The age-adjusted rate for American Indian and Alaska Native males has fluctuated around 20 per 100,000. In fact, a national study of life expectancy found that the lowest life expectancies in the country (including inner city ghettos) for both men and women exist in Indian populations, are similar to ones seen in sub-Saharan Africa, and are the lowest of any nation in this hemisphere except Haiti (IHS, 1998, Section VII). To compound these findings, prevailing economic conditions reveal that 32% of American Indians and Alaska Natives live below the poverty level, compared to 13% of the U.S. general population as of 1990.

Conclusions
There are detectable emergent disability trends, in at least two categories: increasing rates of disability and related conditions, and the emergence of new disabling conditions. Although a number of infectious diseases such as meningitis, hepatitis, pneumonia, and tuberculosis continue at rates much higher than in the general population, the overall rate of infectious diseases seems to be decreasing. The most dramatic increase in a chronic disabling condition among American Indians and Alaska Natives is with diabetes and several conditions associated with the disease. Social pathologies due to violence and accidents are also much higher than the national norm. Emerging disabling conditions would include HIV / AIDS, which IHS has been tracking only since 1987, and FAS, which was identified in 1973 but has yet to be recognized by RSA as a disabling condition.

Further examination of data reveals that existing monitoring systems have identified several trend clusters; one associated with diabetes, another associated with alcohol, and a third associated with injuries and violence. Limitations of data collection from monitoring systems point to problems connected with the public health monitoring of American Indians and Alaska Natives, such as determining who is Indian, how to track individuals who lack telephones or unlisted mail addresses, and the variation in the types of data collected when utilizing diagnostic labels versus functional categories.

Policy implications for these systems have revealed Healthy People 2000 prioritizing the monitoring of suicide rates among American Indians and Alaska Natives, yet lack goals for improving their mental health. Policy change may also result from studies conducted by the World Health Organization’s committee on International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which serves as a multipurpose classification system that assists understanding the concept of disability (and emergent disability) in a wider context by systematically grouping consequences associated with health conditions.

Other implications involve the ability of the IHS to achieve its performance indicators, which has been lacking due to legislative budgets not meeting the costs of services and staffing needs. For a growing number of American Indians and Alaska Native people, the belief in the assurance of adequate health care is beginning to be perceived as another broken promise from the Federal government. Finally, public health initiatives, which have often stopped short of their goals while attention shifts to other priorities, should have maintained their focus of Healthy People 2000 objectives in their work with American Indians and Alaska Natives.

Recommendations
The following recommendations are offered to address both data issues and future issues related to American Indians with disabilities to plan more effective policies, prevention strategies, and vocational rehabilitation.