For more than a decade, Americans have been dying younger than people in other developed countries. Researchers attribute much of this rise in mid-life deaths to what are called “deaths of despair” — that is suicides, drug overdoses and deaths from alcoholic liver disease — among middle-aged white Americans.
But a study published last month in The Lancet shows that these premature deaths have affected American Indian and Alaska Native communities far more than white communities.
“The whole sort of premise of the ‘death of despair’ idea that this is unique to white communities really didn’t stand up when we took a close look at the data,” says Dr. Joseph Friedman, a physician and researcher at the University of California Los Angeles.
“The Lancet article underscores a number of things that we’ve known for a substantial period of time, but have never articulated it in such a sharp fashion,” says Spero Manson, director of the University of Colorado’s Centers for American Indian and Alaska Native Health who wasn’t involved in the new study.
The idea that the rise in deaths of despair was the highest in middle aged white Americans was put forward by two Princeton economists in a study published in 2015. They had looked at death rates for 45-54 year-olds from 1999-2013, and compared the numbers by race and ethnicity.
“Ideally no one should die in that age group, certainly not of overdose, suicide and alcoholic liver disease,” says Friedman.
When he and his colleagues analyzed the mortality data more closely, they found that American Indians and Alaska Native people had been completely left out of the analysis in the original study. And the midlife mortality rates for these groups were far higher than among whites.
“In the same period that deaths among white Americans did go up by about 9%, deaths among Native Americans went up by 30%,” says Friedman.
“The entire narrative about deaths of despair among white Americans depended on the invisibility, or, we might say, the erasure of indigenous presence, invisibility in those datasets,” says psychologist-anthropologist Joseph Gone of Harvard University, a member of the Aaniiih Gros Ventre tribal nation of Montana and a co-author of the Lancet study. “And that’s a problem from our vantage point.”
Data on Native communities are often missing from public health research, he adds, because “our numbers are small and we often get folded into a category like ‘Other’ instead of being reported distinctively for indigenous peoples.”
While the recent rise in deaths among white Americans is, of course, alarming, Gone says, that the factors driving these deaths have affected Native communities for much longer.
“Indian country problems rise and fall with the economy like everyone else’s,” he says, “but we’re just used to a lack of resources and opportunities for a whole bunch of reasons that go way back.”
He adds that “colonial subjugation” by European settlers and historical attacks on the ways of life and livelihoods of indigenous communities have shaped the health and lifespans of Native communities since the early days of this country.
“Part of what I think we’re seeing in these [rising rates of] deaths of despair are attacks on livelihoods,” he says, “and decline in the ability to have good livelihoods.”
“If you look at matters of poverty, education, decreased employment opportunities, restricted access to other kinds of resources that are typically associated with these kinds of health disparities,” says Manson, “they’re very powerful and widely present in American and Alaska Native communities.”
The new study also found that the disparities in midlife mortality have only worsened since 2013, especially exacerbated by the COVID pandemic. In 2020, the death rates among middle-aged Native people due to despair-related causes was twice that among white people.
“This is a sort of astronomical inequality, you know, that should be unthinkable in our society,” says Friedman.
But Manson believes that addressing these longstanding disparities in health and mortality will take more than just focusing on deaths of despair.
“The problem is if we only focus on deaths of despair, we ignore and do not have adequate attention paid to the sources that promote health and well-being in Native people,” he says.
For example, he says, Native people have one of the highest rates of COVID vaccination compared to other racial and ethnic groups. According to the CDC, as of Jan. 25, 2023, nearly 78% of American Indiana and Alaska Native people have received at least one dose of the vaccine — the highest rate compared to all other racial and ethnic groups. And 64% of this group had completed the primary series of vaccination, second only to Asian Americans.
As NPR reported before, this was in large part because of Native people wanting to protect their elders and being more willing to get vaccinated.
Manson has been studying COVID testing and vaccination in six large urban Indian health organizations and found their efforts to be very successful.
“It has been their coming together across their programs, working not only with their urban partners that are non-native, but also working with reservation-based communities adjacent to their catchment areas,” he says.
Reducing deaths of despair, Manson says, will require harnessing the strength and resilience of Native communities and supporting them with resources.
“There are possible solutions,” he adds. “Those solutions are often local. They have to do with self-determination and the ability to have access to the necessary resources to mobilize those solutions.”
Kwa zaidi ya miaka kumi, Wamarekani wamekuwa wakifa wakiwa wachanga kuliko watu katika nchi nyingine zilizoendelea. Watafiti wanataja kuongezeka kwa vifo vya watu wenye umri wa kati kwa sababu ya 'vifo vya kukata tamaa' - yaani, kujiua, kutumia dawa za kulevya kupita kiasi, na vifo kutokana na ugonjwa wa ini unaosababishwa na kileo - miongoni mwa Wamarekani weupe wenye umri wa kati. Utafiti uliochapishwa mwezi uliopita katika jarida la The Lancet unaonyesha kuwa vifo hivyo vya mapema vimeathiri jamii za Wahindi wa Amerika na Wenyeji wa Alaska zaidi kuliko jamii za wazungu. "Kama ilivyoelezwa hapo juu, ""kifo cha kukata tamaa"" ni wazo la jamii nyeupe tu, lakini kwa kweli halikuweza kusimama wakati tulipoangalia data kwa karibu, ""anasema Dk Joseph Friedman, daktari na mtafiti katika Chuo Kikuu cha California Los Angeles." "Kabla ya hapo, ripoti ya Lancet ilionyesha kuwa ""mfano wa kuvutia wa kuvutia wa kuvutia wa kuvutia"" ni Spiro Manson, Mkurugenzi wa Chuo Kikuu cha Colorado na Mkurugenzi wa Kituo cha Afya cha Wenyeji wa Alaska na Wahindi wa Amerika." Utafiti wa mwaka 2015 ulionyesha kuwa idadi ya watu waliokufa kutokana na kukata tamaa ni kubwa zaidi miongoni mwa wazungu wenye umri wa kati, na utafiti huo ulifanywa na wataalamu wawili wa uchumi wa chuo kikuu cha Princeton. Watafiti hao walichunguza idadi ya watu wenye umri wa miaka 45 hadi 54 waliokufa katika kipindi cha mwaka wa 1999 hadi 2013, na kuunganisha idadi hiyo kulingana na jamii na makabila. "Kwa kweli hakuna mtu anayepaswa kufa katika kikundi hicho cha umri, hakika si kwa sababu ya kutumia dawa nyingi kupita kiasi, kujiua na ugonjwa wa ini unaosababishwa na kileo", anasema Friedman. Wakati yeye na wenzake walichanganua data ya vifo kwa karibu zaidi, waligundua kwamba Wahindi wa Amerika na Wenyeji wa Alaska walikuwa wameachwa kabisa nje ya uchambuzi katika utafiti wa awali. Kiwango cha vifo vya watu wa umri wa kati katika makundi hayo kilikuwa cha juu zaidi kuliko cha wazungu. "Katika kipindi hicho hicho vifo vya Wamarekani weupe viliongezeka kwa asilimia 9 na vifo vya Wamarekani wa asili viliongezeka kwa asilimia 30,"" anasema Friedman." "Usimamizi wa Marekani unaoongoza katika suala la watu wazima wa Amerika ya Kaskazini, unaoongoza katika suala la watu wazima wa Amerika ya Kaskazini, unaoongoza katika suala la watu wazima wa Amerika ya Kaskazini, unaoongoza katika suala la watu wazima wa Amerika ya Kaskazini, ""anasema Joseph Gone wa Chuo Kikuu cha Harvard, mwanachama wa kabila la Aani Gros Ventre la Montana na mwandishi mwenza wa utafiti wa Lancet." "Hata hivyo, data kuhusu jamii za wenyeji mara nyingi hazipatikani katika utafiti wa afya ya umma, kwa sababu idadi yetu ni ndogo na mara nyingi tunaunganishwa katika jamii kama ""Mengine"" badala ya kuripotiwa kwa watu wa asili. ""Wakati ongezeko la hivi karibuni la vifo kati ya Wamarekani weupe ni, bila shaka, ya kutisha, ""alisema Gone." "Matatatizo ya nchi ya Wahindi huongezeka na kuanguka na uchumi kama kila mtu mwingine, ""anasema, ""lakini tumezoea ukosefu wa rasilimali na fursa kwa sababu nyingi ambazo zinaanzia nyuma. "" Anaongeza kwamba ""kuangamizwa kwa ukoloni" na wahamiaji wa Ulaya na mashambulizi ya kihistoria juu ya njia za maisha na riziki ya jamii za wenyeji wamebadilisha afya na maisha ya jamii za asili tangu siku za mwanzo za nchi hii. """ """Sehemu ya kile ninachofikiri tunaona katika vifo hivi vya kukata tamaa ni mashambulizi juu ya njia za kuishi, na kupungua kwa uwezo wa kuwa na njia nzuri za kuishi, ikiwa utaangalia masuala ya umaskini, elimu, upungufu wa fursa za ajira, upatikanaji mdogo wa aina zingine za rasilimali ambazo kwa kawaida zinahusishwa na aina hizi za tofauti za afya,"" anasema Manson." Katika mwaka wa 2020, viwango vya vifo kati ya watu wa asili wa umri wa kati kutokana na sababu zinazohusiana na kukata tamaa vilikuwa mara mbili ya wale kati ya watu weupe. "Hii ni aina ya usawa wa nyota, unajua, ambayo inapaswa kuwa isiyowezekana katika jamii yetu", anasema Friedman. Manson anaamini kwamba kushughulikia tofauti hizi za muda mrefu katika afya na vifo itachukua zaidi ya kuzingatia tu vifo vya kukata tamaa. "Tatizo ni kwamba ikiwa tutazingatia vifo vya kukata tamaa, tunapuuza na hatuna umakini wa kutosha kwa vyanzo vinavyoendeleza afya na ustawi katika watu wa asili, "anasema. "Kwa mfano, anasema, ""Watu wa asili wana moja ya viwango vya juu zaidi vya chanjo ya COVID ikilinganishwa na makundi mengine ya kikabila na kikabila.""" Kulingana na CDC, kufikia Januari 25, 2023, karibu 78% ya Wenyeji wa Indiana na Alaska wamepokea angalau dozi moja ya chanjo - kiwango cha juu ikilinganishwa na vikundi vingine vyote vya kikabila na kikabila. Asilimia 64 ya watu hao walikuwa wamekamilisha chanjo ya kwanza, na ni wa pili baada ya Wamarekani wenye asili ya Asia. Kama ilivyoripotiwa hapo awali, hii ilikuwa kwa sehemu kubwa kwa sababu ya watu wa asili wanataka kulinda wazee wao na kuwa tayari zaidi kupata chanjo. Manson amekuwa akisoma upimaji wa COVID na chanjo katika mashirika sita makubwa ya afya ya mijini ya India na kugundua juhudi zao kuwa na mafanikio sana. "Ilikuwa ni kuungana kwao katika programu zao, kufanya kazi sio tu na washirika wao wa mijini ambao sio wenyeji, lakini pia kufanya kazi na jamii zinazotegemea hifadhi zilizo karibu na maeneo yao ya kuvutia", anasema. Kupunguza vifo vya kukata tamaa, Manson anasema, itahitaji kutumia nguvu na uvumilivu wa jamii za asili na kuunga mkono kwa rasilimali. "Kuna suluhisho linalowezekana", anaongeza. <unk>Suluhisho hizo mara nyingi ni za mitaa. Zina uhusiano na kuamua na uwezo wa kuwa na upatikanaji wa rasilimali muhimu kwa ajili ya kuhamasisha ufumbuzi huo. <unk>