Hispanic American Indian and Alaska Native people are less likely than non-Hispanic White people to be up to date on cancer screening tests, according to the IHS’s 2021 Government Performance and Results Act (GPRA) report.
• About 66% of non-Hispanic American Indian and Alaska Native teens from 13 to 17 are up to date with HPV vaccination, compared to 55% of non-Hispanic White teens.

Note: In the statistics above, some comparisons are only between race categories, while others are between race and ethnicity categories (non-Hispanic or Hispanic).

Barriers to Health Care

Compared to non-Hispanic White people in the United States, American Indian and Alaska Native people generally find it harder to get medical care. They often face the following barriers—

• Lack of health insurance. A higher percentage of non-Hispanic American Indian and Alaska Native people are uninsured [PDF-498KB] than members of other races.
• Lower household incomes. In 2019, the median household income for American Indian and Alaska Native people was $49,906, compared to $71,664 for non-Hispanic White households.
• Lower educational attainment. In 2019, about 84% of American Indian and Alaska Native people had at least a high school diploma, compared to about 93% of non-Hispanic White people.
• Remote locations. American Indian and Alaska Native people who live on reservations and in rural areas often find it hard to get health care. They may live far from a screening facility and have little or no access to public transportation.

Colorectal cancer is the third most common cancer in the United States. Despite being one of the most preventable types of cancer, over 50,000 deaths from colorectal cancer occur each year. African Americans and American Indians/Alaska Natives are disproportionately affected. Health care providers recommend routine screening starting at age 45, or earlier if you are at higher risk.

What is colorectal cancer?

Colorectal cancer usually develops from polyps or other precancerous growths in the large intestine (comprised of the colon and rectum). The cancer cells may spread from the growth to other parts of the body in advanced stages.

Who is affected by colorectal cancer?

Most cases of colorectal cancer occur in people over the age of 50, but rates are going up for younger adults. African Americans and American Indians/Alaska Natives have the highest rates of colorectal cancer. Factors that increase your risk of colorectal cancer include:

• Family or personal history of colorectal cancer, inflammatory bowel disease, or other intestinal conditions
• Type 2 diabetes
• Lack of exercise
• Overweight or obese
• Tobacco use
• Consumption of three or more alcoholic drinks per day

What are the symptoms of colorectal cancer?

Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first. If you have symptoms, they may include:

• Changes in bowel movements
  • Constipation or diarrhea
  • Narrow or bloody stools
  • Feeling your bowel is not fully empty
• Vomiting
• Sudden weight loss
• Gas pains or cramps
• Feeling tired or weak

What should I know about screening?

Several non-invasive screening tests are available that can find precancerous changes in stool, tissues, blood, and genes. How often you need to be screened depends on the type of test selected.

If colorectal cancer is found early and treated properly, the survival rate is high for 9 out of 10 people. Health care providers recommend routine screening starting at age 45, or earlier if you are at higher risk.

How is colorectal cancer treated?

Your health care provider will recommend treatment based on the stage of the cancer and your overall health. Several medications act to destroy cancer cells or block them from spreading. Other medications boost the body’s immune system. Cancerous cells can also be surgically removed or destroyed by FDA-approved treatments like freezing, radiation, or chemical injection.

Native Americans (American Indians and Alaska Natives) have a greater chance of having diabetes than any other US racial group. Diabetes is the leading cause of kidney failure, a costly condition that requires dialysis or kidney transplant for survival. Kidney failure can be delayed or prevented by controlling blood pressure and blood sugar and by taking medicines that protect the kidneys. Good diabetes care includes regular kidney testing and education about kidney disease and treatment. Kidney failure from diabetes among Native Americans was the highest of any race. However, this has declined the fastest since the Indian Health Service (IHS) began using population health and team-based approaches to diabetes and kidney care, a potential model for other populations.

Health care systems can:

• Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care.
• Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
• Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care.

• Native Americans are twice as likely as whites to have diabetes.
• In about 2 out of 3 Native Americans with kidney failure, diabetes is the cause.
• Kidney failure from diabetes dropped by 54% in Native Americans between 1996 and 2013.

Problem

Kidney failure from diabetes was highest among Native Americans.

Native Americans are more likely to have diabetes.

• Native Americans are twice as likely as whites to have been diagnosed with diabetes.

Native Americans were more likely to have kidney failure from diabetes than other races until recently.

• Native Americans were nearly 5 times more likely than whites to have kidney failure from diabetes in 1996.
• Reasons include: high blood sugar, high blood pressure, and significant barriers to health care.

Diabetes-related kidney failure among Native Americans decreased by 54% from 1996 to 2013.

• The Indian Health Service uses population health and team-based approaches to diabetes and kidney care.
• Native Americans with diabetes have had important improvements:
  • Use of medicines to protect kidneys increased from 42% to 74% in 5 years.
  • Average blood pressure in those with hypertension was well-controlled (133/76 mmHg).
  • Blood sugar control improved by 10%.
  • Kidney testing in those 65 and older was 50% higher compared to the Medicare diabetes population.

Kidney failure is a disabling and expensive complication of diabetes throughout the US.

• Medical costs for kidney failure from diabetes were about $82,000 per person in 2013.
• Medicare spent $14 billion to treat people with kidney failure from diabetes in 2013.

What Can Be Done?

The Federal government is:

• Funding diabetes treatment and prevention services in Native American communities through the Special Diabetes Program for Indians.
• Improving diabetes outcomes for populations who receive direct health care from federal agencies, including Native Americans, veterans, and others.
• Assisting community health centers throughout the US to provide comprehensive diabetes care.
• Developing a comprehensive system for tracking chronic kidney disease (CKD).

Health care systems can:

• Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care.
• Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
• Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care.

Health care policy leaders and insurers can:

• Set standards and track performance measures requiring health plans to assess the health of all members of their population with diabetes, including those who don’t regularly visit their healthcare provider.
• Promote CKD screening and monitoring and appropriate use of medicines that protect the kidneys in people with diabetes and CKD.
• Support team-based care, care management, patient education, home visits, and community outreach.

Patients with diabetes and their families can:

• Ask about being tested for kidney disease.
• Check their blood pressure and blood sugar regularly; talk with their healthcare provider about goals.
• Talk with their healthcare provider if they are having problems getting or taking their medicines.
• Reduce salt intake to lower blood pressure and protect their kidneys.

Health disparities are differences in the incidence, prevalence, and mortality of a disease and the related adverse health conditions that exist among specific population groups. These groups may be characterized by gender, age, race or ethnicity, education, income, social class, disability, geographic location, or sexual orientation. These health disparities are one reason why HIV, viral hepatitis, STDs, and TB take a greater toll in one population group over another. Find information about how these diseases affect American Indian and Alaska Native populations.

HIV

Though the overall numbers are small, in 2018, the rate (per 100,000 population) of HIV diagnoses in the United States among adult and adolescent American Indian/Alaska Native males was greater (16.2) than the rate for White males (9.6). The rate per 100,000 population among American Indian/Alaska Native females was greater (3.0) than for White females (1.7).

STDs

Chlamydia

In 2018, the rate of reported chlamydia cases among AI/AN was 784.8 cases per 100,000 population. Overall, the rate of reported chlamydia cases among AI/AN in the United States as 3.7 times the rate among Whites.

Gonorrhea

In 2018, the rate of reported gonorrhea cases among AI/AN (329.5 cases per 100,000 population) was 4.6 times the rate among Whites. The disparity between gonorrhea rates for AI/AN and Whites was larger for AI/AN females (6.3 times the rate among White females) than for AI/AN males (3.3 times the rate among White males). The disparity in gonorrhea rates for AI/AN in 2018 was larger in the Midwest than in the West, Northeast, and South.

Primary and Secondary Syphilis

In 2018, the rate of reported P&S syphilis cases among AI/AN was 2.6 times the rate among Whites (15.5 versus 6.0 cases per 100,000 population, respectively). This disparity was greater for AI/AN females (5.4 times the rate among White females) than for AI/AN males (2.1 times the rate among White males).

Congenital Syphilis

From 2014 to 2018, the rate of reported congenital syphilis increased 500% among American Indians/Alaska Natives (13.2 to 79.2 cases per 100,000 live births). In 2018, the rate of reported cases of congenital syphilis among AI/AN was 5.9 times the rate among Whites (79.2 cases versus 13.5 cases per 100,000 live births, respectively).

Viral Hepatitis

In 2018, there were 15,713 death certificates among US residents that listed hepatitis C as the underlying or a contributing cause of death. American Indians/Alaskan Natives have historically experienced the highest age-adjusted hepatitis C-related mortality rates, relative to other race/ethnic groups, and the rate increased from 2016 to 2017. In 2018 American Indians/Alaska Natives again had the highest hepatitis C related death rate among all race/ethnic groups, at 9.05 deaths per 100,000 population.

Tuberculosis (TB)

In 2018, 87% of all reported TB cases occurred in racial and ethnic minorities. TB disease was reported in 104 American Indians and Alaska Natives in the United States, accounting for 1.2% of all people reported with TB disease nationally. The rate of TB disease in American Indians and Alaska Natives was 4.3 cases per 100,000 population, which is over eight times higher than the rate of TB disease in non-Hispanic whites (0.5 cases per 100,000 population). Overall, 9,025 TB cases were reported to CDC from the 50 states and the District of Columbia in 2018.

Heart disease refers to several conditions that affect the heart. In the United States, it affects more than 1 in 10 adults (30 million) and is the leading cause of death for people of most racial and ethnic groups (responsible for about 1 in 4 deaths).

Heart disease may not be diagnosed until a person experiences signs or symptoms of a heart attack, heart failure, or an arrhythmia. These symptoms may include:

• Heart attack: Chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, and shortness of breath
• Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins
• Arrhythmia: Fluttering feelings in the chest (palpitations)

Who is at risk?

High blood pressure, high cholesterol, and smoking are key risk factors for heart disease. About half of all adults in the United States have at least one of these risk factors. Other medical conditions and health behaviors that put you at higher risk are:

• Diabetes
• Alcohol use
• Unhealthy diet
• Physical inactivity
• Overweight and obesity

Your risk for heart disease increases as you age and if you have a history of heart disease in your family.

How is heart disease treated?

Your health care provider may prescribe one or more FDA-approved medications to treat your heart disease or its risk factors. Some types of heart disease are also treated with medical devices such as pacemakers (implanted in the body to regulate the heart rate) or stents (metal tubes that are inserted in an artery to improve blood flow). Your health care provider will work with you to determine which treatment is the best option for your condition.

Participating in a cardiac rehabilitation (rehab) program after having a heart attack, heart failure, or some type of heart surgery is important for recovery. Supervised by a team of health care professionals, this program may include:

• Physical activity
• Counseling to find ways to relieve stress and improve your mental health
• Education about healthy living (such as healthy eating), taking medication as prescribed, and ways to help you quit smoking

Immunization happens when a person becomes protected against a disease through vaccination. Getting vaccinated is one of the safest and most effective ways of preventing infectious diseases.

What is immunization?

When disease-causing viruses or bacteria (germs) invade the body, our immune systems are activated to attack them. Vaccines work by mimicking these germs so that if you are exposed to the real germ, your immune system is prepared to respond quickly.

Vaccines contain dead and weakened forms of germs or small pieces of germs. Others contain genetic instructions for immune cells to identify germs. Since vaccines do not contain germs in disease-causing forms, they will not give you the disease they are designed to prevent.

Most vaccines are given as an injection (shot). Side effects are usually mild, such as redness or soreness where the shot was given or a low-grade fever.

Why is immunization important?

Getting vaccinated is one of the most effective ways of preventing infectious diseases, disabilities, and deaths. In the United States, routine childhood vaccines prevent many diseases, and immunization has reduced the occurrence of most vaccine-preventable diseases by over 95%.

Adults need vaccines too, even if you got all your childhood shots. The protection for some shots can wear off over time, and as you get older you may be at risk for diseases like shingles. All adults should get a yearly flu shot and other vaccines based on age, job, lifestyle, travel, or health conditions.

Getting vaccinated also helps decrease the spread of diseases to other people. When enough people are vaccinated against a disease, it is more difficult for that disease to spread and cause an outbreak. People with serious allergies or weakened immune systems who can’t get vaccinated will also gain some protection from getting sick (known as community or herd immunity).

Are vaccines safe?

Vaccines are one of the safest ways to protect against many infections. Every vaccine is safety tested before it’s approved by the FDA and recommended for use by the Centers for Disease Control and Prevention (CDC). Vaccine manufacturers test each vaccine lot for identity, purity, strength, and sterility before they are released for use. The FDA and the CDC also monitor the safety of vaccines in infants, children, and adults after they come to market.

In the event of a public health emergency, the FDA may issue an Emergency Use Authorization (EUA) to facilitate the availability and the use of a vaccine. An EUA requires an FDA review of data on the quality and consistency of the vaccine product and a review of data collected from studies with people who volunteer to take the vaccine.

African Americans, Hispanics, and American Indians are at high risk for developing kidney failure. This risk is due in part to high rates of diabetes and high blood pressure in these communities. Below is more information about kidney failure for each of these groups.

African Americans

African Americans are almost four times as likely as Whites to develop kidney failure.

While African Americans make up about 13 percent of the population, they account for 35 percent of the people with kidney failure in the United States. Diabetes and high blood pressure are the leading causes of kidney failure among African Americans.

Hispanics

A growing number of Hispanics are diagnosed with kidney disease each year. Since 2000, the number of Hispanics with kidney failure has increased by more than 70 percent.

Compared to non-Hispanics, Hispanics are almost 1.3 times more likely to be diagnosed with kidney failure.

American Indians and Alaska Natives

American Indians also are disproportionately affected by kidney failure. Compared to Whites, American Indians are about 1.2 times more likely to be diagnosed with kidney failure. Diabetes is the leading cause of kidney failure among American Indians. However, better diabetes care is reducing the risk for kidney failure in American Indians with diabetes.

Lupus is an autoimmune disease that can cause pain and inflammation in the body. Symptoms can flare up at any time and are different for every person. Lupus disproportionately affects racial and ethnic minority women. Although lupus cannot be cured, medications can prevent flares, treat symptoms, and reduce organ damage and other problems.

What is lupus?

Lupus is a chronic (long-term) autoimmune disease that can damage many parts of the body. Autoimmune diseases occur when a body’s immune system mistakenly attacks and destroys healthy cells, tissues, and organs. These attacks cause inflammation that leads to tissue damage, which may be permanent in some cases.

What are the symptoms of lupus?

Lupus is a disease where symptoms sometimes are worse (flares) and other times are better (remission). Symptoms may differ from person to person and may change over time. They include:

• Muscle and joint pain
• Prolonged or extreme fatigue
• Rash
• Chest pain
• Hair loss
• Sun or light sensitivity
• Fever
• Mouth sores
• Anemia
• Memory problems
• Blood clotting
• Eye disease
• Kidney problems (lupus nephritis)

Who is affected by lupus?

About 9 out of 10 people diagnosed with lupus are women aged 15 to 44, but men are affected as well. Notably, it's more common in African American, Asian, Hispanic/Latino, and American Indian/Alaska Native women. African American women are three times more likely to get lupus, and they may develop the disease at a younger age and have more serious and life-threatening complications than non-Hispanic white women.

How is lupus treated?

BLyS-specific inhibitors are medications that limit the amount of abnormal B cells (cells in the immune system that create antibodies) found in people with lupus. Belimumab, a type of BLyS-specific inhibitor, is the first and only medication specifically developed for and approved to treat lupus.

Treatment options to manage lupus symptoms

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs may help reduce mild pain and swelling in joints and muscles
• Corticosteroids: may help reduce swelling, tenderness, and pain
• Antimalarials: prevent or treat malaria and also treat joint pain, skin rashes, fatigue, and lung inflammation
• Immunosuppressive drugs/chemotherapy: may be used in severe cases, when lupus affects major organs or other treatments do not work

Mental health matters! Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, act, handle stress, relate to others, and make choices. Mental health is just as important as physical health at all stages of life. Mental health issues are common – about 1 in 5 American adults experiences a mental illness each year. Mental health issues are treatable and often preventable. However, people in some racial and ethnic minority groups face obstacles to maintaining positive mental health.

Obstacles to Mental Health for Racial and Ethnic Minority Groups

The mental health of some racial and ethnic minority groups has worsened since the start of the COVID-19 pandemic relative to that of non-Hispanic white people.

The COVID-19 pandemic has been a challenge for everyone, and racial and ethnic minority groups have been placed at higher risk for COVID-19 infection, COVID-19 severe illness or death, and pandemic-related stressors. These stressors, such as unemployment, loss of a loved one, and COVID-19 stigma, can cause emotional distress and may lead to new or worsening mental health issues. Mental health issues may increase when people face additional stressors, on top of those related to COVID-19, and lack access to the resources and support needed to navigate these challenges.

Mental health care is important for mental wellbeing, yet many people from racial and ethnic minority groups face obstacles in accessing needed care. These obstacles may include lack of or insufficient health insurance, lack of racial and ethnic diversity among mental healthcare providers, lack of culturally competent providers, financial strain, and stigma.

Racism negatively impacts mental health. Racism contributes to unequal access to resources and services, including mental health care. First-hand experiences of racial discrimination, as well as witnessing or hearing about discrimination from others or in the media, can cause or intensify stress and racial trauma.

Working Together for Mental Health Equity

All of society benefits when people from racial and ethnic minority groups have access to mental health care, supportive social conditions, freedom from stressors that can compromise mental health, and access to other resources needed for health. We all have a role to play in promoting health equity.

Individuals can

• Learn about healthy ways to cope with stress and respond to loss. When possible, engage in these practices.
• Get help for mental health issues through free and confidential resources.
• Learn about mental health and take the mental health quiz.
• Share information on mental health, healthy coping skills, and resources with family, friends, neighbors, and other members of your community.
• Encourage open conversations about mental health and use non-stigmatizing language when talking about mental health issues.
• Learn about implicit bias, microaggressions, and other forms of discrimination and make efforts to avoid perpetuating them.

Mental health equity is the state in which everyone has a fair and just opportunity to reach their highest level of mental health and emotional well-being.

Public health organizations can

• Ensure mental health programming incorporates perspectives, ideas, and decision-making from appropriately representative people of racial and ethnic minority groups at all stages of programming – from planning to implementation to evaluation.
• Consider the data on mental health when developing organizational priorities and programs.
• Prioritize action on and/or meaningfully account for the potential influence of social determinants of health when designing mental health programs.
• Measure the impact of racism on mental health and develop best practices for reducing racism and its consequences.
• Ensure mental health educational materials are culturally and linguistically appropriate and follow health equity principles for communication such as using plain language.
• Take intentional steps to increase the reach of mental health information to racial and ethnic minority groups through culturally responsive communication outlets.
• Establish and foster partnerships with other organizations to fill gaps in reach and/or expertise.
• Verify and promote available free and low-cost mental health resources.
• Explore referrals to mental health services to ensure those served can be efficiently connected with needed resources.

Healthcare systems can

• Screen patients for depression and other mental health conditions and refer patients to accessible mental health care services.
• Make mental health educational materials available to all patients during their appointments, via patient portals, and in waiting rooms.
• Make efforts to recruit mental healthcare providers that reflect the race and ethnicity of the populations they serve.
• Provide cultural humility training to mental healthcare providers.
• Ensure mental healthcare services are culturally and linguistically appropriate.

States and communities can

• Expand community-based mental health care that provides culturally responsive mental health services at low or no cost for youth and adults.
• Evaluate policies for their differential impact on social determinants of health, and, when needed, modify these policies or create new policies that ensure equitable access to resources for people from all race and ethnicity groups.
• Evaluate policies for their potential to reinforce mental health stigma and revise or remove stigmatizing policies.
• Encourage community and faith-based leaders to have positive dialogues and discussions around mental health issues to help reduce stigma.
• Make efforts to ensure decision-makers reflect the races and ethnicities of the populations they serve.

CDC is collaborating with partners to improve mental health among racial and ethnic minority groups by

• Developing and sharing culturally responsive resources to promote and strengthen the emotional well-being of populations through How Right Now | Finding What Helps, also available in Spanish
• Gathering data on mental health, access to care, demographics, and more through the Household Pulse Survey, in collaboration with the US Census Bureau
• Analyzing data to better understand mental health disparities during COVID-19
• Recognizing the harm racism has on mental health and overall health, declaring racism a serious threat to the public’s health, and taking actions to address racism
• Implementing the CORE strategy, an agency-wide strategy that aims to integrate health equity into all work at CDC
• Ensuring equity principles guide planning around mental health programming
• Raising awareness of health workers’ mental health issues through the Health Worker Mental Health Initiative
• Identifying policies and practices that connect more children and families to mental health care and seeking to understand the impact of social determinants of health on mental health care – Improving Access to Children’s Mental Health Care
• Developing data systems and tools that appropriately identify, respond to, culturally tailor, and reach historically marginalized and/or racialized populations during crises through Project REFOCUS, in partnership with Howard University, Department of Communication, Culture and Media Studies UCLA Center for the Study of Racism Social Justice and Health Funding, and CDC Foundation

If you experience an urgent maternal warning sign during or within a year after pregnancy, get medical care immediately.

You are the key to life and your life matters – for you, and your family. Listen to your body and get the care you need.

If you are pregnant or gave birth within the last year, it’s important to talk to your healthcare provider about anything that doesn’t feel right. It may be physical, but it could also include feelings of sadness, anxiety, and exhaustion that make it difficult to complete daily care activities for yourself, your baby or others.

We acknowledge that it can be difficult to access quality care. But, if you experience any of the urgent maternal warning signs, it’s important to seek medical care immediately. These symptoms could indicate a life-threatening situation.

You know your body best. If you experience something that seems unusual or is worrying you, don’t ignore it. Talk to your healthcare provider.

If you are not comfortable with your provider or feel like you aren’t being heard, try to find a trusted source of care that will hear your concerns and help you get the help you need. It is important to find someone you feel comfortable with and to speak openly with them so you can get the care you need.

Urgent Maternal Warning Signs

• Severe headache
• Dizziness or fainting
• Changes in your vision
• Fever
• Trouble breathing
• Overwhelming tiredness
• Chest pain
• Severe belly pain
• Severe nausea and throwing up
• Severe swelling
• Thoughts about harming yourself or your baby

Motor vehicle traffic crashes are a leading cause of death for American Indian and Alaska Native people. CDC’s Injury Center works with tribal communities to implement motor vehicle injury prevention programs, reduce injuries, and save lives.

Learn more about American Indian and Alaska Native peoples’ risks on the road and how crash-related injuries and deaths among members of tribal nations can be prevented.

American Indian and Alaska Native people are injured or killed in motor vehicle crashes at much higher rates than other racial and ethnic groups.*

• Motor vehicle traffic death rates among American Indian and Alaska Native children and youth ages 0–19 years are up to 8 times higher than those of other racial and ethnic groups.
• Rates of motor vehicle traffic deaths among American Indian and Alaska Native adults ages 20 years or older are more than twice that of White people.
• Seat belt use among American Indian and Alaska Native people (79%) is lower than that of the United States overall (90%).
• Almost 2 out of every 3 passengers who died in crashes on reservations were not wearing seat belts at the time of the crash.
• American Indian and Alaska Native people have the highest alcohol-impaired driving death rates among all racial and ethnic groups. Alcohol-impaired driving death rates among American Indian and Alaska Native people are 2 to 11 times higher than other racial and ethnic groups.
  *On this webpage, statistics are reported for non-overlapping racial and ethnic groups. All people of Hispanic origin are grouped together, so statistics for American Indian and Alaska Native people and White people are for those who do not identify as Hispanic.

Nearly 1 in 5 people in the United States live in rural areas. Rural residents tend to be older and are at higher risk for poor health outcomes than urban residents.

What is rural health?

Rural health is the health of people living in rural areas, who generally are located farther from health care facilities and other services than people living in urban areas. More than 46 million people in the United States (15% of the population) live in rural areas. There are more older adults, people with disabilities, and veterans living in rural areas. Rural areas tend to have higher rates of people who do not have health insurance and who have limited access to health care services because many medical centers in rural areas are closing.

What are rural health disparities?

People living in rural areas are generally at higher risk of disease and death than people living in urban areas. These differences in risk are known as rural health disparities. Rural residents are at greater risk of death from:

• Heart disease
• Cancer
• Stroke
• Unintentional injury (for example: motor vehicle death, opioid overdose and other substance abuse)
• Chronic lower respiratory disease

Rural residents also are more likely to have multiple health conditions compared to people living in other areas.

Heart disease, stroke, hypertension, diabetes, and arthritis are examples of health conditions that are more common in rural areas.

Within rural areas, members of racial/ethnic minority, tribal, and other diverse groups are at higher risk for poor health outcomes. American Indian/Alaska Native, African American, and Hispanic/Latino adults living in rural areas reported higher rates of fair or poor health compared to non-Hispanic white adults. Rural African American and American Indian/Alaska Native adults are more likely to have multiple chronic health conditions than non-Hispanic white adults.

What causes rural health disparities?

Factors that put people living in rural areas at greater risk for poor health outcomes include:

• Less access to care because of fewer health care providers, medical facilities, and transportation options
• Exposures to specific environmental hazards, such as pollution and poor air and water quality
• Higher rates of cigarette smoking, high blood pressure, and obesity
• Less leisure-time physical activity
• Lower seatbelt use
• Food deserts, areas with fewer grocery options and lower availability of healthy foods
• Higher rates of poverty and less likelihood of having health insurance

Stroke is the fifth leading cause of death and a leading cause of serious disability in the United States. Racial and ethnic minority and other diverse groups are at greater risk for death or disability due to stroke. You can lower your chances of having a stroke by controlling your blood pressure and cholesterol, not smoking, and taking an aspirin daily if prescribed by your health care provider.

What is a stroke?

A stroke happens when brain cells die because they are no longer receiving oxygen and nutrients from the blood supply. There are various types of stroke:

• Ischemic stroke happens when a blood vessel in the brain becomes blocked. This reduces blood flow and oxygen to the brain.
• Hemorrhagic stroke happens when a blood vessel in the brain bursts and causes bleeding.
• Transient ischemic attack (TIA), also known as a mini-stroke, has the same symptoms of a massive stroke, but blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.

Stroke is the number one cause of disabilities among adults in the United States. It can cause physical disabilities such as complete weakness or paralysis on one side of the body. Stroke may also cause changes in thinking, awareness, attention, learning, judgment, and memory.

Some people recover fully from a stroke, but others may have lifelong disabilities. 1 in 4 people who recover from their first stroke will have another stroke within 5 years.

Identify symptoms of stroke with the F.A.S.T. method

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 911

Who is affected by stroke?

Strokes occur more often in African American and American Indian/Alaska Native adults than any other group. African Americans have nearly twice the risk of having a first stroke than non-Hispanic white people and have the highest rate of death due to stroke.

How are strokes treated?

The main goal of treatment is to try to stop a stroke while it is happening by quickly dissolving or removing the blood clot causing the ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Depending on the type of stroke, it can be treated with either medications or surgical procedures.

• Ischemic stroke and TIA: Medications thin the blood and dissolve blood clots. Surgical procedures can open blocked arteries.
• Hemorrhagic stroke: Patients taking medications for thinning the blood or preventing blood from clotting will be taken off these medications, which can make bleeding in the brain worse. Surgical procedures may be used to manage bleeding by removing damaged blood vessels or cutting off their blood supply.

Post-stroke rehabilitation helps stroke survivors improve their physical functioning and well-being. Therapy may involve relearning motor activities such as walking and sitting, everyday activities such as eating and dressing, as well as language and speaking skills.

Many tribes use tobacco in a traditional way for ceremonial or medicinal purposes, such as healing ceremonies and offerings. Traditional tobacco use differs from commercial tobacco use. Commercial tobacco products are addictive and contain thousands of chemicals that harm the body due to regular use.

How common is commercial tobacco use in AI/AN populations?

Since 1978, American Indians/Alaska Natives (AI/AN) have had the highest use of commercial tobacco compared to people of other races or ethnicities.

Among AI/AN populations:

• 1 in 2 young adults aged 18 to 25 years use tobacco
• 1 in 5 adults aged 18 and over smoke cigarettes
• 1 in 12 adults aged 18 and over use smokeless tobacco
• 1 in 6 women smoked during pregnancy

Smoking prevalence is highest in the Northern Plains region (Iowa, Michigan, Minnesota, Montana, Nebraska, North and South Dakota, Wisconsin, and Wyoming)

What are the health risk of tobacco use?

The use of commercial tobacco affects nearly every organ in the body and can have serious health effects leading to disability and premature death. Smoking can lead to an increased risk of developing lung cancer, diabetes, heart disease, stroke, and chronic obstructive pulmonary disease (COPD).

Health risks also exist among AI/AN women using commercial tobacco products before, during, and after pregnancy. Some of these risks include fertility problems, premature birth, birth defects, and sudden infant death syndrome (SIDS).

Why should I quit?

Stay healthy by not using commercial tobacco products and be a positive role model for your loved ones, family, and community.

• 2 weeks after quitting, your breathing improves
• In 1 year, your risk for a heart attack is cut in half
• In 5 years, your risk for a stroke is the same as a person who never smoked
• In 10 years, your risk of lung cancer is reduced by half
• To lower your cholesterol levels
• To lower your risk of developing type 2 diabetes
• To lower your risk for gum disease
• To avoid exposing your friends and family to secondhand and thirdhand smoke

How do I quit?

FDA-approved smoking cessation products can help you quit. Talk to your doctor or pharmacist to find a treatment that is right for you.

• Over-the-counter nicotine replacement medications may come in the form of skin patches, gum, lozenges, inhaler, or nasal spray.
• Prescription products are available through a prescription from your health care provider. These products may come in the form of pills, inhaler, or nasal spray.

Know the Facts

Cigarette smoking is more common among American Indians/Alaska Natives than almost any other racial/ethnic group in the United States.*

• More than 1 in 4 (27.1% ) American Indian/Alaska Native adults smokes cigarettes.*

Smoking increases the chances of:

• Losing members from your tribal community to smoking-related illnesses
• Losing elders to smoking-related diseases or exposure to secondhand smoke before they can pass down tribal customs and traditions

If you are an American Indian or Alaska Native, you likely know someone with health problems from cigarette smoking—possibly a member of your family with a smoker’s cough who is struggling to breathe or a friend with lung cancer.

Smoking cigarettes while you are pregnant increases the risk for pregnancy complications. These health problems may be a special risk in AI/AN communities, where smoking during pregnancy is more common than among other ethnic groups.

If you smoke during pregnancy, you may give birth to a premature baby or a baby who weighs less than 5½ pounds. Sudden infant death syndrome (known as SIDS or crib death) is another danger for babies of moms who smoke during pregnancy.

Babies and children who are exposed to tobacco smoke can continue to have health problems. These health problems can include bronchitis, pneumonia, and ear infections. You can help protect future generations by keeping children away from cigarette smoke.

Learn what percent of people currently smoke cigarettes, both in the United States overall and among specific populations.

*Tobacco Product Use Among Adults – United States, 2020. Morbidity and Mortality Weekly Report 2022.

Substance use disorders can result from all types of substance use—alcohol, marijuana, opioids, heroine, etc.—that interferes with being able to meet life's responsibilities, interferes with physical health, or is an illegal substance.

There are many resources out there to help people with substance use disorders. Just like behavioral health has a specific tribal approach, many of the medication-assisted treatments now have a tribal approach as well.

Addiction 101

Addiction is a chronic illness, just like diabetes or asthma. Like other chronic illnesses, it is very hard for someone to manage their illness without help.

Addiction is a brain disorder that makes someone want to use something despite the harm it may cause. A person can be addicted to almost anything—drugs, alcohol, food, shopping, etc. It is not the focus of the compulsion that makes addiction, but rather the motivating factors.

How does addiction start?

What may start as a choice can turn into an addiction when the person can no longer quit the behavior. As addiction is a brain disorder; the wiring within the brain changes as someone develops an addiction. The person is no longer able to make a choice around the addiction. Meeting the need becomes the person's priority.

Can you recover from an addiction?

People who receive treatment learn how to cope with their addiction, but the addiction never goes away. Relapse is common, and many behavioral health providers consider it part of the healing process. It doesn't mean the person isn't trying. People with diabetes are never cured from it, but they can have it under control. Addiction is the same way.

How do you help someone with an addiction?

Admitting there is a problem is the hardest part of treatment. If someone you know has taken this critical first step, supporting them without judgement is the best way to help them get better.

Does opioid use always result in addiction?

Many people take opioids without getting addicted. A doctor may prescribe opioids after surgery, a major injury, or for chronic pain. Doctors then monitor the patient closely to ensure they use the opioids safely and as prescribed.

Physical Dependence v. Addiction

People can become physically dependent on something, like medication, when their bodies require it to live comfortably. Addiction is when someone needs to have something no matter what it does for them. A person can have a physical dependence without having an addiction.

To help understand—think of shoes in the winter. Everyone needs to wear shoes so their feet don't get frostbite or injured. Your body physically depends on shoes to protect your feet and walk properly. A shoe addiction is when you begin buying more shoes that you could ever use, when money for your responsibilities goes to shoes. When you have to start hiding shoes from others and you get pleasure from buying new shoes, even though it only lasts a moment, that is when it's become an addiction.

Signs of Addiction

Addiction interferes with rational thought. People with an addiction may act without much thought and secretively, by lying about or hiding their behavior. It can ultimately affect their ability to go to school or hold a job, pay rent, keep friendships, stay healthy, and more. Addiction is a chronic illness.

It may be difficult to tell whether someone has an addiction. If you aren't sure, these questions may help.

• What happens if they don't take it?
• How long can they go without it?
• Do they need to take more to have the same relief?
• Are they being honest about how much they take?
• Have they been dishonest to those close to them about it?
• Are they able to perform well at work/school/etc. while on it?
• Have they ever been shocked about how much they want it?
• Do they feel like they crave it?
• Do they feel guilty about it?
• Have they tried to quit but been unsuccessful?

What you can do if you think someone has an addiction?

If you are worried that someone has an addiction, ask them to talk to their health care provider. Health care providers are there to help without judgement. They can provide an evaluation and recommend treatment options.

Medication-Assisted Treatment 101

MAT stands for Medication-Assisted Treatment. MAT combines prescribed medicine with a behavioral health provider to treat opioid use disorder while avoiding an overdose.

What is tribal MAT?

Tribal MAT was developed to provide culturally competent care to American Indian and Alaska Native populations. It was created to honor and recognize the values, traditions, and culture of each tribe. Rather than approaching MAT from a medical perspective only, tribal MAT provides ways to bring culture and tradition into the treatment plan. An example would be adding a traditional medicine appointment or provider to the MAT team. That person would then have a medical doctor to monitor the medicine used to help, a behavioral health practitioner to help guide the behavioral choices, as well as a traditional health provider to supplement the person's recovery. This is one example, but the concept is the same: the person's culture, history, and traditions become an important component of their recovery and treatment plan.

What is tele-MAT?

Tele-MAT uses audio and video to allow providers to connect with those in need who may live far away from a MAT provider. Tele-MAT breaks distance and transportation barriers and allows patients to be served where they are most comfortable.

What is the medication in MAT?

The most common medication used for MAT is currently buprenorphine, with the brand name of Suboxone^®. Other medications may be methadone or naltrexone. The medication used varies for each person and is a decision they make with their provider.

How is buprenorphine different than methadone?

There are many differences between buprenorphine and methadone. Please check with your behavioral health practitioner to discuss options and products.

Buprenorphine

• It doesn't cause the same reaction in the brain as an opioid or heroine. It works to lessen the physical symptoms of withdrawal without creating the feeling of being "high."
• It stays in your blood stream longer than opioids, which means you feel relief for a longer time. Buprenorphine lasts, on average, 24 to 60 hours, depending on several health factors. Each person is different.
• It reaches a ceiling effect – The ceiling effect is a maximum amount a drug will affect someone no matter how much is taken. As a result, it is very hard to abuse or become addicted to this medication.
• It can be prescribed and taken outside of a clinical setting as a tablet or as a sublingual strip, which is a small piece you put under your tongue that dissolves. You can receive a prescription for it and take it at home, rather than having to come into the clinic to receive the medicine.

Methadone

• It has the same reaction as opioids or heroin in your brain. It recreates the feelings of relief and euphoria created by the original substance.
• It lasts longer than a standard opioid medicine, lasting anywhere from 8 to 59 hours, but the effects are not as steady as some other options.
• It does not reach a ceiling effect, meaning that the more you take, the more effect it has on your body. This means an overdose could occur as well as there is a chance someone could become addicted to it.
• It must be administered in a structured clinic, meaning it must be provided in a doctor's office or clinic rather than having a prescription that can be taken at home. (This may vary depending on location and the rules regulating methadone use.)

What is naloxone?

Naloxone is a medicine used to resuscitate a person experiencing an opioid overdose. It works very fast to reverse the effects of the overdose. Naloxone restores regular breathing that has slowed or stopped due to opioids or heroin use.

It is most commonly given in a nasal spray, often with the brand name Narcan, but can also be provided as a prefilled auto-injection device, often with the brand name Evzio. The auto-injection works similar to an epi-pen, but it comes with a case that provides audio directions on how to administer it. Depending on where you live, this option may require a prescription.

Naloxone has a proven track record of helping revive people who have overdosed. It is important to note that like someone who has had an epi-pen, anyone who has had naloxone should be seen in the emergency room as soon as possible, as overdoses are life-threatening emergencies.

Many tribal MAT programs have trainings and resources to help ensure naloxone is available to anyone who may be at risk or know someone who is at risk for an overdose of opioids or heroin. Talk with your health care provider or behavioral health practitioner to learn more.

How does MAT work?

MAT provides a treatment plan that helps remove the pain from withdrawals while supporting recovering from a substance use disorder. MAT is a collaboration between the person with a substance use disorder, a behavioral health practitioner, and often a primary or medical care provider.

Tribal MAT may include additional components, such as traditional health providers or community groups. Ultimately MAT addresses the physical and behavioral components of addiction.

Data are for the U.S.

Live births for American Indian or Alaska Native non-Hispanic population

• Number of births: 26,813
• Births per 1,000 women aged 15–44: 52.7

Source: Births: Final Data for 2020 [PDF – 1 MB]

Health status for American Indian or Alaska Native population

• Percent of adults aged 18 and over in fair or poor health: 22.9% (2021)

Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2021

Smoking for American Indian or Alaska Native population

• Percent of adults aged 18 and over who currently smoke cigarettes: 16.5% (2021)

Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2021

Health insurance coverage for American Indian or Alaska Native population

• Percent of adults aged 18–64 without health insurance coverage: 26.4% (2021)

Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2021

• Percent of children under age 18 years without health insurance coverage: 16.7% (2019)

Source: Interactive Summary Health Statistics for Children: National Health Interview Survey, 2019-2020

Mortality for American Indian or Alaska Native non-Hispanic population

• Number of deaths: 24,725
• Deaths per 100,000 population: 1,016.5

Source: National Vital Statistics System – Mortality data (2020) via CDC WONDER

Leading causes of death for American Indian or Alaska Native non-Hispanic population

• COVID-19
• Heart disease
• Cancer

Source: National Vital Statistics System – Mortality data (2020) via CDC WONDER

Infant deaths for American Indian or Alaska Native non-Hispanic population

• Infant deaths per 1,000 live births: 7.68

Source: Infant Mortality in the United States, 2020: Data From the Period Linked Birth/Infant Death File [PDF – 1 MB]