The history of the health of Great Plains tribes can be characterized as a series of epidemiological transitions highlighted by several distinct eras. Before European American colonization, Plains peoples suffered from low-virulence infections and socially induced mortalities. Paleopathological evidence reveals numerous afflictions: malnutrition, anemia, tuberculosis, treponematosis, and other degenerative, chronic, and congenital conditions. Together with periodic trauma, such as accidents and warfare, these afflictions determined morbidity and mortality patterns.
European American contact brought elevated levels of morbidity and mortality. Most tribes experienced deteriorating health conditions and sustained population declines. The crucial factor was the introduction of Eastern Hemisphere infectious diseases such as cholera, influenza, measles, and smallpox. Even before 1730 Plains populations were exposed to epidemics. Then, between 1730 and 1877, approximately fifty epidemics swept across the Northern Plains; Southern Plains societies suffered similar catastrophes. Smallpox was particularly devastating: the 1837.38 epidemic, for example, killed an estimated 17,200 Indians in the Northern Great Plains, including 8,160 Blackfoot.
Epidemics were accompanied by increased warfare, impairment of subsistence activities and consequent famine, breakdown of social systems, which crippled a tribe's capacity to care for its sick, and deep cultural stress. In response, Great Plains societies employed a number of adaptive strategies, altering their kinship, marital, and adoption practices, and modifying their ideological systems to explain the introduced pathogens. Some tribes accepted select western medical techniques, such as vaccination, adding them to their traditional repertoire of healing practices.
Rudimentary governmental health services were introduced after 1819 under the auspices of the War Department. Army physicians, missionaries, and even traders administered sporadic medical care. Some U.S. government treaties promised medical care, but of the numbered treaties in Canada, only Treaty Number 6 (1876), with the Crees, referred specifically to medical services. Concerted efforts to provide health care for Plains Indians did not occur until long after their confinement to reservations and reserves.
Although epidemics, including influenza, still sporadically occurred, after about 1880 the main causes of morbidity and mortality were aÄictions brought about by the impoverished conditions of life on the reservations and reserves, especially tuberculosis, trachoma, and dysentery. For example, in 1898 the high (54 per 1,000) death rate among the Canadian Sarcee (Sarsi) was largely the result of tuberculosis.
In response, in both the Canadian and U.S. Great Plains a rudimentary system of health care delivery was developed that included hospital-based care, civilian physicians, and field matrons. In particular, tuberculosis, trachoma, and high infant mortality rates were targeted. Prior to 1940, however, health care delivery to Plains reservations and reserves was plagued by inadequate facilities, a lack of medical supplies, personnel problems, as well as by a general resistance to western medicine. Western medical practices were rejected both because they were culturally alien and also because they undermined Indigenous healing and associated religious beliefs.
In Canada after World War II the responsibility for Native health services was transferred to Health and Welfare Canada, and then, in the 1970s, to the Department of Indian Affairs and Northern Development. In the United States, since the mid-1960s the goal of the Indian Health Service has been to bring Native American health up to the level of the rest of the nation. Still, the health of Native Americans and First Nations remains well below the national averages.
Indeed, the Native peoples of the Plains have similar epidemiological and demographic profiles to those found in the developing world. They are young, poorly educated, and have low income, and their societies are characterized by high fertility and mortality rates, with prevalent occurrences of chronic diseases and social pathologies. Plains Indians have a life expectancy that is seven years lower than the U.S. and Canadian averages. Infant mortality, though falling, was still 3.5 times higher among First Nations of the Prairies than in Canada as a whole in 1996, and in 2000 the infant mortality rate in the Aberdeen, South Dakota, service area exceeded the national average by more than 50 percent.
With the notable exception of another introduced disease, the human immunodeficiency virus that leads to AIDS, infectious diseases on the reservations and reserves have waned because of improvements in sanitation and, to a degree, rising standards of living. The three leading causes of death are now heart disease, malignant neoplasms (tumors), and accidents. Type 2 diabetes, hypertension, and arthritis are also prevalent, and alcoholism, substance abuse, homicide, and family violence also occur at rates substantially higher than the national averages. To one degree or another, these are all addictions of poverty and associated dysfunctional lifestyles and behavior.
Although such statistics reveal how large the gap is in health equity between Plains Indigenous and non-Indigenous peoples, improvements are being made on a number of health fronts. Great Plains tribes are assuming greater responsibility in defining their health needs and controlling health resources. They are integrating traditional medical practices with western medical techniques to address their health concerns in a culturally appropriate manner. It is hoped that the result will be sustained improvements in health.
Gregory R. Campbell University of Montana
Campbell, Gregory R. "Indian Health Service." In Native America in the Twentieth Century: An Encyclopedia, edited by Mary B. Davis. New York: Garland Publishing, Inc., 1994: 256–61.
Waldram, James B., D. Ann Herring, and T. Kue Young. Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives. Toronto: University of Toronto Press, 1995.
Young, T. Kue. The Health of Native Americans: Towards a Biocultural Epidemiology. New York: Oxford University Press, 1994.