Barriers to Healthcare: A Spotlight on Native Americans and Alaska Natives

November 3, 2025

As part of Native American Heritage month, we’re spotlighting health inequities among the Native American (NA) and Alaska Native (AN) populations.

Summary

Nearly 9 million people in the U.S., or 2.6% of the population, identify as partially NA or AN, and they report significantly worse health outcomes compared to the general U.S. population.
NA and AN communities experience higher rates of chronic heart disease, obesity, suicide, PTSD, tuberculosis, and infant mortality. They also have the shortest life expectancy in the country.
These ongoing health disparities are due to underfunded services, lack of data collection, geographic isolation, cultural and linguistic issues, and historical trauma.

Poor health outcomes

Nearly 9 million people in the U.S. identify as partially NA or AN, which comes to 2.6% of the population. In 2021, this group reported worse health status than the general population—their reported rate of fair or poor health was 22.9% compared to 13.6% for the adult population in the U.S. Certain health disparities persist in the NA and AN population, including:

50% higher rates of chronic heart disease.
40% higher rates of obesity.
Highest suicide rate of any group in the U.S.
Over 50% higher rates of post-traumatic stress disorder.
8x higher rates of tuberculosis.
2x higher infant mortality rate.
Shortest life expectancy of U.S. population.

Barriers to healthcare

1. Underfunded services

The Indian Health Service (IHS), which is part of the Department of Health and Human Services, provides federal health services to NAs and ANs. The IHS is underfunded, however, and has been on a regular basis. Underfunding has caused staff shortages and reduced access to care. This contributes to people not getting the care they need and can contribute to health inequities.

2. Data collection

There is a lack of good health data for this population due to their relatively small size and misclassification of racial or ethnic information. The group is also not homogenous—there are 574 federally recognized NA tribes and AN villages—and specific data on tribes, villages, and socioeconomic status is limited. Without proper data, monitoring health outcomes and formulating policy can be difficult.

3. Geographic isolation

About 40% of NA/AN populations live in rural areas, which means they are often further from healthcare providers and facilities. If they don’t have reliable transportation, that can make the situation even harder. For example, in 2020, almost 25% of births of NA/AN babies occurred in maternal care deserts. Additionally, this population may live in food deserts, where there is limited access to fresh food.

4. Cultural and linguistic issues

Many providers do not have cultural competence as it relates to NAs/ANs. Language, culture, values, and communication styles should be taken into consideration when receiving healthcare treatment. For example, approximately 175 Native American languages are spoken in the U.S. Providers who are knowledgeable about Native American and Alaska Native traditions can often provide a better experience for their patients, which could result in better overall care.

5. Historical trauma

Native American and Alaska Native communities have historically been marginalized and oppressed. These communities have endured removal from their land, cultural suppression, and familial separation, among other obstacles. Trauma can be passed down from one generation to the next. Some researchers think that chronic stress from colonization and forced assimilation contributes to poor health outcomes in Native Americans and Alaska Natives

Final thoughts

Various social determinants of health, along with chronic underfunding of the IHS, have contributed to unequal access to care. The barriers faced by the NA/AN population require attention and care. This community deserves appropriate treatment and access to healthcare.