Native American Children’s Health and Well-Being
Current Status, Enduring Inequities and a Path Forward
The Annie E. Casey Foundation recently reported the latest demographic trends for American Indian and Alaska Native (AI/AN)* children in the United States. This is a follow-up to that post, with a look at the status of their health and well-being, including the solvable inequities they face.
Our country has a long history of violence and oppression of Indigenous peoples, the effects of which are still apparent today. This systemic inequity continues, with the United States currently not upholding many of its treaty obligations to Native nations. The country is also not fully implementing policies intended to support their well-being.
It is critical that we work to remove the structural barriers that remain for Indigenous populations. Despite past and present injustices, Native nations have shown leadership and strength in their contributions to society. Supporting all aspects of their well-being is a key part of working toward equity and justice.
The Status of Native Children’s Health and Well-Being
AI/AN families’ resilience is evident in their cultural values which include a deep respect for family and elders, a strong sense of community and a shared responsibility to care for children and the environment. According to the KIDS COUNT Data Center, AI/AN families are exceeding the national average on a significant measure of health: Babies born to AI/AN mothers are more likely to have a healthy birth weight, which reduces the risk of long-term health and developmental problems. Additionally, several trends noted below are moving in a positive direction for AI/AN families, such as rising median family incomes, improving health insurance coverage for kids and declining rates of youth in juvenile detention.
At the same time, historical trauma and generations of discriminatory policies have led to AI/AN children, youth and families having disproportionately poor experiences across many measures of health and well-being compared to the general population. Studies have documented the adverse effects of trauma on the physical and mental health of AI/AN populations — effects that endure for generations. Some of the wounds inflicted by U.S. policies are relatively recent. For instance, the government’s sanctioned removal of AI/AN children from their homes due to forced assimilation policies continued in different forms until 1978, when the Indian Child Welfare Act (ICWA) was passed. Other historic and ongoing U.S. policies and practices have led to isolation, economic deprivation, food scarcity and chronically under-resourced health care and education systems for AI/AN communities.
The following selection of data not only elucidate the disparate conditions experienced by AI/AN children and families, but also demonstrate the need to prioritize equity at all levels of government and expand the opportunities and support available to AI/AN communities.
- In 2022, nearly one-third (29%) of AI/AN children were living in poverty, almost double the national rate of 16%. The AI/AN child poverty rate has remained well above the national level for decades.
- AI/AN kids are nearly three times as likely to live in high-poverty neighborhoods compared to their counterparts: 22% vs. 8%, according to 2017–2021 data. This trend has held since the KIDS COUNT Data Center began tracking this measure in 2006–2010.
- Just under half (43%) of AI/AN children live in families where parents do not have secure, full-time employment, compared to 29% on average in 2021.
- About 1 in 8 AI/AN teens ages 16–19 (12%) were not in school or working in 2021, outpacing the nationwide rate of 7%.
- While the median income for AI/AN families with children has steadily increased over the last decade, it remains far below the average family income, and the gap has widened in recent years, reaching $53,900 vs. $84,200, respectively, in 2021.
- In 2022, about half (49%) of AI/AN fourth-grade students were considered chronically absent from school in the previous month, an alarming jump from 31% in 2019, and well above the national average of 36% in 2022. For two decades, AI/AN fourth-graders have been more likely than their peers in other racial or ethnic groups to experience chronic absenteeism, which can include excused absences due to health issues, transportation problems or other barriers.
- In 2022, more than 8 in 10 (82%) AI/AN fourth-grade students scored below proficient in reading, an increase from previous years and a higher share than the national average (68%).
- Similarly, close to 9 in 10 (89%) AI/AN eighth-grade students scored below proficient in math in 2022, 10 percentage points higher than a decade earlier and 15 percentage points above the national average of 74%. Math proficiency in eighth grade and reading proficiency in fourth grade are bellwether indicators of long-term academic success — including graduating from high school, which increases employment and earning potential in adulthood.
- One in 4 (25%) AI/AN high school students is not graduating on time. This is higher than the national rate (14%) and that of all other racial and ethnic groups with data, according to 2019–2020 data.
Health and Mental Health Inequities
- AI/AN kids ages 0–18 are more than twice as likely to lack health insurance than other children (11% vs. 5% in 2022), although the rate of uninsured AI/AN kids improved by three percentage points compared with 2019.
- The death rate for AI/AN children and youth ages 1 to 19 from all causes has remained above the U.S. rate since it has been tracked on the KIDS COUNT Data Center. In 2021, the rate was 33 vs. 30 per 100,000, respectively.
- AI/AN communities face an ongoing crisis of missing and murdered women and girls. While the federal response to tracking these cases has been woefully lacking for decades, a comprehensive database of cases for all genders is being created thanks to Indigenous-led work, and federal action is beginning to improve.
- According to the CDC’s 2021 Youth Risk Behavior Survey, AI/AN high school students are more likely to seriously consider attempting suicide than other students: 27% vs. 22%. Tragically, they are also more likely to attempt suicide, with 16% of AI/AN students reporting at least one suicide attempt in the previous year, compared to 10% of all high school students. AI/AN students were the most likely of any racial and ethnic group with data& to report seriously considering or attempting suicide in 2021.
- A 2023 National Academies of Sciences, Engineering, and Medicine report found that AI/AN populations experience sadness, anxiety, anger and shame related to the traumas they have faced — including forced migration, broken treaties and loss of land, family ties, language and culture. The report also called for more data on AI/AN well-being and recommended making this a federal priority.
Family and Community Inequities
- Over one-third (37%) of AI/AN children have had at least two adverse childhood experiences (ACEs) — more than double the national average (17%), according to 2020–2021 data. ACEs are potentially traumatic events such as: exposure to family or neighborhood violence, parental death or incarceration, frequent economic hardship or living with someone who has mental illness or substance abuse problems. Studies have documented connections between colonization, trauma and ACEs, with intergenerational effects.
- AI/AN children continue to be overrepresented in the foster care system. In 2021 and previous years, AI/AN kids made up 2% of those in foster care — double the share of the general child population (1%). Even after the Indian Child Welfare Act was passed to provide minimum federal protections and end the forcible removal of children from their homes, the law has not been implemented consistently, and the child welfare system continues to demonstrate systemic bias. AI/AN children remain more likely than their white peers to experience maltreatment investigations and be placed in foster care.
- Among AI/AN youth transitioning out of foster care — who also participated in a follow-up survey — 43% reported experiencing homelessness between ages 19 and 21, significantly higher than the national rate of 29%.
- AI/AN youth are also disproportionately detained and incarcerated by the justice system. The latest National Center for Juvenile Justice data show that 181 AI/AN youth per 100,000 ages 10 to 21 were residing in juvenile detention in 2021, a substantial decline from previous years but well above the national rate of 74 per 100,000. Detention for any length of time has been shown to negatively affect youth, and it does not improve public safety.
This selection of findings is not comprehensive but sheds light on the persistent inequities faced by AI/AN children, youth and families.
Achieving equity for AI/AN communities is certainly possible, if prioritized, but it will take public policy and systems change, increased resources, improved collaboration and long-term commitments, particularly from non-Native allies. We must promote awareness among non-Native allies about the structural inequities that continues to drive disparities in AI/AN children’s health and well-being. We also must prioritize and incorporate AI/AN views and knowledge as we identify culturally responsive solutions. In that spirit, the following resources offer recommendations from members of AI/AN communities to address systemic inequities:
- The Generational Impact of Racism on Health: Voices from American Indian Communities
- American Indian and Alaska Native Cultural Wisdom Declaration in the Substance Abuse and Mental Health Services Administration’s National Tribal Behavioral Health Agenda
- Federal Policies that Contribute to Racial and Ethnic Health Inequities and Potential Solutions for Indigenous Children, Families, and Communities
These highlight the need to integrate wellness approaches for Native communities into government plans to ensure that strategies are culturally tailored and relevant, recognizing the diversity of Indigenous communities. Recommendations also include using the Cultural Wisdom Declaration above as a cross-cutting framework for all programs, including health, mental health, education, child welfare, juvenile justice and economic supports.
Along with building on the wisdom and expertise of the AI/AN communities, it is critically important to honor U.S. treaty obligations and support the sovereignty and self-determination of Native nations in any efforts to improve the health and well-being of these children. The Indian Child Welfare Act (ICWA) provides one opportunity to respect this sovereignty and address systemic racism. For instance, the ICWA aims to keep AI/AN kids connected with their families, culture and communities by requiring active efforts to prevent children’s removal from their homes. If removal is necessary, however, it requires placement with AI/AN families before non-AI/AN families. The ICWA also mandates active efforts to support family reunification when possible. Ensuring that states and agencies fully comply with the ICWA is an essential strategy to correct structural biases and protect AI/AN families.
Additional opportunities to strengthen the well-being of AI/AN children, youth and families include but are not limited to:
- Prioritize equity throughout state and federal policies, including ending the chronic underfunding of health care and education infrastructures in Indigenous communities.
- Recognize and support Indigenous cultures as a protective factor in any program and policy solutions.
- Fully implement existing policies intended to advance equity, such as the ICWA described above.
- Strengthen coordination across federal agencies and departments to streamline program delivery and improve equitable access to services.
- Promote ongoing efforts to eliminate discrimination in the child welfare and juvenile justice systems and prevent young people from entering these systems in the first place. Maximizing juvenile justice diversion responses and supporting Indigenous-led restorative justice models that focus on treatment, accountability, healing and repairing harm to the community are just two ways to help rather than punish.
- Prioritize accurate, representative data collection for AI/AN populations across all domains of health and well-being and, specifically, for cases of murdered and missing Indigenous individuals.
By prioritizing actions like these, we can move toward a future in which AI/AN children, youth and families have equitable opportunities to thrive in safe, healthy and sustainable communities. Equally important is ensuring that today’s AI/AN children have the opportunity to grow up in communities where their sovereignty and self-determination are supported, and they are fully connected to their cultural identity, practices, language and land. Indeed, Indigenous communities have maintained these vital cultural assets despite generations of destructive U.S. policies, and efforts to fully restore and uplift Native cultures will continue while we work toward a shared, positive future for all.
More Resources Related to the Health and Well-Being of AI/AN Families
- A Look at the Latest Population Trends for Native Children
- Judge William Thorne on the History and Healing of American Indian Families
- All Data by Race and Ethnicity on the KIDS COUNT Data Center
- “Healing Native Youth Through Youth Justice Reform,” Association on American Indian Affairs
- Practice Brief: “Tribal Children and Forced Assimilation,” Native Child Advocacy Resource Center
- Guidelines for Implementing the Indian Child Welfare Act, Bureau of Indian Affairs
- Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity, National Academies of Sciences, Engineering, and Medicine
- Land Rights and Health Outcomes in American Indian/Alaska Native Children, American Academy of Pediatrics Journal
- The Other Side of the ACEs Pyramid: A Healing Framework for Indigenous Communities, International Journal of Environmental Research and Public Health
* As noted in our previous post, we primarily use the term “American Indian and Alaska Native (AI/AN)” to be consistent with the data sources referenced. Other terms commonly used to encompass the widely heterogenous original peoples of North, Central and South America include: American Indian, First Nations, Native American, Native and Indigenous. Naturally, terminology is evolving and personal, and preferences vary on which labels to use. These broad terms are meant to refer to the many different Native nations in what we now call the United States, although using specific Native nation names is preferable when referring to individuals or single groups.