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AI/AN Caucus Member Dr. Joe Coulter explains the crisis of unintended deaths and injuries in Indian Country

posted Jun 8, 2017, 6:45 AM by Tech Support   [ updated Jun 8, 2017, 6:46 AM ]

An Unintended Legacy: Unintentional Injuries are a Leading Cause of Death for American Indian and Alaska Native Populations
By Joe D. Coulter, Ph. D.


It is no secret that American Indian and Alaska Native (AI/AN) populations face unique challenges. Whether it be the extreme remoteness of some tribal lands, the lack of available resources, environmental concerns, or access to adequate healthcare, gaining health equity for AI/AN populations might seem insurmountable. However, given the right amount of focus, resources and involvement from the community, even the most pressing barriers and obstacles to care facing AI/ANs can be addressed – leading to greater health of Native populations.

Among the myriad of challenges faced by American Indians and Alaska Natives, unintentional injuries remains one of the leading causes of death. There are a number of factors that may explain why unintended injuries continue to be a leading cause of death, but the bigger question and the greater challenge is how to reduce unintended deaths and injuries among AI/ANs.

Unintentional Death and Injuries Among the AI/AN Population

For American Indians and Alaska Natives, death and injury rates are staggering compared to those for the non-AI/AN population. For example, while eight percent of the general population will die before they reach 45 years of age, for AI/ANs, that number increases to 25% (one out of four). The sad but true fact is that a quarter of the Native population won’t see their 45th birthday not because of medical, chronic or genetic issues but rather avoidable and preventable unintentional injuries that lead to death. When the data are broken down by age, this is a common trend regardless of which age group is being examined.

Why Unintentional Injuries are So Dangerous

Support for many of the social determinants of health that contribute to a Native person’s overall well-being are lacking for this population. Many factors – such as socioeconomic status, geographic location, access to health care and health services, transportation, nutrition, and lack of physical activity contribute to the problem.

Most Indian tribal lands are located in remote, isolated areas. According to the National Highway Traffic Safety Administration, deaths from car accidents are greater in rural than urban areas. Among AI/AN 19 years old and younger, motor vehicle crashes are the leading cause of unintentional injury-related death, followed by drowning and poisoning.

Being rural alone does not lead to the unintentional death rate crisis that AI/AN people currently face, but it does contribute to another key factor, which is environment. Many tribes and Indian tribal lands are located in areas where the environment can be seen as perilous. Similarly, access to health services is extremely limited in these areas meaning that Native individuals need to travel great distances to receive their medical care. Conversely, medical professionals need to travel great distances to reach those who call for help. Additionally, lack of healthy and/or nutritional options and lack of transportation other than people’s own vehicles exacerbate both the causes of unintentional injuries and death.

What can be Done?

While the statistics paint a bleak picture, there is hope. Although the data on unintentional injury leading to death rates for American Indian and Alaska Natives are striking, they actually show a slight improvement – indicating both the scope of the problem and the fact that small changes, such as education and intervention, can lead to significant improvements. As attention to this issue increases, more solutions can be developed and implemented. By starting with culturally competent, socially acceptable approaches and focusing on each of the aforementioned social determinants, progress can – and will – be made to alleviate the extremely high rates of unintentional injuries and deaths among our Native populations.


Dr. Joe Coulter is Professor Emeritus, College of Public Health, Carver College of Medicine, The University of Iowa, a member of the National Partnership for Action’s (NPA) AI/AN Caucus and an enrolled member of the Potawatomi Tribe.

Author’s note: all statistics come from the HIS report, "Trends in Indian Health: 2014" unless otherwise noted. For more information, the full report can be found here.