The Annie E. Casey Foundation The Annie E. Casey Foundation The Annie E. Casey Foundation

Native American Children’s Health and Well-Being

Current Status, Enduring Inequities and a Path Forward

Updated November 10, 2026 | Posted November 20, 2023
By the Annie E. Casey Foundation
A young Native mother plays outside with her two small children, showing them how to blow bubbles with a bubble wand and solution.

The Annie E. Casey Foun­da­tion recent­ly report­ed on demo­graph­ic trends for Amer­i­can Indi­an and Alas­ka Native (AI/AN)* chil­dren in the Unit­ed States. This com­pan­ion post exam­ines 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

The resilience of AI/AN fam­i­lies is root­ed in rich cul­tur­al val­ues, includ­ing 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 com­mu­ni­ties are excelling on a key mea­sure linked to youth well-being: 95% of AI/AN teens ages 14 to 17 can share ideas and talk about things that real­ly mat­ter with their par­ents, right above the nation­al aver­age of 93%. Hav­ing pos­i­tive, open com­mu­ni­ca­tion and safe, nur­tur­ing rela­tion­ships with par­ents or care­givers is crit­i­cal for healthy youth devel­op­ment and men­tal health. 

Addi­tion­al­ly, sev­er­al trends are mov­ing in a pos­i­tive direc­tion for AI/AN fam­i­lies, such as ris­ing medi­an fam­i­ly incomes, on-time high school grad­u­a­tion rates and declin­ing rates of teen births and child pover­ty. Data also show that the AI/AN pop­u­la­tion now match­es the nation­al aver­age on anoth­er key health indi­ca­tor — the child and youth death rate.

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 health­care and edu­ca­tion sys­tems for AI/AN communities.

The fol­low­ing selec­tion of data — large­ly from the KIDS COUNT Data Cen­ter — 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.

Eco­nom­ic Inequities

Edu­ca­tion Inequities

  • In 2024, near­ly two in five (38%) AI/AN fourth-grade stu­dents were con­sid­ered chron­i­cal­ly absent from school in the pre­vi­ous month, an improve­ment from 49% in 2022 but still high­er than all pre­vi­ous years on the KIDS COUNT Data Cen­ter. For two decades, AI/AN fourth graders have been more like­ly than their peers nation­wide (31% in 2024) and in oth­er racial or eth­nic groups to expe­ri­ence chron­ic absen­teeism, which includes excused absences due to health issues, trans­porta­tion prob­lems or oth­er challenges.
  • The share of AI/AN fourth graders who are not read­ing pro­fi­cient­ly has grad­u­al­ly wors­ened in the past decade, with learn­ing loss­es start­ing before the COVID-19 pan­dem­ic — from 78% scor­ing below pro­fi­cient in 2015 to 85% in 2024. The lat­est fig­ure is a 15-per­cent­age point dif­fer­ence from the nation­al aver­age of 70%.
  • Sim­i­lar­ly, near­ly nine in 10 (88%) AI/AN eighth graders were not pro­fi­cient in math in 2024 — also 15 points from the U.S. aver­age (73%). For AI/AN stu­dents, this fig­ure improved slight­ly from 89% in 2022 but remains sub­stan­tial­ly behind what it was a decade ear­li­er (79% in 2013). Eighth-grade math and fourth-grade read­ing pro­fi­cien­cy are bell­wether indi­ca­tors of long-term aca­d­e­m­ic suc­cess — includ­ing grad­u­at­ing from high school, which increas­es employ­ment and earn­ing poten­tial in adulthood.
  • AI/AN high school stu­dents have made progress on grad­u­at­ing with­in four years, from 70% achiev­ing this mile­stone in 2013–14 to 76% in 2023–24. Still, about one in four stu­dents (24%) are not grad­u­at­ing on time — near­ly dou­ble the nation­al fig­ure (13%) and above that of all oth­er racial and eth­nic groups with data.
  • In 2023, one in three (33%) AI/AN young adults ages 18 to 24 were enrolled in col­lege or had a bachelor’s degree, below their peers nation­wide (48%) and those in oth­er racial and eth­nic groups with data. At the same time, this col­lege sta­tis­tic for AI/AN young adults is up from 24% in 2005, which is the low­est point on the KIDS COUNT Data Center.

Native Youth Per­spec­tives on Edu­ca­tion, Health­care and More: A recent nation­al study gath­ered the views of young Native Amer­i­cans ages 18 to 24 on issues such as their cul­tur­al strengths, high­er edu­ca­tion, civic engage­ment, health­care and access to resources. 

Health and Men­tal Health Inequities

Find more data about AI/AN health in the KIDS COUNT Data Cen­ter includ­ing access to pre­na­tal care, low birth-weight babies and par­ent-report­ed child health sta­tus. 

Fam­i­ly and Com­mu­ni­ty Inequities

Access addi­tion­al data relat­ed to fam­i­lies and com­mu­ni­ties such as young par­ents, chil­dren with incar­cer­at­ed par­ents and young peo­ple in the child wel­fare and fos­ter care sys­tems.

The selec­tion of find­ings pre­sent­ed above is not com­pre­hen­sive but sheds light on the per­sis­tent inequities faced by AI/AN chil­dren, youth and families. 

Look­ing Forward

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 such allies about the struc­tur­al inequal­i­ties that con­tin­ue to dri­ve dis­par­i­ties in AI/AN children’s health and well-being. We also need to pri­or­i­tize and incor­po­rate AI/AN views and knowl­edge as we work toward cul­tur­al­ly respon­sive solu­tions. In that spir­it, the fol­low­ing resources offer rec­om­men­da­tions from mem­bers of AI/AN com­mu­ni­ties to address sys­temic inequities:

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 these com­mu­ni­ties. Rec­om­men­da­tions also include using the Cul­tur­al Wis­dom Dec­la­ra­tion above as a cross-cut­ting frame­work for all pro­grams, includ­ing phys­i­cal, men­tal and behav­ioral health, edu­ca­tion, child wel­fare, juve­nile jus­tice and eco­nom­ic sup­ports. Addi­tion­al­ly, they include pro­vid­ing sus­tained, flex­i­ble fund­ing and strength­en­ing coor­di­na­tion across agen­cies and pro­grams to sup­port com­pre­hen­sive, Trib­al-direct­ed services.

Along with build­ing on the wis­dom and exper­tise of the Indige­nous 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 health­care and edu­ca­tion infra­struc­tures in Indige­nous communities.
  • Sup­port edu­ca­tion sys­tems that are tai­lored for Native stu­dents — from ear­ly child­hood through high­er edu­ca­tion and voca­tion­al train­ing — rec­og­niz­ing the impor­tance of Native cul­tures and lan­guages for pos­i­tive youth outcomes.
  • Acknowl­edge and sup­port Indige­nous cul­tures as a pro­tec­tive fac­tor in any pro­gram or pol­i­cy solu­tion, and pro­mote a focus on resilience rather than risk fac­tors, over­all.
  • Ful­ly imple­ment exist­ing poli­cies intend­ed to advance equi­ty, such as the ICWA described above.
  • Strength­en mean­ing­ful col­lab­o­ra­tion across fed­er­al, state and Trib­al enti­ties to stream­line pro­grams and expand equi­table access to mul­ti­dis­ci­pli­nary ser­vices. As part of this, improve respons­es to miss­ing per­sons, sup­port the juris­dic­tion­al author­i­ty of Native nations and ensure that strong, cul­tur­al­ly ground­ed pub­lic safe­ty and fam­i­ly sup­port sys­tems are in place.
  • 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.
  • Advance accu­rate, rep­re­sen­ta­tive, acces­si­ble research and data col­lec­tion in col­lab­o­ra­tion with AI/AN pop­u­la­tions across all domains of health and well-being and, specif­i­cal­ly, for cas­es of mur­dered and miss­ing Indige­nous indi­vid­u­als. Such efforts should be respon­sive to Native com­mu­ni­ties and ele­vate their unique expe­ri­ences and views, includ­ing those of youth. 

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 iden­ti­ties, prac­tices, lan­guages 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 Native Chil­dren and Families

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* As not­ed in our post on pop­u­la­tion trends for Native chil­dren, 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 het­ero­ge­neous orig­i­nal peo­ples of North, Cen­tral and South Amer­i­ca include: Amer­i­can Indi­an, First Nations, Native Amer­i­can, Native Hawai­ian, 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.

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