SciLine interviewed: Dr. Nicole Redvers, ND, MPH, an assistant professor in the Indians into Medicine program and in the Department of Family & Community Medicine, School of Medicine & Health Sciences, University of North Dakota. She is also a licensed practicing naturopathic doctor and an enrolled member of the Deninu K’ue First Nation.
Is COVID-19 having a disparate impact on American Indian and Alaskan Native populations?
NICOLE REDVERS: I think that’s a really important and relevant question to ask. And I think given some of the information that’s come out lately with ethnicity disparity, it’s very worthy of the question. And across the board in the United States, we’re seeing multiple pieces of evidence to back up this question of disparity in American Indian and Alaskan Native populations. In fact, in places like New Mexico, American Indian and Alaska Natives make up 43% percent of the cases, but only 10% of the population. Similarly, in Wyoming, 20% of the cases and 3.7% of the population. Mississippi, 4.5% of the cases and less than 1% of the population. So clearly, we’re seeing the disparity across the board, not necessarily dependent on the state. It really is across all regions that we can tell at this point in time.
Can you describe what’s happening as far as serious illnesses and deaths in these groups?
NICOLE REDVERS: Yeah, the American Public Research Lab has done a great estimate of race-related data in terms of effects of death and mortality. And right now, as of a few days ago actually, about 1 in 1,300 Black Americans have died of COVID-19, whereas in indigenous populations, it’s just over 1 in 1,600. And this is compared to about 1 in 3,200 white Americans. So clearly, the, you know, adjustment is much, much higher. In fact, it’s about 3.5 times higher, the risk of dying, if you’re an American Indian or Alaskan Native from COVID-19. And even putting death aside, if we look at chronic disease, illness, we have about 34% of American Indians and Alaska Natives between the ages of 18 and 64, which is not even considered the highest risk range. Most often, of course, apply to the over 65 who are at much higher risk of severe illness compared to about 21% of white people.
So, you know, with these disparities existing, we can see that race, age, socioeconomic status clearly amplifies the impact of the new coronavirus. And in fact, we can often have double or triple disparities within the American Indian and Alaska Native communities in the United States.
What are some of the causes of those disparities?
NICOLE REDVERS: Absolutely. You know, the rates, unfortunately, of poverty and many of the social determinants of health are exponentially increased within our indigenous populations within the United States. And, you know, this poverty is across the board in terms of lower socioeconomic impacts, of course, less jobs, resources, but also less access to adequate health services, you know, in many regions. The unfortunate part is a lot of this stemmed from unfortunate underfunding of the Indian Health Service system, which has been a problem for decades.
And due to this lack of infrastructure within our IHS health systems, in addition to the public health infrastructure, you know, it wasn’t unexpected that we had this problem. In fact, we couldn’t expect anything other than what’s occurring right now. When you don’t have the infrastructure in place to do contact tracing, to do, you know, testing, to be able to treat adequately, you know, we’re going to have these issues. And one fact I’ll throw out there, which I think a lot of Americans don’t realize, is that the amount of money that’s spent on an American Indian or Alaska Native’s health is actually much lower than what we spend on our federal prisoners in the United States.
What specific measures could curb the spread of COVID-19 among Indigenous groups?
NICOLE REDVERS: Well, if we look at COVID generally, you know, from an infectious disease standpoint as well as from a public health standpoint, the three T’s are incredibly important. The first T being, of course, testing, the second T being contact tracing and then the third T being treatment. And without having adequate public health infrastructure, that testing and tracing becomes very difficult to do. So to be able to, you know, stem the tide of increase within our indigenous nations, we really have to be putting resources into building up the public health infrastructure within these communities so they have a fighting chance to be able to get ahead of the curve and start to make impacts preventively in their communities. Now, this is across the board in many communities across the United States. Unfortunately, it’s exponentially increased within indigenous nations.
What do you think is missing in the conversation about COVID-19 and Indigenous Populations?
NICOLE REDVERS: I think one of the most important pieces that are most often missed in this conversation is the right of health care that American Indian and Alaska Natives have within the United States. In fact, they’re the only population born with the right to health care. And this is premised on treaties that were longstanding. And unfortunately, the federal government hasn’t lived up to those treaties. And we’ve seen, of course, the consequences of that due to the underfunding of many of our social systems.
So even despite having that right to health, right to housing, in return, of course, for giving away and oftentimes not giving away much of our land bases, we still see that enshrined within our laws of the United States. So I think this is an important piece that many of our native organizations have been trying to put forward, is just reminding Americans and also government that this is a responsibility. It is the federal government’s responsibility to ensure the health of American Indian and Alaska Native communities, regardless of COVID, but more important given the pandemic times we’re in now.
Is there a question we didn’t ask that you’d like to answer?
NICOLE REDVERS: One thing that often comes up in terms of the questions is some of the ability to prevent. For example, on Navajo Nation and in a lot of the reservation communities, there’s a complete lack of access to clean water and often electricity. So the ability to do basic public health measures, such as being able to wash hands, being able to clean, but also to be able to access good information due to not having electricity, let alone having an Internet connection. So these provide additional barriers. And in the last case, being as many of our indigenous homes are – often have multiple generations or multiple families living inside. So the ability to self-quarantine becomes very difficult when you have three families living with them if the infrastructure is not in place in a community to be able to support those people through that process. So lots of barriers that we face, but important that we face them.