The Impact of Indian Gaming on American Indian Poverty, Health and Risk-Taking Behaviors

The primary goal of this project is to examine the effects of the income increases associated with Indian gaming on health and poverty among American Indians, one of the nation's lowest-income and most vulnerable populations.

Since the early 1990s, many American Indian tribes have initiated casino and slot machine gambling—defined as Class III gambling under the Indian Gaming Regulatory Act of 1988. In 2005, there were 241 Class III gaming tribes, out of 562 federally recognized Indian Tribes. By 1998, approximately a third of the on-reservation population of the lower 48 states (as estimated in the 1990 census) lived on a reservation with a Class III gaming compact. The income increases associated with the legalization and institution of casino gambling are likely to have had important effects on many aspects of American Indian well-being. Although the primary concern of this research is with the effects of the income increases on the health status and health care utilization of American Indians, the researchers will also study effects on poverty levels, medical care, and risk-taking behavior, all of which are indirectly associated with health status.

Principal investigators for this research project are Barbara Wolfe, Professor of Economics and Population Health Sciences; Robert Haveman, John Bascom Professor Emeritus of Economics; Gary Sandefur, Professor of Sociology; and Richard Carpiano, a Robert Wood Johnson Health and Society Scholar at the University of Wisconsin–Madison. The first three are members of the of the UW–Madison faculty and are IRP affiliates. The project is being funded by the Robert Wood Johnson Foundation.

The adoption of a gaming enterprise is associated with substantial positive impacts on tribal budgets. These revenues have been used to both improve tribal infrastructure and services (in particular, health care facilities) and provide social and financial support to tribal members. Both the gaming operations and the investments from operation revenues have provided jobs and income to tribal members and have stimulated the local economy through related business activities. But these sizable increases in income have accrued only to some communities, not to all. Real median income on reservations with gaming increased by 35 percent compared to 14 percent on reservations without gambling. This variation among tribes should allow researchers to parse out the effects of gaming-related income increases on health status and health care utilization (and potentially on other important indicators of socioeconomic well-being).

Using survey data on health status, health care facilities, and health care utilization, combined with data regarding Indian gaming facilities, investigators will compare health-related outcomes for three groups: (1) American Indians before and after the institution of Class III gaming, (2) American Indians in counties with and without Class III gaming activities, and (3) American Indians versus non–American Indians in counties with Class III tribal gaming activities. This last analysis will make it possible to control for other changes in the county that might influence health outcomes.

The relatively recent legalization of Indian casino gaming and the sizable income flows that it has generated also provide a unique opportunity to study the tie between income and health more generally. Through their analysis of data on income changes for American Indian communities with and without gaming, together with detailed measures of the health status, health care utilization, and health-related behaviors of the members of these communities, the researchers hope to develop a more reliable estimate of the income-health relationship than has heretofore been possible. The effect of income on health is a central issue in health economics, medical sociology, and social epidemiology. But many factors are related to both income and health, and separating out the independent causal effect of income on health status is not straightforward.

The analysis will not only increase understanding of the determinants of the health of a very vulnerable population, but will allow evaluation, on a national level, of the potential impact of an important (and publicly debated) social policy and poverty alleviation approach—the stimulation of local economic development.

For more information on these topics, see Jonathan B. Taylor and Joseph P. Kalt, American Indians on Reservations: A Databook of Socioeconomic Change between 1990 and 2000 Censuses. (Cambridge: Harvard Project on American Indian Economic Development, 2005). This work is part of the HPAIED project entitled Cabazon, the Indian Gaming Regulatory Act and the Socioeconomic Consequences of American Indian Governmental Gaming: A Ten Year Review. The Harvard Project on American Indian Economic Development is located at the Malcolm Weiner Center for Social Policy at the John F. Kennedy School of Government, Harvard University.