Updated May 29, 2014

For decades, if you lived on South Dakota’s Pine Ridge Indian Reservation and wanted a drink, you'd have to stroll a few feet south of its border. But earlier last August, after furious debate, the tribe members voted to end its century-old prohibition of alcohol.

Supporters hoped to channel the money spent at outside liquor stores back into the community, and its underfunded alcohol treatment programs. But critics believe the new policy will only drive up the rate of alcohol abuse, a notorious scourge in Indian country.

Alcoholism is the most well-known health problem in the Native community, and a source of ample stereotyping. But there are many other reasons why Native Americans and Alaska Natives die younger, on average, than other Americans.

“We are the sickest racial, ethnic population in the United States,” said Irene Vernon, a professor at Colorado State University who specializes in Native American health.

Native communities suffer more of the usual predictors of poor health, such as poverty, unemployment and a steep high school dropout rate. There’s also a heavy history: the removal of Native Americans from their lands, and the boarding school movement, when many Native children were separated from their families, renamed, stripped of their language and often abused.

“These traumatic impacts -- loss of land, loss of community, loss of family, warfare -- have been passed on from generation to generation,” Vernon said.

Then there’s the issue of care. A large minority of Native Americans and Alaska Natives live on reservations in rural areas, mostly serviced by clinics, often a lengthy drive to a hospital, and usually strapped for funds. “The money we get for health is less than the money given to prisoners,” Vernon said. “It’s shamefully small, per person.”