Although the birth rate is still high, increasingly the health issues are those of an aging population. Survival in infancy has led to greater challenges in meeting the health needs of children and youth. Survival into adult life has led to greater stressors on the economic capacity of the communities in which people live. Survival into later adult life has led to changes in social roles and disease patterns. Correspondingly, communities are seeing different health problems.
Economic hardship contributes to a variety of health problems.
Assimilation into the dominant society has led to disruptions in family and community values. Suicide, homicide, family violence, and chemical dependency are more significant issues than in the past. Raising children and encouraging young people in this environment is difficult. Accidents still claim a disproportionate number of young people. There are a significant number of homes without access to water and sewer systems.