Those who can’t remember the past are destined to repeat the same mistakes– At least, according to the philosopher George Santayana. Most of us simply shorten it to history repeating itself. But in terms of healthcare, is this true? A look at the history of Native Americans shows that it is.
During the 1918 influenza pandemic, The global mortality rate ranges from 2.5% to 5%. However, for the Navajo people, the death rate is as high as 12%. If this sounds familiar, it is because a century later, the Native American reservations have once again suffered catastrophic Covid-19 infection and death rates compared to other parts of the United States.The Navajo Nation has one The Covid-19 death rate is higher than any state in the United States. A CDC study found American Indians and Alaska Natives are 3.5 times more likely than others The number of people diagnosed with the coronavirus is four times that of whites, and the likelihood of being hospitalized is four times that of whites.While at the same time 35% of Native Americans who died of Covid-19 were under 60, This only applies to 6% of white Americans.
Why do we see the same pandemic pattern appear twice? More importantly, what can we do to stop the next medical crisis in India?
The answer to the first question is simple: a Bridge to economic, cultural and medical barriers Link the two epidemics. The answer to the second question involves their demolition-but it is more complicated.
Economic barriers
As we all know, tribal facilities are underfunded. U.S. Civil Rights Commission Report It was revealed that the United States allocated US$9,207 per capita for health care in 2017, but allocated US$3,332 per capita for health services in India.Yes, that was four years ago-but the first $2.2 trillion Covid-19 stimulus plan in March 2020 was Also unevenly distributedThe stimulus funds cover US$6,703 per person in the United States, but the Navajo Nation Reservation only covers US$4,552 per person.
This lack of funding means a lack of medical resources, which may limit access to care and Covid-19 testing and treatment. Although tribal communities usually try to make up for these funding gaps with casino profits and other business income, the pandemic closure makes this difficult.
Cultural barriers
Although mainstream media tends to describe Native Americans as a homogeneous group, there are 326 Native American reservations in the United States, and 574 recognized indigenous peoples. Dialects and languages may differ between communities. Limited Internet coverage may also make it difficult for tribal residents to access websites, social media, and other digital information. These factors posed challenges to the Covid-19 public health campaign, many of which failed to reach the target audience.
Health issues also play a role in helping infectious diseases spread more quickly. In some tribal communities, as many as 35% of households do not have indoor plumbing, making it difficult to wash their hands. A crowded house may contain up to 15 or more family members, which makes it easy for one person to infect others.
During the Covid-19 pandemic, Dr. Vikar Shankar practiced medicine in the Peace Corps in sub-Saharan Africa and the New York City ICU department. He said that nothing in his previous experience was similar to the poverty he observed in tribal communities. “See it I am shocked by the devastating impact of our Covid case,” he said. “At some point, it seemed that everyone who stepped into our emergency room was infected.”
Finally, the past experiences of Native Americans Unethical medical practices at the hands of the U.S. government A large amount of distrust of traditional healthcare plans has been cultivated. The initial vaccine trial report was met with skepticism-but in the end, the participation and advocacy of community elders encouraged a high level of participation in the tribal vaccine program.
Medical barriers
Indian Health Service (IHS) Clinic The average supplier vacancy rate is 25% -Estimated annually Their doctor’s turnover is 46%. This may be because more than half of American Indians live in rural areas, where there is the greatest shortage of suppliers. These shortages may force locals to spend hours on nursing care or skip services altogether. Even if they do receive treatment in a remote clinic, they are unlikely to have a consistent relationship with a doctor who understands their long-term health.
Finally, the high incidence of chronic diseases in tribal communities has exacerbated the catastrophic impact of Covid-19. A quarter of Native Americans are food insecure, Something that drives High incidence of diabetes, hypertension, chronic respiratory diseases and heart disease In indigenous communities-making them particularly vulnerable to the virus.
Build healthcare resilience in tribal communities
The removal of the aforementioned obstacles will not happen overnight, but tribal healthcare leaders are leading the way. Some strategies include:
- Enrich the pipeline of indigenous talents. Native Americans account for only 0.04% of doctors, which means that young Native Americans rarely see native clinicians and may not consider a career in medicine. Increasing the diversity of clinicians can build trust in healthcare providers to a large extent.
- Culturally informed care. Cultural competence training helps providers understand community values and nuances. For example, although medical students are taught to make eye contact with patients, looking directly into the eyes of Apache elders may be a sign of disrespect. Traditional indigenous therapies also help to promote more active participation of patients.
- Staffing agility. Current staffing challenges in tribal areas will not be solved overnight, but local staffing and telemedicine can expand existing coverage. On-site clinical training can help local providers learn new care delivery methods and build community confidence in their local resources.
- Behavioral health resources. Native Americans have one of the highest death rates Alcoholism and Fetal Alcohol Spectrum Disorder In the U.S.–and Suicide rate among American Indians It has increased by 139% since 1999. Combining elementary, emergency, and behavioral expertise with comprehensive support is essential to create healthier indigenous communities and economies.
- It is more representative in clinical research. Moderna and Pfizer’s vaccine trial The proportion of Native American participants is disproportionately low, According to the fact sheet of the Food and Drug Administration-0.8% and 0.6% respectively, of which the Native American population is 1.7%. Improving research diversity can not only improve clinical results, but also increase community trust in new therapies.
The Covid-19 pandemic is not completely over, which means that now is the best time to implement transformative healthcare strategies in Indigenous communities. At some point, another pandemic is almost inevitable-but the disproportionate impact on indigenous peoples may be a thing of the past.
Photo: grandriver, Getty Images
