Measuring Rural-Urban Differences in Indigenous American Indian and Alaska Native Health

In the United States, there are 574 federally recognized tribes and approximately 9.7 million Indigenous American Indian and Alaska Native (AI/AN) people. Many AI/AN people in the United States are rural residents, with 40% of AI/AN people living in rural areas, both on and off tribal land (13% live on reservations). AI/AN people also have lower life expectancy and face persistent challenges in access to and quality of health.

AI/AN people living in rural areas may experience particular health risks. 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 policy and decision-making. The federal government has a unique relationship with sovereign tribal nations, and both legal decisions and treaty agreements establish a federal trust responsibility for AI/AN health.

This project describes rural-urban differences in the health of AI/AN people and measures differences in health care access for AI/AN people in rural communities, identifying promising practices and opportunities to improve health for rural AI/AN people.

Publications

• Reasons for Experiencing Delayed or Forgone Health Care Among Rural American Indian/Alaska Native and Rural Non-Hispanic White Individuals, 2022
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 09/2025
  The purpose of this policy brief is to show reported reasons for experiencing delayed or forgone health care and how this differs between rural American Indian/Alaska Native (AI/AN) and rural non-Hispanic white people as well as by Indian Health Service care access among rural AI/AN people.