Social Determinants of Health

Having conversations about health: Public health disparities on the Pine Ridge Native reservation

Indigenous communities have suffered for centuries at the hands of colonialism, and their isolation on reservations has affected their health and well-being in a myriad of ways. In this post, I’ll discuss the public health situation at one reservation in particular: Pine Ridge.

I recently had the privilege of speaking with Paula Sibal, a staff member at Re-Member who is passionate about bringing public awareness to issues faced by Indigenous communities. As I learned, many public health disparities are either ignored or worsened by the federal government—a logic of strategic elimination that is part-and-parcel of settler colonialism, very much alive today. In writing this post, I recognize that merely shedding light on this issue is not enough; tangible actions must follow. By sharing an account of a few of the injustices experienced by Pine Ridge, I hope to encourage readers, in whatever ways they can, to remedy this.

Life on the Reservation

Located in rural South Dakota, the Pine Ridge reservation exists on the physical, economic, and symbolic periphery of America. Disconnected from the urban centers that characterize the West, the position of this reservation reflects how Natives were isolated in a region with scant resources or opportunities. Surrounded by a largely-white town often hostile to them, inhabitants are often unable to land or maintain a job. Little attention is paid by the federal government to this region, leading to a lower quality of life for Indigenous communities there. While these impacts are indeed innumerable, in this post, I’ll discuss how three particular social determinants are impacted: potable water, adequate housing, and nutritious food.

Badlands National Park—the area of the reservation—the has a largely-barren landscape without many resources. Attribution: Martin Kraft, CC BY-SA 3.0, via Wikimedia Commons

Potable Water

Most of the country enjoys reliable access to clean water sources. Historically, clean and filtered water has drastically reduced death rates from contaminants like bacteria, dust particles, and chemicals. Yet, Indian reservations have been left behind by the revolution.

Editor’s Note: Sections marked in italics represent transcribed audio segments from Soham’s conversation with Paula.

Paula: Pine Ridge is the second-largest reservation in the country, so the area that Pine Ridge is located on, [Badlands National Park] is right there… The soil composition is clay substrate, and so for many people, you [have] to go down over 100 feet to get water, and many people just can’t afford that. The cost of dropping a well is exorbitant. Then, the other issue is trying to connect to the water line, which is basically the public water system. Because of the Dawes act, which is land appropriation, areas of the reservation were assigned to families as, “This is your land. This is what we are giving to you…” These pieces of land are basically out in the middle of nowhere. I have a friend whose family land is out in the middle of the Badlands about 13 miles off the paved road. When you get out there, basically on a two-track*, there’s no way to go out there and drop a well. And so, that’s why there are people… who have to haul water in buckets, or whatever they carry it in, and use an outhouse, because that’s all they have access to. 

*a two-track is an unpaved road

Soham: Wow, we take many of these things like water and sewage for granted. It’s very eye opening to see that people don’t have access to that.

Paula: Yes, it’s very sobering. There are third-world conditions on Pine Ridge that most Western reservations suffer from.

Adequate Housing

As an important social determinant of health, housing can protect people from excessive exposure, reducing risks of bacteria, UV radiation, and toxic exposure. Yet, many Natives don’t have access to adequate housing on Pine Ridge, partly because of construction companies that see little potential profit and due to a government indifferent to their struggles. In other parts of the country, housing is at least constructed (even if unaffordable), but here, there simply aren’t enough houses. Furthermore, initiatives to remedy this problem—like micro-housing projects—are often well-intentioned yet unable to tackle the full scale of this crisis.

Paula: There is an organization, they were coming in and building tiny houses, like micro-housing, for people here. The work they are doing is truly wonderful. But when the need is so great, you could be building micro-housing for the next 20 years and still not get everyone a house on the res… It’s a pretty dire situation. Really, what it needs is the federal government to honor the treaties and step up to provide the housing to those who need it.

Commodity cheese. Attribution: PeRshGo, CC BY-SA 3.0, via Wikimedia Commons

Nutritious Food

Food is the backbone of preventative healthcare, as it has cascading effects on nearly every health condition. Because of this, American public health has recently seen the increased promotion of organic foods and the creation of nationwide initiatives to reduce the prevalence of obesity. Yet hypocritically, the government’s own welfare programs act in the opposite direction by providing only highly-processed and high-calorie foods to marginalized communities. As a result, areas like the Pine Ridge reservation have become “food deserts” without access to affordable nutritious food. When fatty and high-calorie diets are consumed for a lifetime, it can wreak havoc on bodily well-being, resulting in a greater occurrence of preventable health conditions.

Yet, mental well-being is affected just as much: the Oglala Lakota were traditionally hunter-gatherers whose way of life starkly differed from eating store-bought, pre-packaged meals. For the first generations—and arguably current ones as well—the transition to sedentary food consumption has been deeply disorienting. 

Paula: It’s not a healthy diet. It’s all processed food: commodity cheese, bleached flour… The stuff provided to people on reservations is food that the rest of society would probably not eat. 

Soham: Wow, that’s so shocking.

Paula: It’s ridiculous. That’s all they have to eat—the plains tribes were hunters and gatherers, so they don’t understand farming, so they can’t grow their own food in many cases. There has been a big push to educate people so that they can adapt to farming, so now, there are people who are planting gardens and growing their own food, which is making things better.

Soham: There’s a lot of research coming out about how there are so many preventative measures we can take against diseases. People say we should try to eat healthy food and things like that, but when things are siphoned off from the Native Americans, it must be so difficult to deal with the resulting health conditions. 

Paula: Yes, that’s very true.

It’s shocking that within a first-world country, there remain such vast gaps in access to basic necessities, such as food, water, and housing. If we are to advance our societal public health, we must begin by addressing these disparities.

Further Reading

Friedman, Misha. For Native Americans, Health Care Is A Long, Hard Road Away. National Public Radio, 13 Apr. 2016,

Friedman, Misha. “Health Care’s Hard Realities On The Reservation: A Photo Essay.” Kaiser Health News, 4 Aug. 2016,

Smith, Mary. “Native Americans: A Crisis in Health Equity.” American Bar Association,

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3 thoughts on “Having conversations about health: Public health disparities on the Pine Ridge Native reservation

  1. This is really excellent work – thank you for bringing light to these issues!

    I’m fortunate enough to be in a department with several faculty members working with Indigenous peoples (and who are Native themselves) as well as a dear colleague of mine. I’ve learned a great deal from them about the issues facing Native tribes across North America. There’s a lot of great harm reduction programs designed and operated by and for Native peoples, which is what initially piqued by interested.

    And unfortunately, you’re absolutely right in that all of these problems stem directly from historical and ongoing colonial efforts by the US government. It’s a travesty that more Americans don’t care about these issues happening in our own backyards. This is definitely one of the areas that I think anthropology, public health, and educational media could absolutely work together on.

  2. Wow this was phenomenal! I live in South Dakota and work for the states DOH. This is so informative. Well done.

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