It is both devastating and unsurprising that COVID-19 is impacting and killing indigenous communities at disproportionately high rates. Indigenous communities, which are inclusive of people who identify as American Indian and Alaska Native, have long faced systemic oppression in this country and this is reflected in poor health outcomes. Indigenous communities experience disproportionate rates of disease such as heart disease and have a life expectancy that is 5.5 years shorter than the national average.
As a Native American woman and as the newly elected board chair of Health Equity Solutions—a nonprofit focused on advocating for health equity in Connecticut and which is working to center equity in COVID-19 response efforts— I am concerned by the absence of Native American voices in the state’s pandemic response and recovery planning.
When I saw this piece in the New York Times, I immediately wondered about the underlying vulnerabilities of communities closer to home, here in Connecticut. The essay points out the disproportionate impact of COVID-19 on people in Navajo Nation, where the incidence of COVID-19 per-capita is only rivaled by rates seen in New Jersey and New York. While data on AI/AN disparities is available nationally, state level data is much more inconsistent and difficult to come by. Analysis by the Guardian highlighted that only half of states reporting race and ethnicity data on COVID-19 include AI/NA in these reports.
According to the 2018 American Community Survey, 1% of Connecticut residents identify as American Indian or Alaskan Native. Connecticut recognizes five tribes and has six reservations; however, racial and ethnic data on COVID-19 cases and related deaths are limited to Hispanic, Non-Hispanic White, Non-Hispanic Black, and Non-Hispanic Asian. Among Connecticut’s positive COVID-19 cases, 37% are missing any racial or ethnic data. Evidence demonstrates that AI/AN populations have a greater likelihood of having their race misclassified in surveillance and on death certificates and are the U.S. Census’ most undercounted racial group. In addition to incomplete data collection, data suppression—the exclusion of categories with very small numbers to maintain privacy—is a barrier to publicly reporting data on smaller communities. This leads to significant underestimates of the burden of disease and mortality in these communities.
So, how can we as a state ensure that the needs of these communities are not overlooked in Connecticut’s response efforts? Inclusion and outreach.
When a state appoints a person or group to consider the needs of traditionally underserved communities, those needs are less likely to be forgotten or assumed to be in alignment with needs within the state on average. Intentional inclusion means recognizing and addressing the disproportionate social and economic burdens faced by some communities.
Outreach means making sure all communities have information about and access to services. Engaging tribal leadership and tribal health and community groups can ensure that unintentional harm is avoided. For example, outreach to assess the accessibility of testing and case tracing strategies to AI/AN communities could provide needed information to adjust these initiatives so that they are culturally, linguistically, and physically accessible to our communities. Ensuring that the forthcoming strategy for reopening the state intentionally embeds health equity and includes outreach to native communities can help the state to minimize preventable death and illness.
The barriers to health faced by indigenous communities are not new and the solutions are well grounded in evidence. COVID-19 highlights and offers us the opportunity to see, acknowledge, and address the inequities in our midst.
Michele Scott is Executive Director of the Health Education Center / Mashantucket.