COVID-19 in Native American Communities: A Quiet Crisis That Has Become an Ear-Deafening Emergency

The Navajo Nation surpassed New York for the highest per-capita coronavirus infection rate in the United States. With over 4700 cases, the Navajo Nation, which spans parts of Arizona, New Mexico and Utah, has a higher infection rate than the worst-hit zip codes in New York City.

What the U.S. Commission on Civil Rights once called a “quiet crisis” has become an ear-deafening emergency.

This coronavirus pandemic has elevated to the public’s consciousness what Native Americans have known for decades — that the amount of funding and resources dedicated to Native American health and well-being is unconscionable.

This crisis is not limited to the Navajo Nation. There are over 574 federally-recognized Indian Tribes in the country, and many of them are sounding the alarm as well.

For instance, for the Cheyenne River Sioux Tribe in South Dakota, which has over 10,000 members, the nearest critical care facility is over three hours away, and the U.S. government-run Indian Health Service (IHS) hospital on the reservation has only eight beds, one respiratory therapist, and no ICU beds.

The current crisis has been building for decades. The IHS — an agency within the Department of Health and Human Services — provides care to over 2.2 million Native Americans. Although IHS fulfills treaty responsibilities to provide health care for federally-recognized tribes, Congress has consistently underfunded the Agency. As a result, tribal members have a different health care reality than many other U.S. citizens. A report by the U.S. Commission on Civil Rights stated, “In 2017, IHS health care expenditures per person were $3,332, compared to $9,207 for federal health care spending nationwide.”

Against this decades-long underfunding, there are overarching challenges in health care that further exacerbate access to care for American Indians. For example, a common challenge in many tribal communities is the shortage of medical personnel. In 2018, the Government Accountability Office reported that IHS did not have enough doctors or nurses to provide quality and timely health care to American Indian and Alaska Native people and that IHS data show an average vacancy rate for physicians, nurses, and other care providers of 25%.

It is necessary to address this situation in American Indian and Alaska Native communities. As what has become the mantra during this crisis that “we are all in this together” it is certainly true that we need to improve health care access and delivery in Native communities to reduce the spread of the virus.

In order to help to fight COVID-19 in Native communities, resources need to be deployed to improve the workforce, expand technology and build critical infrastructure both in the short term and the long term.

The COVID-19 pandemic and resulting economic downturn have negatively affected people already suffering from mental illness and substance use disorders and increased funding for tribes to help address mental and behavioral health issues including substance use disorders, overdose, mental illness, historical and intergenerational trauma and suicide is critical to dealing with the coronavirus pandemic.

COVID-19 has made it even more critical to improve access to healthcare for Native Americans. Telemedicine allows people in tribal communities to connect with a healthcare provider safely and can be transformative in tribal communities.

There is a severe lack of housing and water infrastructure in Native communities. A lack of adequate housing means many generations often live under one roof where the younger generation could endanger tribal elders. And many people in Indian Country do not have running water which negatively impacts the ability to stop the spread of the virus. Thirty-six percent of people on the Navajo reservation do not have access to running water. Because the virus will be with us for some time, unfortunately, now is the time to invest in critical infrastructure such as housing and to provide access to running water for Native American families.

Finally, in the short-term, there should be a significant investment in community health aides. For instance, on the Navajo reservation hundreds of community health representatives, or CHRs, monitor the health of community members and visit and assess the elderly, many of whom speak only Navajo, delivering medication and making hospital referrals. Because the CHRs are community members, they can help ensure that community members practice safe practices and provide much needed services. It is also imperative that the CHRs receive personal protective equipment.

While these actions are not a panacea, they are necessary measures to curb the current crisis.

Mary Smith, an enrolled member of the Cherokee Nation, was a past senior leader of the U.S. Department of Health and Human Services, and the past chief executive of the Indian Health Services which provides health care to over 2.2 million Native Americans.

Daughter, Native American, former CEO, citizen

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Mary Smith

Mary Smith

Daughter, Native American, former CEO, citizen

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