Health disparities affecting Native Americans in Oregon
With help from a grant from the Dennis A. Hunt Fund for Health Journalism and the University of Southern California Annenberg/National Health Journalism Fellowships program, I am embarking on a project to look at the scope of health disparities affecting Native Americans in Multnomah County, reasons for these disparities and possible changes in policy that might reduce them.
Most federal health money for Native Americans in Oregon flows through Indian Health Services to the nine federally recognized tribes and reservations spread across the state. Yet about 70 percent of the state's more than 50,000 Native Americans live in Multnomah County, home to Oregon's largest city, Portland.
Multnomah County, named for a band of the Chinook Indians, was once also home to villages of the Kathlamet and Clackamas bands of the Chinook as well as the Tualatin Kalapuya, Molalla and other tribes along the Columbia River. Today, Multnomah County's Native American population includes descendents of about 400 tribes from the Northwest and across the country. The population is young with a median age of 29. Forty-three percent are under age 25. One report says it is the ninth largest Native American population of any city in the nation.
Yet health and social services are failing to reach Portland's Native Americans, and the consequences are severe. Virtually all single Native American women with children under five live in poverty. A third of Native American mothers get no prenatal care in the first trimester. They deliver babies with low birth weights at a 42 percent higher rate than the general population, and the mortality rates of their babies are twice as high. Native Americans in Portland die at higher rates from HIV/AIDS, have higher diabetes rates and are less likely to have health insurance. They get fewer interventions for heart treatment, less pain medicine in hospice, and more bed sores in hospitals and nursing homes.
I'm tentatively looking at three goals for this project. First, I want to document the scope of health disparities with statistics, and more importantly, with personal stories that show how these disparities play out in people's lives. I'm looking at focusing on health care for single mothers with young children, HIV/AIDS and diabetes. I'll also be comparing the health picture in Multnomah County with that among Native Americans on reservations elsewhere in Oregon.
Secondly, I want to reach some conclusions about the reasons good primary and preventative care seems so far out of reach for urban Native Americans in Multnomah County. I'll look at what federal services are available, what the county is doing and how problems are masked by a big problem with misclassification of Native Americans in vital statistics that understate the scope of their health problems.
Finally, I'll be looking for policies and practices that reduce disparities for Native Americans and other minority groups. For this, I may visit the exemplary Nuka System of Care operated by Native Americans for Native Americans through the Southcentral Foundation in Anchorage, Alaska.
In addition, I would like to include a web component in this project, particularly since the Warm Springs Indian Reservation in Central Oregon is now in the process of bringing the Internet to its residents. I would hope to enlist the help of local Native Americans in constructing this site. It would need to be interactive and self-sustaining, a kind of virtual longhouse where the state's Native Americans and health professionals could meet to discuss ways to improve health care for Native Americans throughout the state.
Health and social conditions for Native Americans appear to be worse in Multnomah County than in many other cities and on the decline. I hope with this project to shine a light on that problem and reveal some possible practices and policies that could improve the health for the Oregon's largest concentration of Native Americans. I'm grateful for support for this project from the Dennis A. Hunt Fund and USC Annenberg/National Health Journalism Fellowships