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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.114538v1 98/3/404    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kunitz, S. J. PubMed PubMed Citation Articles by Kunitz, S. J. Related Collections Cardiovascular Disease Diabetes Access to Care Native Americans Government Mortality

Stephen J. Kunitz, MD, PhD

The author is with the Department of Community & Preventive Medicine, University of Rochester School of Medicine, Rochester, NY, and the Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM.

Correspondence: Requests for reprints should be sent to Stephen J. Kunitz, MD, PhD, Department of Community & Preventive Medicine, University of Rochester Medical Center, PO Box 278969, Rochester, NY 14627-8969 (e-mail: stephen_kunitz{at}urmc.rochester.edu).

Mortality rates for American Indians (including Alaska Natives) declined for much of the 20th century, but data published by the Indian Health Service indicate that since the mid-1980s, age-adjusted deaths for this population have increased both in absolute terms and compared with rates for the White American population.

This increase appears to be primarily because of the direct and indirect effects of type 2 diabetes. Despite increasing appropriations for the Special Diabetes Program for Indians, per capita expenditures for Indian health, including third-party reimbursements, remain substantially lower than those for other Americans and, when adjusted for inflation, have been essentially unchanged since the early 1990s.

I argue that inadequate funding for health services has contributed significantly to the increased death rate.