In the United States, there are 574 federally recognized tribes and approximately 9.7 million Indigenous American Indian and Alaska Native (AI/AN) people. AI/AN people are more likely than any other racial/ethnic group in the United States to be rural residents, with 40% living in rural areas, both on and off tribal land (13% live on reservations). AI/AN people also have the lowest life expectancy of all U.S. racial/ethnic groups, and face persistent challenges in access to and quality of health care and other social determinants of health. As a result, AI/AN people experience substantial health disparities.

AI/AN people living in rural areas experience intersecting risks related to identity and place. Rural counties where more than half of the residents are AI/AN show elevated rates of premature death. Among AI/AN people, rural residents tend to suffer worse health outcomes and have more challenges accessing care than urban AI/AN people, partly due to residing in remote locations. Current and comprehensive data on AI/AN health and health care access are needed to inform federal policy and decision-making. The federal government has a unique relationship with sovereign tribal nations, established in Article 1 of the U.S. Constitution, and both legal decisions and treaty agreements require the U.S. government to provide health care to AI/AN people who are enrolled tribal members. However, programs like the Indian Health Service have long been underfunded, and vary by region.

Generational cycles of health challenges faced by AI/AN people contribute to long-standing inequities, and addressing both identity and place in research will support more effective programs and policies in the future. This project will describe rural-urban and regional differences in the health of Indigenous AI/AN people and measure disparities in health between AI/AN people and non-Indigenous white people, assessing whether disparities are greater in rural areas, and identifying opportunities to reduce inequities faced by rural AI/AN people.