There are many populations throughout the United States and the world that are disproportionately affected by the COVID-19 pandemic. One of these groups is individuals living on the 326 Native American reservations in the United States, comprised of the 574 recognized Native Nations.
Many factors contribute to the disproportionate COVID burden on reservations, including limited access to healthcare caused by historic governmental neglect. While there are not any Native American reservations in Vermont because the Native Nations that were here ended up in Canadian reservations, this is an important national issue as it greatly affects a significant population of our country.
Native American reservations have experienced higher levels of COVID-19 than many other regions in the United States.  Research in April looked at many reservations (287 out of 326) and compared the rate of COVID-19 cases on those reservations with the national rate. It found an average rate of 0.24 COVID-19 cases per 1,000 people on the Native American reservations while the national rate was only 0.057. In other words, the COVID infection rate on the Native American reservations was more than four times higher than that of the total United States population. Death rates are also higher. The Navajo Nation, which is the largest Native American nation in the United States, had a higher COVID death rate than any state in the U.S. as of Oct. 8.
COVID infection and death rates are higher on reservations for many reasons. First and foremost, folks living on the reservations have a long history of being neglected by the government. As a result, reservations tend to have insufficient medical resources, including limited access to health care facilities and supplies (including COVID tests), which likely contributes to the high COVID infection and death rates. According to a report from the U.S. Commission on Civil Rights, in 2017 the United States government reported an average expenditure of $9,207 per capita for health care, but allocated only $3,332 per capita for expenditures by the Indian Health Service, the federal agency that provides health care funding for the Native Nations.
During the COVID-19 pandemic, the first $2.2 trillion economic stimulus package passed last March was also unevenly distributed. On average, there was $6,703 in stimulus funding per person throughout the nation as a whole, but only $4,552 per person on the Navajo Nation Reservation. Traditionally, the way the reservations have addressed their gap in funding is through their businesses that bring in money, such as casinos. Because of the COVID-19 pandemic, these businesses have been closed, and funding is quickly diminishing.
Limited health care support is one of several factors that contributes to the high rates of COVID-19 cases on the reservations. Other factors include communication barriers, a relative lack of indoor plumbing, and overcrowding of households and public spaces. There are many languages spoken throughout the Native Nations, which makes communication of public health guidance about COVID-19 particularly challenging. Additionally, the lack of indoor plumbing makes sanitation difficult, which likely enables the disease to spread faster. Lastly, the overcrowding of households and public spaces precludes physical distancing, which makes the virus more likely to spread.
There are many reasons that those living on Native American reservations are more susceptible to some diseases and are not able to receive proper care. This is a big issue especially during this pandemic, but what has happened during COVID-19 is only the latest illustration of health disparities on reservations. A hundred years ago during the 1918 flu pandemic, 12% of the Navajo Nation died, compared to a global average of 2.5% to 5%. As long as this COVID-19 pandemic persists, those living on reservations are going to continue to struggle in ways exacerbated by historical and social issues that have persisted throughout time.
References
(1) Rodriguez-Lonebear, D.; Barceló, N. E.; Akee, R.; Carroll, S. R. American Indian reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic. J. Public Health Manag. Pract. 2020, 26 (4), 371–377. journals.lww.com/jphmp/Fulltext/2020/07000/American_Indian_reservations_and_COVID_19_.14.aspx.
(2) Wagner, D.; Grantham-Philips, W. “Still killing us”: The federal government underfunded health care for Indigenous people for centuries. Now they’re dying of COVID-19. USA Today, 26 October 2020. usatoday.com/in-depth/news/nation/2020/10/20/native-american-navajo-nation-coronavirus-deaths-underfunded-health-care/5883514002.
 (3) Liz Mineo. For Native Americans, COVID-19 is ‘the worst of both worlds at the same time.’ Harvard Gazette, 8 May 2020. news.harvard.edu/gazette/story/2020/05/the-impact-of-covid-19-on-native-american-communities.