Life expectancy for American Indians and Alaska Natives has dropped to levels not seen in decades, alarming public health experts. Between 2019 and 2021, their life expectancy fell from 72 years to 68 years — a number that mirrors the overall U.S. population in the 1940s.
The decline reflects a convergence of health crises. Native communities have the highest prevalence of type 2 diabetes of any racial group, along with twice the death rate from end-stage kidney disease compared with white Americans. They also face higher rates of heart disease, cancers, substance use, and suicide. From 2019 to 2020, drug overdose deaths among Native people rose nearly 40%, surpassing all other groups. Suicide has become the second leading cause of death for Native youth and young adults, with rates continuing to climb.
The COVID-19 pandemic deepened these losses, erasing four years of life expectancy in just two years. Yet the decline predates the pandemic, rooted in persistent inequities. One in four Native people lives in poverty, while education and employment gaps remain wide. Researchers stress that settler colonialism — the historical displacement and ongoing marginalization of Indigenous communities — must be recognized as a driver of health inequities.
Experts argue that Tribal sovereignty and self-determination are critical to reversing these trends. Community-led programs, such as culturally grounded diabetes initiatives and food sovereignty projects, show that when Native governance and knowledge are centered, health outcomes improve and cultural continuity is strengthened.
See: “Stagnating Life Expectancy Among American Indians and Alaska Natives: Understanding the Drivers and Recommendations for Research, Policy, and Practice” (November 12, 2024)
