According to 2003 United States Census Bureau estimates, a little over one third of the 2,786,652 Native Americans in the United States live in three states: California at 413,382, Arizona at 294,137 and Oklahoma at 279,559.
Native American struggles amid poverty to maintain life on the reservation or in larger society have resulted in a variety of health issues, some related to nutrition and health practices. The community suffers a vulnerability to and disproportionately high rate of alcoholism.
Numerous tribal governments have long prohibited the sale of alcohol on reservations, but generally it is readily for sale in nearby border towns, and off-reservation businesses and states gain income from the business. As an example, in 2010, beer sales at off-reservation outlets in Whiteclay, Nebraska generated 3,932 that year in federal and sales taxes. Their customers are overwhelmingly Lakota from the Pine Ridge Indian Reservation in South Dakota.
Acknowledging that prohibition has not worked, in a major change in strategy since the late 20th century, as of 2007, 63 percent of the federally recognized tribes in the lower 48 states had legalized alcohol sales on their reservations. Among these, all the other tribes in South Dakota have legalized sales, as have many in Nebraska. The tribes decided to retain the revenues that previously would go to the states through retail sales taxes on this commodity. Legalizing the sales enables the tribes to keep more money within their reservation economies and support new businesses and services, as well as to directly regulate, police and control alcohol sales. The retained revenues enable them to provide health care and build facilities to better treat individuals and families suffering from alcohol abuse. In some cases, legalization of alcohol sales also supported the development of resorts and casinos, to generate revenues for other economic enterprises.
"It has long been recognized that Native Americans are dying of diabetes, alcoholism, tuberculosis, suicide, and other health conditions at shocking rates. Beyond disturbingly high mortality rates, Native Americans also suffer a significantly lower health status and disproportionate rates of disease compared with all other Americans."
â€” The U.S. Commission on Civil Rights, September 2004
In addition to increasing numbers of American Indians entering the fields of community health and medicine, agencies working with Native American communities have sought partnerships, representatives of policy and program boards, and other ways to learn and respect their traditions, and to integrate the benefits of Western medicine within their own cultural practices.
In the early 21st century, Native American communities have exhibited continuing growth and revival, playing a larger role in the American economy, and in the lives of Native Americans. Communities have consistently formed governments that administer services such as firefighting, natural resource management, social programs and health care, housing and law enforcement. Numerous tribes have founded tribal colleges. Most Native American communities have established court systems to adjudicate matters related to local ordinances. Most also look to various forms of moral and social authority, such as forms of restorative justice, vested in the traditional culture of the tribal nation. Native American professionals have founded associations in journalism, law, medicine and other fields to encourage students in these fields, provide professional training and networking opportunities, and entree into mainstream institutions.
To address the housing needs of Native Americans, Congress passed the Native American Housing and Self Determination Act (NAHASDA) in 1996. This legislation replaced public housing built by the BIA, and other 1937 Housing Act programs directed towards Indian Housing Authorities, with a block-grant program. It provides funds to be administered by the Tribes to develop their own housing.