Addressing COVID-19 Disparities Among Indigenous Americans
Due to historically strained relationships with the U.S. government and lack of apt and timely funding and resources, the American Indian and Alaska Native population has been hit particularly hard by the coronavirus pandemic.
COVID-19 has had detrimental effects on the social, economic, and health well-being of citizens across the United States. It has caused a tremendous loss of life, spikes in unemployment, and insecurity in housing, employment duration, healthcare, education, and overall stability. As of November 17, there have been a recorded 11.4 million cases of COVID-19 in the country and 248,000 deaths.
Although this crisis has had a sweeping impact on the nation, COVID-19 has had a devastatingly disproportionate effect on indigenous American populations. Across the U.S., the rate of COVID-19 infections within the American Indian and Alaska Native (AI/AN) population is 3.5 times the rate of white Americans and the death rate is nearly twice as much comparatively, despite accounting for only .7% of the population. Currently, resources and support available to AI/AN populations to battle the disproportionate rates of COVID-19 in their communities has been inadequate.
The Indian Health Service (IHS) has been historically underfunded and federal assistance to address COVID-19 has not been forthcoming — while the CARES Act provided $1 billion to the IHS, unmet needs are currently estimated at $32 billion. In addition to the resources being inadequate, what has been made available has come slowly and information on how to access it has been scarce and inconsistent.
“CARES Act funds were not readily made available to the tribes, resulting in delays applying for grants while others had a head start,” said Mae-Gilene Begay, Program Manager, Navajo Community Health Representative Program. “This narrowed the window of opportunity for a greater number of tribes to apply for the funds. I was tapped to jointly apply for FCC Telehealth with Navajo Tribal Utility Authority (NTUA) and were awarded. I don’t think many tribes were privy to resources to partner with to apply for COVID-19 relief funds.”
This significant deficit in funding has left Native American populations unable to meet the needs of their communities in terms of proper communication strategies, testing, and treatment. Policymakers need to take action to prevent an even higher disproportion of detrimental effects caused by COVID-19 on Native American communities.
Although supplementing the critical funding shortage needed by the IHS and the tribal nations they serve would help combat the steep numbers of cases and deaths from COVID-19 in Native American communities, it’s highly unfeasible to get the additional funding approved, nonetheless in time to stop the spread in a timely fashion.
To temper the disproportionate rates of infections and deaths from the coronavirus among Native American communities, the United States needs a prevention plan that includes appropriate, comprehensive communication strategies and the monitoring and response to early signs of potential high risk. I believe the most effective short-term strategy is to work preemptively to lower the rates of future cases and deaths.
I recommend a short-term research-based strategy to mitigate the increase of COVID-19 cases and deaths through 1) comprehensive and culturally competent communication strategies and 2) monitoring communities for early signs of potential risk.
Collaborative Communication
This policy would introduce more intentional and direct communication strategies to better serve Native American communities and would rely on tribal leaders working directly with federal entities and medical professionals to deliver consistent messaging that aligns with each tribal nations’ specific needs, culture, and language.
This policy targets the inconsistencies in communication related to COVID-19 Native American populations have faced due to lack of access to communication channels and messaging that is inconsistent with individual tribal nations’ cultural values and/or languages. This would ensure general advisory guidelines (mask-wearing and social distancing) and regional information (testing sites, intensive care capacities, and access to PPE equipment) are communicated via the appropriate communication channels and within the context of each individual tribe’s cultural values and native languages.
The Navajo Nation tried this approach and found success in lowering its infection rate from a daily high of 240 new cases in mid-May to just 54 by late July through simple, clear, and culturally tailored communication. This communication wove in community values to reinforce the importance of wearing masks for protection and prioritizing high-risk community members.
“We framed it within our cultural teaching: We teach that we have fought monsters, but today we also have modern monsters, like alcoholism, depression, suicide, and disease,” said Navajo Nation President Jonathan Nez. “In our society, we value our elders and we let people know they are warriors, and they are supposed to protect their families — in this case, to shield their elders, who have traditional and cultural knowledge for the future of our people. Because of the failure and slowness of the federal government to give us our share of the Cares Act, we had to use our sovereign ability to govern ourselves and keep our people safe.”
Although this policy implementation wouldn’t necessarily lead directly to a reduction of future deaths or cases, communication strategies that are considerate of tribes’ cultural standards and their preferred/accessible forms of communication could disseminate health protocols further and more effectively in Native American communities. An effective collaborative effort between a coalition of tribal leaders and U.S. government entities could also be challenging considering the existing fraught relationship and history.
Oximeter Contact Tracing
This policy addresses the low access to healthcare facilities and treatment for Native American populations during the COVID-19 pandemic by employing an early detection strategy through oximeter contact tracing used to identify early signs of compromised lung function. This strategy would rely on teams of medical professionals within the IHS extensively testing high-risk households for oxygen levels via oximeter pulse readings allowing early detection of anything hindering the respiratory system.
Although this type of tracing does not stop the spread of the virus, early detection of respiratory issues can potentially prevent contracting COVID-19 in addition to death from or long-term ailments due to the virus. This approach was successful within the White Mountain Apache Tribe in rural Arizona in which oximeter tracing was key in tracking and monitoring households with at-risk individuals. Being able to identify, care for, and isolate these individuals early on allowed the White Mountain Apache tribe to lower their infection rates from roughly 11% of the total confirmed cases in Arizona to just 5% and bring their case fatality rate to just 1.1%, less than half the rate reported for the rest of Arizona.
These direct policies, if implemented successfully and simultaneously, will help reduce future cases and deaths from COVID-19 in Native American populations while also introducing additional data sets that can influence subsequent responses to combatting the disproportionate effect the virus has had on this population. Due to the historic friction between the IHS and HHS (and more broadly tribal nations and the United States government), focusing on short-term policy that includes appropriate, comprehensive communication plans and the monitorization and response to early signs of potential risk is an effective way to address the crisis.
References
Begay M. (October 13, 2020). Personal interview [Email].
COVID-19 Among American Indian and Alaska Native Persons — 23 States, January 31–July 3, 2020. (2020, August 27). https://www.cdc.gov/mmwr/volumes/69/wr/mm6934e1.htm.
Covid in the U.S.: Latest Map and Case Count. Retrieved November 17, 2020. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Close, R. M., & Stone, M. J. (2020). Contact Tracing for Native Americans in Rural Arizona. New England Journal of Medicine,383(3). doi:10.1056/nejmc2023540
Parshley, L. (2020, July 28). How the Navajo Nation slowed one of the worst Covid-19 outbreaks in the US. Retrieved November 02, 2020, from https://www.vox.com/2020/7/28/21344969/covid-19-masks-arizona-new-mexico-utah-navajo-nation
