The Health Status of American Indians Native Americans in

The Health Status of American Indians/Native Americans in Massachusetts Department of Public Health Center for Health Information, Statistics, Research, and Evaluation Division of Research and Epidemiology

National American Indian Heritage Month During National American Indian Heritage Month, we honor the generations of American Indians and Alaska Natives who have added to the character of our Nation. This month is an opportunity to celebrate their many accomplishments and their rich ancestry and traditions. George W. Bush , 2006 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Native American Collaborators • Mashpee Wampanoag Tribe • Aquinnah Wampanoag Tribe • North American Indian Center of Boston Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Indian Health Service Areas Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Making History One of the first comprehensive reports on Native American health by a state Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Making History in Massachusetts • First health report on American Indians • First statewide report to collaborate with Native Americans • First report to integrate information from federal, state and tribal data collections • First report to use Indian-driven data Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

American Indian Population by County Massachusetts: Census 2000 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Outline of Today’s Presentation 1. Socio-demographics 2. Survey Results - Behavioral Risk Factor Surveillance System Mashpee Wampanoag Community Health Survey NAICOB Community Health Survey Youth Risk Behavior Survey 3. Health Outcomes 1. 2. - Births Deaths 4. Summary Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Socio-Demographics

Race According to Census 2000 United States Massachusetts White Black Asian American Indian Other Two+ Source: Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

American Indians in Race Combinations Census 2000 United States Massachusetts Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Different Counts of the American Indian/Alaska Native Population in Massachusetts: 2000 15, 015 Census 2000 19, 390 MDPH 2000 20, 760 MARS 2000 38, 050 Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Age Distribution of American Indians in Massachusetts: Census 2000 American Indian Massachusetts Overall 65+ 45 -64 25 -44 0 -24 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

American Indian and Alaska Native Tribes Massachusetts: Census 2000 Tribe (Self-Identified) Number Tallied Percent of MA AIAN Population (Alone or in Combination) Cherokee 4, 037 10. 6% Canadian and Latin American 2, 716 7. 1% Wampanoag 2, 546 6. 7% Aquinnah Wampanoag* Mashpee Wampanoag 303 178 Micmac 1, 554 4. 1% Blackfeet 1, 521 4. 0% Iroquois 1, 464 3. 8% Nipmuc 710 1. 9% Abenaki Nation of Missiquoi 696 1. 8% Other Tribes 20, 689 54. 4% Tribe Not Specified & Not Elsewhere Classified 2, 117 5. 6% Source: U. S. Census 2000 * Only federally recognized American Indian Tribe in Massachusetts Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

American Indian Population by City/Town Massachusetts: 2000 > 1% MA population <= 1% MA population Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Cities with the Largest American Indian Populations Massachusetts: Census 2000 City / Town Boston American Indian (Alone) 2, 365 City / Town American Indian (Alone, or in Combination) Boston 5, 384 Worcester 769 Worcester 1, 700 Lawrence 583 Springfield 1, 473 New Bedford 579 New Bedford 1, 288 Springfield 569 Lawrence 921 Mashpee 377 Brockton 876 Brockton 338 Cambridge 853 Lynn 332 Lynn 796 Cambridge 290 Lowell 676 Barnstable 283 Fall River 587 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

American Indian Population Massachusetts: Census 2000 City / Town American Indian (Alone) City / Town American Indian (Alone, or in Combination) • • • Mashpee 377 Mashpee 502 Aquinnah 126 Aquinnah 148 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Economic Indicators: 1999 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Socio-Demographic Indicators: 2000 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Less Than High School Education Massachusetts: 2000 Source: U. S. Census 2000, SF-4 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Census 2000 Adjusted Count Massachusetts: 2000 Source: U. S. Census 2000 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Survey Results

Health Status Findings Behavioral Risk Factor Surveillance Survey Massachusetts: 2001 -2005 Source: Behavioral Risk Factor Surveillance System (BRFSS) 2001 -2005 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Access to Health Behavioral Risk Factor Surveillance Survey Massachusetts: 2001 -2005 Source: Behavioral Risk Factor Surveillance System (BRFSS) 2001 -2005 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Health Status Indicators North American Indian Center of Boston Community Health Survey: 2002 Source: North American Indian Center of Boston Community Health Survey, 2002. Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Health Status Indicators Mashpee Wampanoag Community Health Survey Massachusetts: 2002 Source: Wampanoag Community Health Survey, 2002. Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

The Health Status of High School Students Youth Risk Behavior Survey: 1993 -2003 Source: Department of Education, YRBS: 1993 -2003 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

The Health Status of High School Students Youth Risk Behavior Survey: 1993 -2003 Source: Department of Education, YRBS: 1993 -2003 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Health Outcomes

Birth Indicators Massachusetts: 1999 -2004 Source: Massachusetts Births 1999 -2004 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Birth Indicators Massachusetts: 1999 -2004 Source: Massachusetts Births 1999 -2004 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Leading Causes of Death (NCHS Ranking) Massachusetts: 1994 -2004 American Indians Massachusetts (N=443) (N=611, 825) 1. Heart Disease (28%) 1. Cancer (23%) 2. Cancer (25%) 2. Heart Disease (22%) 3. Stroke (6%) 3. Injuries & Poisonings (9%) 4. CLRD 1 (5%) 4. Stroke (5%) 5. Injuries & Poisonings (4%) 5. Pneumonia & Influenza (4%) Chronic Lower Respiratory Disease Source: Massachusetts Department of Public Health, Massachusetts Deaths 1994 -2004 1 Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Underestimation in Mortality Rates for American Indians Because it is more likely for race to be reported as Native American in the Census than it is in the death certificates, this results in a net underestimation of mortality • The number of deaths (numerator) and the population count (denominator) are inconsistent. • Race is self-reported on the Census; whereas, on death certificates, race may be reported by the family, the certifying physician, the funeral director, or other informant. • More than one race can be reported on the Census, whereas, currently, only single races are allowed on the death certificate • The American Indian population count (denominator) in mortality rates may be inaccurate because of the large number of mixed-race persons who are, in part, Native American. Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

All Cause Mortality Age-Adjusted Death Rates: 1994 -2004 Adjusted Estimate Underestimate Age-adjusted to the 2000 US standard population. Source: Massachusetts Department of Public Health, Death certificates. Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Summary

Summary The Health Status of American Indians/Native Americans in Massachusetts • Makes history in Massachusetts public health • A baseline by which we can track improvements in American Indian health • A much needed resource for American Indian groups to assess the health needs of their communities • Highlights the need for better methods of collection of race and ethnicity data • Starting point for research into the health of American Indians and the development of programs targeted to this population Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

How Can You Access this Report? • Hard Copies: (617) 624 -5640 (617) 624 -5639 • TDD/TTY: (617) 624 -6001 • DPH Website: http: //www. mass. gov/dph/pubstats. htm Prepared by the Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Thank You