Society of Bioethics and Medicine
Inequity and Indigenous People: The COVID-19 Crisis
Written by Elizabeth Badalov
Edited by Anling Chen
The COVID-19 pandemic has drastically shifted the norms which dictate how people interact with each other. These effects are felt not only on the individual level, but throughout entire communities and populations. Social distancing restrictions advise physical separation from loved ones to minimize the spread of the virus and protect at-risk individuals. Unfortunately, distance is a luxury few can afford - especially for members of the Navajo Nation.
Throughout the US Indian Reservation of northeastern Arizona, southeastern Utah, and northwestern New Mexico, the Navajo tradition of intergenerational households is what has kept Native American culture alive through crises for centuries. But the COVID-19 pandemic has jeopardized even this lifeline, as crowded homes are one of the deadliest places to be amidst a public health crisis.1 Residence in multigenerational homes is central to the cultural resiliency of the Navajo people, as multigenerational interactions are essential to communicating important aspects of Navajo culture to future generations. A wealth of knowledge of culturally-specific healing practices, medicinal herbs, and traditional food is shared. Engaging within close living quarters, Navajo elders pass down language, ceremonies, and songs to younger generations, facilitating the spread of Native culture and tradition. Unfortunately, close living quarters also facilitate the spread of disease. One of the Navajo community’s greatest strengths has become tragically fatal during the pandemic. Native communities are hit harder than any other US population, burdened by a hospitalization rate 3 times higher than that of White communities, and a mortality rate 2 times as high.1
The drastically higher COVID mortality and morbidity rates suffered by Native populations are yet another indicator of the historical marginalization they have faced within the United States. Notwithstanding the pandemic, “normal” living standards on the Navajo Nation mean “a lack of clean water and health services, and higher levels of overcrowded, substandard housing.”1 Prior to the pandemic, Native populations reported higher rates of chronic illness and lower overall life expectancies, exacerbated by a rural lack of access to healthcare centers and insurance.2 Native American populations are more likely to live in food deserts, and the lack of access to healthy nutrition is “a contributory factor to the community’s high rate of diabetes, obesity, and heart disease.”³ These inequities indicate that the Navajo population is disproportionately vulnerable to COVID-19, and yet Native communities have not been and are not prioritized. The Indian Health Service (IHS), a federal organization dedicated to delivering healthcare to Indigenous communities, is granted a $6 billion budget to cover the health needs of an estimated 2.5 million people.³ Although not all Indigenous people rely solely on the IHS to meet their healthcare needs, this budge per capita “represents far lower resources than that of Medicare, Medicaid, and the Veterans Health Administration.”³ In April 2020, when $8 billion in COVID-19 relief aid was allocated to tribal governments as part of the CARES Act for necessary supplies and funds, there was a seven week delay in the distribution of this support.2
The COVID-19 pandemic has highlighted great disparities in the way that healthcare and other basic resources are allocated to members of the US population. The United States, as a nation, can only be as healthy as its most vulnerable communities. The tragedies that the Navajo people have faced amidst the pandemic are a sign of the urgent need for structural reform, both at the tribal and federal level. Navajo land is in need of proper infrastructure, such as access to quality healthcare and running water. This infrastructure subsequently plays a large role in pandemic prevention and preparedness. Quality healthcare can help address comorbidities, potentially lowering the risk of contracting COVID among at-risk individuals. Handwashing is an essential preventive measure, one that becomes a challenge without access to running water. Funding is further necessary to provide affordable housing options, as living space in the Navajo Nation is “generally smaller and 6.5 times more overcrowded than the average U.S. home.”1
Additional efforts must begin with a recognition of the inequities that marginalized populations, such as the Navajo people, have endured. Though large-scale infrastructural reform takes time and cannot undo years of neglect, there are creative fixes that can make the difference between life and death for the Navajo community. Personal protective equipment can be distributed on Navajo land to curb the spread of infection among families living in close quarters. Government-funded hotel quarantine stays, culturally informed vaccination efforts, and the construction of temporary shelters are also measures that provide options for families. Despite the logistical challenges posed by delivering resources to remote areas, it is imperative to tend to the needs of populations who have been overlooked.
These measures will not only save human lives, but the life of a rich culture whose longevity is at stake. Two-thirds of COVID-related deaths are Navajo elders over the age of 65, and younger generations worry that important traditions and cultural knowledge will fade with them.¹ The pandemic has already taken the lives of “scores of elders, custodians of the languages, history, and traditions of Native Americans.”³ If COVID continues to ravage Native populations, the losses at stake cannot be quantified by numbers alone.
1. Sadler H, Woehr D. For Navajo, crowded homes have always been a lifeline. The pandemic threatens that. The Washington Post 2021.
2. Robbennolt S. Historical Marginalization Has Left the Navajo Nation Uniquely Vulnerable to COVID-19. Prosperity Now 2020.
3. COVID-19 among American Indians and Alaska Natives. Burki, Talha. The Lancet Infectious Diseases, Volume 21, Issue 3, 325 - 326.
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