As the coronavirus pandemic spreads around the United States, there's been a common refrain uttered, perhaps in hopes of igniting unity: that the virus doesn't discriminate, and it can impact you no matter who you are. While that may be true, the U.S. health care system and the country's systemic inequality does discriminate — and the evidence is clear within the disproportionate impact of the virus on Native American populations.
According to CNN, the Navajo Nation, the largest reservation in the United States, has faced unique challenges that have led to a death toll higher than that of 13 different states combined. NBC reports that the Nation, which stretches across three states, saw its first COVID-19 case on March, and as of Monday has had 1,197 positive cases. The Navajo Nation has a per capita infection rate 10 times higher than that of neighboring Arizona and the third-highest infection rate in the country behind those of New York and New Jersey.
And that's just the numbers we know about — a report from The Guardian found that Native Americans are being left out of demographic data on the impact of the coronavirus across America, raising concerns about uncovered health emergencies.
Valarie Blue Bird Jernigan, director of the Center for Indigenous Health Research and Policy at Oklahoma State University, tells InStyle that indigenous people face a concentration of risk factors at the individual, systemic, and policy level that put them at greater threat for poor health outcomes.
"Many Native communities are in rural areas where there is an extreme shortage of health care providers, the health care systems are underfunded, you have to drive a very far distance to get medical care," she says. "In extreme cases, you have very rural communities with no electricity or running water. All of those risk factors lead to poor health, and we have them all."
Jernigan says that historical context also comes into play — Native people have agreements with the U.S. government in the form of treaties that exchange land for services, including medical care, such as the Indian Health Service.
"However, unfortunately and sadly, the U.S. government has not held up their end of the agreement by appropriately and adequately funding the Indian Health Service," she says. "As a result, you see the high rates of chronic diseases and, when a crisis like COVID-19 emerges, the underlying inequities in the system."
On Wednesday, the Navajo Nation, along with ten other tribes, filed a lawsuit against the U.S. Secretary of the Treasury in an effort to secure their "fair share" of federal COVID-19 funding. Jernigan adds that while we're seeing delays in coronavirus testing across the nation, there's been a disproportionate impact on rural areas and Native nations due to the delayed and limited funds.
"State health departments and their epidemiologists don’t regularly communicate with Native nations," she says. "And few Native nations actually have their own epidemiologists. Without epidemiologists and constant communication where the disease is, where and how it is spreading, you cannot properly plan."
For now, the Indian Health Service has sought medical experts for mobile critical care teams to help treat COVID-19 patients in Indian Country, citing an inadequate supply of health professionals with emergency medicine or critical care knowledge and skills. The Service has also expanded telehealth services to in hopes of increasing health care access.
While minority communities like Native Americans and Black and Latinx people are not more susceptible to the virus itself, longstanding and persisting economic inequalities and differences in access to health care have caused deadly disparities in impact from the coronavirus. Moving forward, Jernigan says, "there has to be a prioritization of health care and public health in the U.S. that does not exist under this current administration — we’re seeing the consequence of that."