Academic journal article Bilingual Review

Overcoming Obstacles and Improving Outcomes

Academic journal article Bilingual Review

Overcoming Obstacles and Improving Outcomes

Article excerpt


The two million Native Americans who live in the United States have been called the most neglected minority ethnic group in the country. The leading cause of death is accidents, and this group has a much higher rate of disabilities than the general population. Many Native Americans also experience poverty, substandard health care and housing, racial discrimination, and substance abuse. The poverty rate is twice that of the general population, and the unemployment rate is five times higher. The death rate from alcohol-related causes is three times greater for Native Americans than for the general population.

Of all the barriers to obtaining good health, poverty may be the most significant for Native Americans- Poverty, usually due to unemployment, is associated with increased rates of mortality, illness, disability, alcoholism, and suicide. Native Americans with disabilities are significantly poorer than other Native Americans. In areas with high unemployment for people without disabilities, the Tate of unemployment for people with disabilities is much higher.

Isolation is another problem. Of course, Native Americans who still live on their traditional homelands in remote areas may not consider isolation a problem per Se, since they are living where they want to live. But it becomes a problem in terms of receiving health and rehabilitation services, since it necessitates traveling long distances over poor roads. Emergency services may take much longer, so that vehicle accidents result in more disabilities than accidents in urban areas would.

If obtaining health care is inconvenient, it is also less likely to be sought. Public transportation is rare on reservations. Given the unemployment and poverty rates, it is not surprising that many Native Americans lack vehicles. Public transportation accessible to people with disabilities is particularly rare. Many reservations have dirt roads and lack sidewalks, making wheelchair use a problem. Even tribal and Indian Health Service buildings are usually inaccessible, and making them accessible for people with disabilities is considered a low priority. Many Native American homes on reservations lack telephones, electricity, and running water.

Lack of services and the lack of awareness of services is another major barrier. Although Native Americans have more disabilities than the general population, they are less likely to receive services. Many Native Americans with disabilities are unaware of the existence of programs for which they are eligible, and many service agencies do little outreach to reservations and urban areas. Outreach is made difficult by other barriers, such as isolation, lack of transportation, language differences, and differences in values and lifestyles. Many public agencies are already overburdened with large caseloads and have little incentive to do expensive and time-consuming outreach to find new clients in rural areas.

There are also cultural barriers that are unique to the Native American population. One must keep in mind that this group is not homogeneous; there are hundreds of distinct tribes and languages. Beliefs about health, illness, and disability may differ greatly from the European-American tradition. Often traditional-minded Native Americans have major disabilities but do not consider themselves disabled because they live in extended families that accommodate their needs. They may not be fully functioning, but they are fully accepted in the families and the community, and their contributions are valued. Some American Indian cultures do nor even have a term in their language for disability; the closest term is "being different."

Some traditional Indian healers say that disabilities occur because the individual or one of his or her relatives broke a taboo or failed to follow prescribed codes of behavior. Often there is little emphasis on the "specialness" of the individual with a disability. …

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