Dublin Core
Title
Report on COVID-19 impact on New Mexico Indigenous Tribes
Subject
COVID-19 impact on Indigenous Tribes
Description
An in-depth statistical and critical analysis of the impact of COVID-19 on the disparate Native tribes in New Mexico and also a deep critique of existing mechanisms and structures that create discriminatory healthcare and bad policies.
Creator
Carmel M. Roybal
Source
University of New Mexico
Publisher
University of New Mexico
Date
June 2020
Format
doc, pdf
Language
English
Type
Dissertation, Paper
Text Item Type Metadata
Text
Intersections of Inequality: Tribal Peoples and Native Nations and Coronavirus Pandemic
Carmela M. Roybal, MA MBGPH
Ph.D. Candidate, University of New Mexico
The novel coronavirus has had a disparaging impact on health, education, employment, and cultural impact on tribal populations. In turn, tribal populations have taken exemplary precautions and actions to protect their people during COVID-19. Tribal populations have experienced extreme health and educational disparities, political disenfranchisement, food insecurity, and the lack of economic mobility, to name a few issues. These and other pre-existing conditions are the foundation for the present and long-term impacts that the indigenous population of the United States will experience if not radically addressed.
The following report is intended to inform the Special Rapporteur on the rights of indigenous peoples to the General Assembly on the impact of COVID-19 on indigenous peoples. The current report will cover pre-existing inequalities that have exacerbated education and health disparities. It will cover the challenges and responses to sovereignty, potential human rights violations, best practices, the unequivocal resilience of indigenous peoples and Native Nations, and the first peoples of the U.S. continent. I will start by saying this report does not cover all tribes and does not represent all 578 federally recognized tribes and indigenous peoples. Case studies do not represent all 50 states and will represent only several tribes at most. In addition, this report will mention tribal and Indigenous populations that are in the margins and due to nonfederal status, nativity, or mixed-race status are not eligible for tribal, state, and federal aid.
Pre-Existing Health Conditions
In more recent years, Native Americans have been impacted by contemporary epidemics such as those related to diabetes, suicide, addiction, and HIV, all of which have negatively impacted tribal populations (Roybal 2020). Such contemporary epidemics illustrate the current state of health among tribal peoples and residual effects of centuries of colonization.
New Mexico
In the state of New Mexico, tribal nations have been hit extremely hard by the pandemic. Tribal and community responses have been extraordinary, as tribal nations have exercised sovereignty through border closures, curfews, and policies to protect their communities. Despite the failures of the federal government, tribal nations within the state of New Mexico have taken important measures to help not only their communities but those around them. The state of New Mexico has 23 federally recognized tribal nations, not including genizaros or non-federally recognized indigenous populations. In New Mexico, tribal peoples represent roughly 11% of the state’s total Native American population (US. Census 2010) yet represent 54% of the state’s total positive COVID-19 cases (NMDOH 2020).
New Mexico Tribal Rates
The Navajo Nation is the second largest tribal nation in the United States with approximately 298,197 members (U.S. Census 2010). The Navajo Nation reservation reaches into four states, New Mexico, Arizona, Utah, and Colorado, in an area known as the Four Corners. To date the Navajo Nation has reported 6,110 cases of COVID-19 and 277 confirmed deaths, with a rate of 35.3 cases per 1,000 residents (NMDOH 2020; Navajo Nation Health 2020). According to Navajo Nation President Jonathan Nez, more than 15% of the total population has been tested. Roughly, 3.5% of the Navajo peoples have been tested for COVID-19. The nation has enforced tribal closures, curfews, and lockdowns to stop the spread of the virus.
In addition, several of the Pueblo Indian tribes have also been hit extremely hard by COVID-19. Pueblo communities across New Mexico immediately closed their borders to nontribal people. Pueblo governors instituted lockdown orders The Pueblo of San Felipe experienced an early onset of community spread with a total of 134 positive COVID-19 cases. Zia Pueblo reported 93 cases, and Santo Domingo Pueblo reported 36. The remaining pueblos reported less than 20 cases as sharp measures and polices were put into place to stop the spread and address the healthcare needs of the individual nations. The Jicarilla Apache Nation reported two cases, while Mescalero Apache reported 2 cases.
Human Rights Violation--- Policies Currently Violating the Rights of Indigenous Women and Infants.
One prominent hospital in Albuquerque, NM enacted a policy that separates Native American newborns from their mothers as soon as a response to COVID19. According to news sources, the hospital screens all patients and if a woman appears to be Indigenous, they would be racially profiled. If the women registered under a tribal zip code they would be immediately separated from their infants after birth. The current story was released last week. The policy deprives women and children of one of the most important bonding moments in the lives of these families. http://nmindepth.com/2020/06/13/albuquerque-hospitals-secret-policy-separated-native-american-newborns-from-their-mothers/
Best Practices the State of New Mexico
Tribal Practices, Closures, Lockdowns, and Curfews
Tribes across the state of New Mexico closed their borders to nontribal members to prevent the spread of COVID-19. The Navajo nation and other pueblos have been on strict lockdowns. In the several of the pueblos closing borders has proven to extremely successful in protecting tribes from community spread. Tribal lands across the state remain close, and tribal authorities fight to keep their communities safe.
Designing Emergency Response Plans
According the CEO of Kewa Health in Santo Doming Pueblo, the pueblo was able to isolate exposed individuals, everyone with positive cases, and stop community spread. The tribe does not depend on federal funding and used all internal resources to stop the spread of COVID 19 within the pueblo. According their CEO of Kewa Health, the tribe was successful because they previously designed emergency plans prior to the outbreak, in addition they were able to keep all of their health services open to tribal members so that tribal members did not have to leave the pueblo and risk being infected. The one challenge that he noted is the interference with the Bureau of Indian Affairs, who entered the pueblo and released homeless individuals who were Covid19 positive and were sheltered in community housing.
Opening of Tribal-Owned Hotel to Isolate
The pueblo of Pojoaque has graciously opened their casino to house individuals who need to be quarantined due to COVID19. Governor Talachy of Pojoaque Pueblo opened doors to all tribes in New Mexico. Tribes across the state can send individuals who have been exposed or test positive to the tribe’s hotel located in the Pojoaque Valley, New Mexico.
State Tribal Collaboration
The New Mexico Indian Affairs Department (NMIAD) prepared a tribal response plan. It included immediate steps, such as the activation of an incident command center, strategies for preventing the spread across tribal communities, testing, early identification, and isolation of individuals with confirmed cases. The department’s efforts extend to well beyond a response plan, as the department worked collaboratively with local agencies to distribute food and PPE and to launch communitywide testing. In addition, the department collaborated with researchers at the University of New Mexico to evaluate the impact on tribes of COVID-19.
Federal Best Practices, Permanent Funding for Indian Health Service
Inadequate funding of the federal Indian Health Service (HIS) has impacted the health across tribal populations for decades. Tribal nations across the United States depend on IHS to meet their healthcare needs. In 1955, the service was established, and clinics and hospitals were built to address the healthcare needs of Native Americans. Today, only 26 hospitals, 59 health centers, and 32 health stations exist in the United States to serve 573 tribes and more than 5 million people. Federal funding of the IHS is discretionary, and spending is optional and varies by administration. The program is historically underfunded, making it difficult to serve patients across the country. In 2020, the U.S. Department of Interior announced a 14% cut in funding for tribal programs. According to the IHS chief medical officer, the entire IHS system had only 625 hospital beds, only six ICU beds, and only 10 ventilators. According to the Indian Health Board, only 16% of tribal providers reported receiving any type of federal resources, and only 4% received personal protective equipment.
Annexes:
Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 122
Tribal Communities and Nations in a Time of COVID-19 –
Carmela M. Roybal, MBGPH Ph.D. candidate, Department of Sociology Doctoral fellow, Robert Wood Johnson Center for Health Policy, University of New Mexico, USA Email: cmoral7@unm.edu
Abstract Indigenous nations across the United States and the globe are not strangers to epidemics and germ warfare. Over multiple generations of humankind, U.S. tribal populations have experienced one of the greatest downsizing of numbers on the planet: from nearly 17 million (Thornton 1987) to their current population of approximately 5.2 million (U.S. Census 2010) in the United States alone. Biological warfare, smallpox, and government policies have been used to reduce and wipe out entire nations. This article looks at the potential impacts of COVID-19 on tribal populations in the United States today, including the potential loss of elders, knowledge keepers, and language speakers. America’s indigenous communities today are aging communities, and significant portions of their populations are at risk of death due to the current health status of tribal populations, distance to medical resources, inadequate resources, and extreme poverty. Using insight from tribes in the American Southwest, this presentation will offer insight into sustainability for tribal nations, community ties, cultural capital, and resiliency as buffers to the virus.
Introduction Since the founding of the United States, indigenous populations across the North American continent have been subjected to disease, germ warfare, and existential threats by European settlers. The colonization of North America, also referred to as the North American holocaust (Thornton 1987), led to the eradication of nearly 12 million Native Americans. Today, the population of indigenous peoples in the United States is approximately 5.2 million. According to the Bureau of Indian Affairs (BIA 2016), there are 573 federally recognized tribes in the United States, not counting tribes fighting for federal recognition (https://www.ncsl.org). Historically, the indigenous peoples of the United States have been subjected to disease and illnesses brought by European settlers, including but not limited to smallpox, bubonic plague, chicken pox, cholera, diphtheria, influenzas’, malaria, measles, and scarlet fever. According to Carlos and Lewis (2012), the smallpox epidemic of 1781-82 in the Hudson Bay region of Massachusetts devasted indigenous populations living there. Studies suggest that the smallpox epidemic among tribal populations had a mortality rate of between 20% and 50% (Carlos and Lewis 2012; Fenner et al. 1988). In addition, the U.S. government facilitated a massive genocide by ordering the distribution by the U.S. military of smallpox blankets to indigenous peoples (Valencia Weber 2002). “In the old day blankets infected with smallpox were given to tribes in an effort to decimate Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 119 them” (Deloria 1970). Hopkins (1983) illustrated how colonists fostered the spread of the disease in order to break indigenous resistance and to facilitate land grabs by European settlers. An estimated 90% of the North American tribal population was reduced in the years following the European invasion (Thornton 1987). In more recent years, Native Americans have been impacted by contemporary epidemics such as those related to diabetes, suicide, and HIV, all of which have negatively impacted tribal populations. Such contemporary epidemics illustrate the current state of health among tribal peoples and residual effects of centuries of colonization. In 1955, the Indian Health Service (IHS) was established, and clinics and hospitals were built to address the health of Native Americans. Today, a total of only 26 hospitals, 59 health centers, and 32 health stations exist in the United States to serve 573 tribes and more than 5 million people. Federal funding of the IHS is discretionary, and spending is optional and varies by administration. The program is historically underfunded, making it difficult to serve patients across the country. In 2020, the U.S. Department of Interior announced a 14% cut in funding for tribal programs. According to the IHS chief medical officer, the entire IHS system had only 625 hospital beds, only six ICU beds, and only 10 ventilators (https://www.politico.com/news/ 2020/03/20/c o ronav i r u s - american - i n d i a n - health-138724). According to the Indian Health Board, only 16% of tribal providers reported receiving any type of federal resources, and only 4% received protective equipment since the start of the epidemic. According to the Center for Disease Control and Prevention (CDC 2020) the Coronavirus Preparedness and Response Supplemental Appropriation Act, 2020 (P.L. 116-123) $8.3 billion in emergency funding for federal agencies to respond to the COVID19 pandemic, $40 million which is to be allocated to tribes, tribal organizations, and health service providers. Divided across 573 tribes, this amounts to roughly $70,000 per tribe, barely enough to make ends meet. In the face of the COVID-19 pandemic, the IHS system is not prepared and is not funded to support the needs of everyday populations and offers little support. In this paper, I make several arguments. First, the failure of U.S. and state governments to address the social determinants of health among tribal populations and minorities has placed tribal populations at an elevated risk during this pandemic. Second, the lack of engagement and investment by national and state political leaders and policymakers have exacerbated health conditions across tribes, contributing to a shortage of investments in life-saving resources such as education, healthcare, internet access, and preventative care. Third, and most importantly, the indigenous peoples and tribal nations of North America possess community cultural wealth (Yosso 2005) that encompasses a multitude of strengths and measures that each tribe can call upon to ensure the protection of their communities.
Elevated Risk and Underlying Health Conditions
The current health profile for American Indians and Alaska Natives in the United States demonstrates deep disparities compared to other racial and ethnic groups in the United States. According to the CDC (2014), death rates among Native Americans are 50% greater than those of non-Hispanic Whites. Death records for both Native American men and women combined show that the leading cause of death in the United States is cancer, followed by heart disease (CDC 2014). Heart disease is a leading cause of death in the United States among all populations: Approximately 610,000 people die of heart disease every year (CDC 2017). Heart disease is a leading cause of death among Native Americans in the United States, with the CDC (2018) reporting 3,632 deaths among Native populations between 1999 and 2016. While other racial and ethnic groups have seen a decrease in mortality rates due to heart disease, Native American populations have not seen a substantial decrease in heart disease-related deaths since 1993 (CDC 2016). Between 1993 and 2017, there was an average of 100.4 deaths of Native American males across the United States per 100,000 population (CDC 2016). Heart disease is the second leading cause of death among Native American women (CDC 2017). The CDC (2015) reported that 17% of all deaths among Native American women were related to heart disease (CDC 2015). According to the CDC (2014), Native American men are 20% more likely to smoke cigarettes and are 30% more likely than non-Hispanic Whites to have high blood pressure. Native Americans died from heart disease at younger ages than any other racial and ethnic groups in the United States (CDC 2004). According to the CDC (2004), 36% of heart Eubios Journal of Asian and Int ernational Bioethics 30 (3) (April 2020) 120 disease-related deaths occurred before the victims were 65. Cancer is the No. 1 cause of death among Native American women and the second leading cause of death of men (American Indian Cancer Foundation 2014). While cancer rates decreased for non-Hispanic Whites over the past 20 years, Native Americans have seen a substantial increase (AICF 2014). Disparities in health outcomes vary across tribal nations. Some groups experienced elevated rates of diabetes, heart disease, and mortality rates compared to others. For example, Native Americans in New Mexico died at younger ages and have the highest percentage of children who will not outlive their parents. Native American toddlers between the ages of 1 and 4 have a premature death rate of 55.6 per 100,000, compared to the non-Hispanic White counterparts (-0.5 per 100,000). In South Dakota, the Pine Ridge reservation has one of the lowest life expectancies in the United States: 47 for men and 55 for women, compared to the U.S. life expectancy of 78.69 years for men and 81 for women.
Aging Populations, Knowledge Keepers, and Language Speakers
COVID-19 is attacking--and could decimate --America’s Native American populations in such a violent manner, killing vast numbers of men and women over the age of 25, that the tribes could be at risk of never recovering. More than just lives lost, the virus sweeping across America could wipe out tribal cultural knowledge and heritage, tribal traditions, and tribal languages. All are at a real risk. Especially vulnerable to COVID-19 are tribes’ elders. According to the American Community Survey (ACS), in 2011-2013, there were close to half a million Native American elders 65 and older. Some 35% of all Native Americans were concentrated in Arizona, Texas, New Mexico, Oklahoma, Florida, North Carolina, and New York. Elders are integral to tribal communities. Protecting the knowledge only they possess is at the forefront of tribal efforts everywhere. Ohkay Owingeh Pueblo of New Mexico, along with several other pueblos, have closed their borders and ordered tribal members to stay home. Ohkay Owingeh tribal members are actively assisting the community by distributing masks and cleaning products to the homes of elders. Ensuring their safety and the safety of the community is key. Protecting our elders is essential to sustaining traditions, language, and our cultural knowledge. At the pueblo where I live, Ohkay Owingeh, in New Mexico, the tribal leadership has positioned over the past few days cement barricades and signs, blocking entrances onto pueblo lands. No one from outside of the pueblo is allowed to enter. No one. Stay home, tribal members have been told. Only by self-isolation, tribal leaders believe, can COVID-19 be defeated. Other pueblos have taken the same or similar drastic and decisive measures. Michael Chavarria, governor of Santa Clara Pueblo and chair of All Pueblo Council of Governors describes “our mission is to protect the life and health and safety of all our members and employees of Santa Clara Pueblo, we had to close down our casino, golf course, restaurants, and all our entities” (KSFE, Santa Fe Public Radio 2020). He described the Tinancial hardship that his tribe is going through and the difTiculty of preparing for a threat that cannot be seen. He urged tribal members to not take anything or anyone for granted and reminded the community that no one is immune. President Nez of the Navajo Nation argued in public commentary that tribes once again have been forgotten. The Navajo Nation as of April 2, 2020, had 389 reported cases of COVID-19 (New Mexico Department of Health 2020). The Navajo Nation has since closed its borders and ordered a curfew for the nation. The Navajo Nation is one of the largest tribes in the United States with close to half a million members.
Community Cultural Wealth and Tribal Capital
If decisive action does not take place, COVID-19 has the potential to devastate communities. Yet despite pre-existing health conditions of many members of virtually every tribe, America’s tribes have the potential to buffer the effects of COVID-19 and to Tlatten the curve for their own communities. Tribal populations in the United States are no strangers to scarcity and life-altering pandemics. Tribal peoples of North America possess community cultural wealth. Community cultural wealth focuses on cultural knowledge, skills, abilities, and networks within communities and across communities (Yosso 2005). According to Yosso (2005), many of these skills go unrecognized and unacknowledged. Yosso (2005) described community wealth, an array of capital that exists within marginalized groups, including resistance capital, linguistic capital, navigational capital, and familial capital. Resistance capital refers to knowledge and skills that challenge inequality, where linguistic capital includes the intellectual and social skills gained through communication experience. Navigational capital refers to the skills of maneuvering through social institutions entrenched in structural inequalities. Familial capital refers to the cultural knowledge that’s nurtured among family or kin and community history and to social capital as networks and community resources. Tribal populations possess community cultural wealth that dates back thousands of years--since the creation of the universe and dissention of the Tirst peoples on mother earth. Building on Yosso’s (2005) forms of capital, I add tribal capital. Tribal capital is the strengths and resources that tribal nations possess in addition to other forms of capital that are speciTic to tribal populations that have gained federal recognition. Tribal capital includes but is not limited to sovereignty and federal recognition. Federal Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 121 recognition signiTies that the U.S. government has recognized the right of an Indian tribe to exist as a sovereign entity and that a government-to-government relationship exists (www.ncsl.org). Tribal sovereignty predates the formation of the United States and is recognized through the U.S. Constitution and numerous federal statutes and court cases. Tribal governments are on equal footing with state governments and have a government-to-government relationship with the federal government (National Conference of State Legislatures). In the case of the COVID-19 pandemic, sovereign nations could request aid from other sovereign nations, including countries such as Cuba, and from organizations such as the World Health Organization. During the American Indian Movement (AIM), members of that group received aid and support from Cuba and built a platform of solidarity around the globe. Where the federal government has failed tribes, tribal capital can be exercised to bring aid and support to the sovereign nations of the United States. In addition to sovereignty, tribal nations have traditional forms of government. Although, many tribes have one government, many have dual forms of government. Dual governments equate to traditional forms of government that follow indigenous governing bodies, separate from governing bodies that deal with the federal government or state governments. Traditional governing bodies can provide protection for communities and have an in-depth knowledge of community members and traditions and stand to protect the well-being and survival of communities. In-depth knowledge of the community allows for the recognition of peoples that may be at higher risk, including knowledge of any preexisting health conditions that community members might have. This allows for the isolation and immediate protection of elders and members whose health may be compromised-- and thus provides an added layer of protection, communication, and togetherness with nations. Since the coronavirus pandemic was declared, many tribes have closed their borders and provide food and medicine to elders. Tribal populations can close their borders to nontribal members. Many have internal resources such as hotels and casinos that could double as makeshift areas to house and protect elders. Others have access to food services that can deliver food and sustenance into tribal areas without members leaving reservation borders. Food services that normally serve tribal education, and adult service centers, and casinos can provide food for tribal members. Eliminating the need to enter crowded towns and urban centers to shop for necessities. There are many other resources available. It is time for tribal leaders to think outside of the box, in an effort to protect their nations at all costs.
Tribal Traditions and the Power to Survive
Tribal traditions and healing practices and a knowledge of medicines are an integral component of tribal nations. Understanding the COVID-19 pandemic from a traditional perspective reduces anxiety and reinforces inner strength. Dr. Rodney Haring, a Seneca tribal community member of New York, describes COVID-19 as creating “a time when people of cultures have an opportunity to reconnect and recreate. Reconnect to identity, person-in-environment, and place and time. A micro yet global self-evaluation. It’s also, perhaps, a sign to slow down, let the Earth rebalance, “take a breath” from the everyday hustle and bustle of human impression.” In some communities, art is being used to promote the use of masks and safety. One nonprofit, Dukes Up of Albuquerque, N.M., placed billboards across the city to promote the use of masks and to direct people to practice social distancing. The intention was to remove the stigma of wearing masks in tribal communities in an effort to protect the health and well-being of family. Together, the indigenous of North America will continue to thrive. Many are using their artistic skills to create awareness. Many communities are using song and dance to create unification and healing. Other communities are organizing prayer groups. Some are offering their art. As traditional people, we have the power to resist and to hold strong to elements that have provided mechanisms for survival for the past 2,000 years.
Conclusion In summary, there is an urgent need to support and protect tribal nations across United States and globally. Indigenous people in the United States and throughout the Americas are at great risk. Centuries of tribal downsizing efforts by the U.S. government and governments across the Americas have made indigenous peoples some the most at risk populations in the world. Until structural racism and the social determinants of health are addressed among tribal peoples their existence will be challenged.
References
APCG Chair J. Michael Chavarria Discusses The Impact of COVID-19 on Indian Country http://tinyurl.com/w75ew5v
Carlos, Ann M., and Frank D. Lewis. "Smallpox and Native American mortality: The 1780s epidemic in the Hudson Bay region." Explorations in Economic History 49, no. 3 (2012): 277-290.
Centers for Disease Control and Prevention, (January 2020). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Deloria, Vine.
Custer Died for Your Sins. An Indian Manifesto . (Sixth Printing.). Macmillan Company, 1970. Fenner, Frank, Donald Ainslie Henderson, Isao Arita, Zdenek Jezek, and Ivan D. Ladnyi.
Smallpox and its eradication. Vol. 6. Geneva: World Health Organization, 1988.Hopkins, Donald R., and George I. Lythcott. Princes and peasants: smallpox in history. Chicago: University of Chicago Press, 1983.
HufTington Post (President Nez, of the Navajo Nation). https:// www. h u f f p o s t . c o m / e n t r y / n a v a j o - n a t i o n - coronavirus_n_5e838c96c5b6871702a59ee8
National Indian Health Board https://www.nihb.org/ National Conference of State Legislatures: Legislative Newshttps://www.ncsl.org
Portman, Tarrell A.A., and Michael T. Garrett. “Native American healing traditions.” International Journal of Disability, Development and Education 53, no. 4 (2006): 453-469. https://www.politico.com/news/2020/03/20/coronavirus-americanindian-health-138724
Thornton, Russell. American Indian holocaust and survival: A population history since 1492. Vol. 186. University of Oklahoma Press, 1987.
U.S. Department of the Interior, Indian Affairs https://www.bia.gov/bia United States Census Bureau / 2010 Census.U.S. Census Bureau, 2010.Web. 1 April 2https://www.census.gov/topics/ families.html >. Valencia-Weber, Gloria.
"The Supreme Court's Indian Law Decisions: Deviations from Constitutional Principles and the Crafting of Judicial Smallpox Blankets." U. Pa. J. Const. L. 5 (2002): 405. Yosso,*
Tara J. “Whose culture has capital? A critical race theory discussion of community cultural wealth.” Race ethnicity and education 8, no. 1 (2005): 69-91.
Carmela M. Roybal, M.A., MBGPH
Carmela M. Roybal is a doctoral candidate in the Department of Sociology at the University of New Mexico. Her specialties include: medical sociology, bioethics, and public health with a focus on the study of race, gender, ethnicity, discrimination and health disparities. Her research uses intersectionality as a tool for examining racialized and gendered inequalities in health, with an emphasis on Indigenous peoples of the United States and globally.
In addition, Carmela is a doctoral fellow at the Robert Wood Johnson Center for Health Policy, She is a senior research fellow at the American University of Sovereign Nations (AUSN), where in 2017 she received her second master’s degree in Bioethics and Global Public Health, and is a member of the AUSN Board of Governors. She is currently a research assistant at the Native American Budget Policy Institute at the University of New Mexico, where she takes on critical policy projects that support the health and wellbeing of tribal communities across the state of New Mexico.
Recent publications include a sole-authored piece in the Eubios Journal of Asian and International Bioethics titled “Tribal Communities and Nations in a Time of COVID-19” and a co-authored chapter titled " “Cultivating Intersectional Communities of Practice: A Case Study of the New Mexico Statewide Race, Gender, Class Data Policy Consortium as a Convergence Space for Co-Creating Intersectional Inquiry, Ontologies, Data Collection and Social Justice Praxis,” in the Intersectionality and Policy Handbook, edited by Olena Hanvisky and Julia
Carmela M. Roybal, MA MBGPH
Ph.D. Candidate, University of New Mexico
The novel coronavirus has had a disparaging impact on health, education, employment, and cultural impact on tribal populations. In turn, tribal populations have taken exemplary precautions and actions to protect their people during COVID-19. Tribal populations have experienced extreme health and educational disparities, political disenfranchisement, food insecurity, and the lack of economic mobility, to name a few issues. These and other pre-existing conditions are the foundation for the present and long-term impacts that the indigenous population of the United States will experience if not radically addressed.
The following report is intended to inform the Special Rapporteur on the rights of indigenous peoples to the General Assembly on the impact of COVID-19 on indigenous peoples. The current report will cover pre-existing inequalities that have exacerbated education and health disparities. It will cover the challenges and responses to sovereignty, potential human rights violations, best practices, the unequivocal resilience of indigenous peoples and Native Nations, and the first peoples of the U.S. continent. I will start by saying this report does not cover all tribes and does not represent all 578 federally recognized tribes and indigenous peoples. Case studies do not represent all 50 states and will represent only several tribes at most. In addition, this report will mention tribal and Indigenous populations that are in the margins and due to nonfederal status, nativity, or mixed-race status are not eligible for tribal, state, and federal aid.
Pre-Existing Health Conditions
In more recent years, Native Americans have been impacted by contemporary epidemics such as those related to diabetes, suicide, addiction, and HIV, all of which have negatively impacted tribal populations (Roybal 2020). Such contemporary epidemics illustrate the current state of health among tribal peoples and residual effects of centuries of colonization.
New Mexico
In the state of New Mexico, tribal nations have been hit extremely hard by the pandemic. Tribal and community responses have been extraordinary, as tribal nations have exercised sovereignty through border closures, curfews, and policies to protect their communities. Despite the failures of the federal government, tribal nations within the state of New Mexico have taken important measures to help not only their communities but those around them. The state of New Mexico has 23 federally recognized tribal nations, not including genizaros or non-federally recognized indigenous populations. In New Mexico, tribal peoples represent roughly 11% of the state’s total Native American population (US. Census 2010) yet represent 54% of the state’s total positive COVID-19 cases (NMDOH 2020).
New Mexico Tribal Rates
The Navajo Nation is the second largest tribal nation in the United States with approximately 298,197 members (U.S. Census 2010). The Navajo Nation reservation reaches into four states, New Mexico, Arizona, Utah, and Colorado, in an area known as the Four Corners. To date the Navajo Nation has reported 6,110 cases of COVID-19 and 277 confirmed deaths, with a rate of 35.3 cases per 1,000 residents (NMDOH 2020; Navajo Nation Health 2020). According to Navajo Nation President Jonathan Nez, more than 15% of the total population has been tested. Roughly, 3.5% of the Navajo peoples have been tested for COVID-19. The nation has enforced tribal closures, curfews, and lockdowns to stop the spread of the virus.
In addition, several of the Pueblo Indian tribes have also been hit extremely hard by COVID-19. Pueblo communities across New Mexico immediately closed their borders to nontribal people. Pueblo governors instituted lockdown orders The Pueblo of San Felipe experienced an early onset of community spread with a total of 134 positive COVID-19 cases. Zia Pueblo reported 93 cases, and Santo Domingo Pueblo reported 36. The remaining pueblos reported less than 20 cases as sharp measures and polices were put into place to stop the spread and address the healthcare needs of the individual nations. The Jicarilla Apache Nation reported two cases, while Mescalero Apache reported 2 cases.
Human Rights Violation--- Policies Currently Violating the Rights of Indigenous Women and Infants.
One prominent hospital in Albuquerque, NM enacted a policy that separates Native American newborns from their mothers as soon as a response to COVID19. According to news sources, the hospital screens all patients and if a woman appears to be Indigenous, they would be racially profiled. If the women registered under a tribal zip code they would be immediately separated from their infants after birth. The current story was released last week. The policy deprives women and children of one of the most important bonding moments in the lives of these families. http://nmindepth.com/2020/06/13/albuquerque-hospitals-secret-policy-separated-native-american-newborns-from-their-mothers/
Best Practices the State of New Mexico
Tribal Practices, Closures, Lockdowns, and Curfews
Tribes across the state of New Mexico closed their borders to nontribal members to prevent the spread of COVID-19. The Navajo nation and other pueblos have been on strict lockdowns. In the several of the pueblos closing borders has proven to extremely successful in protecting tribes from community spread. Tribal lands across the state remain close, and tribal authorities fight to keep their communities safe.
Designing Emergency Response Plans
According the CEO of Kewa Health in Santo Doming Pueblo, the pueblo was able to isolate exposed individuals, everyone with positive cases, and stop community spread. The tribe does not depend on federal funding and used all internal resources to stop the spread of COVID 19 within the pueblo. According their CEO of Kewa Health, the tribe was successful because they previously designed emergency plans prior to the outbreak, in addition they were able to keep all of their health services open to tribal members so that tribal members did not have to leave the pueblo and risk being infected. The one challenge that he noted is the interference with the Bureau of Indian Affairs, who entered the pueblo and released homeless individuals who were Covid19 positive and were sheltered in community housing.
Opening of Tribal-Owned Hotel to Isolate
The pueblo of Pojoaque has graciously opened their casino to house individuals who need to be quarantined due to COVID19. Governor Talachy of Pojoaque Pueblo opened doors to all tribes in New Mexico. Tribes across the state can send individuals who have been exposed or test positive to the tribe’s hotel located in the Pojoaque Valley, New Mexico.
State Tribal Collaboration
The New Mexico Indian Affairs Department (NMIAD) prepared a tribal response plan. It included immediate steps, such as the activation of an incident command center, strategies for preventing the spread across tribal communities, testing, early identification, and isolation of individuals with confirmed cases. The department’s efforts extend to well beyond a response plan, as the department worked collaboratively with local agencies to distribute food and PPE and to launch communitywide testing. In addition, the department collaborated with researchers at the University of New Mexico to evaluate the impact on tribes of COVID-19.
Federal Best Practices, Permanent Funding for Indian Health Service
Inadequate funding of the federal Indian Health Service (HIS) has impacted the health across tribal populations for decades. Tribal nations across the United States depend on IHS to meet their healthcare needs. In 1955, the service was established, and clinics and hospitals were built to address the healthcare needs of Native Americans. Today, only 26 hospitals, 59 health centers, and 32 health stations exist in the United States to serve 573 tribes and more than 5 million people. Federal funding of the IHS is discretionary, and spending is optional and varies by administration. The program is historically underfunded, making it difficult to serve patients across the country. In 2020, the U.S. Department of Interior announced a 14% cut in funding for tribal programs. According to the IHS chief medical officer, the entire IHS system had only 625 hospital beds, only six ICU beds, and only 10 ventilators. According to the Indian Health Board, only 16% of tribal providers reported receiving any type of federal resources, and only 4% received personal protective equipment.
Annexes:
Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 122
Tribal Communities and Nations in a Time of COVID-19 –
Carmela M. Roybal, MBGPH Ph.D. candidate, Department of Sociology Doctoral fellow, Robert Wood Johnson Center for Health Policy, University of New Mexico, USA Email: cmoral7@unm.edu
Abstract Indigenous nations across the United States and the globe are not strangers to epidemics and germ warfare. Over multiple generations of humankind, U.S. tribal populations have experienced one of the greatest downsizing of numbers on the planet: from nearly 17 million (Thornton 1987) to their current population of approximately 5.2 million (U.S. Census 2010) in the United States alone. Biological warfare, smallpox, and government policies have been used to reduce and wipe out entire nations. This article looks at the potential impacts of COVID-19 on tribal populations in the United States today, including the potential loss of elders, knowledge keepers, and language speakers. America’s indigenous communities today are aging communities, and significant portions of their populations are at risk of death due to the current health status of tribal populations, distance to medical resources, inadequate resources, and extreme poverty. Using insight from tribes in the American Southwest, this presentation will offer insight into sustainability for tribal nations, community ties, cultural capital, and resiliency as buffers to the virus.
Introduction Since the founding of the United States, indigenous populations across the North American continent have been subjected to disease, germ warfare, and existential threats by European settlers. The colonization of North America, also referred to as the North American holocaust (Thornton 1987), led to the eradication of nearly 12 million Native Americans. Today, the population of indigenous peoples in the United States is approximately 5.2 million. According to the Bureau of Indian Affairs (BIA 2016), there are 573 federally recognized tribes in the United States, not counting tribes fighting for federal recognition (https://www.ncsl.org). Historically, the indigenous peoples of the United States have been subjected to disease and illnesses brought by European settlers, including but not limited to smallpox, bubonic plague, chicken pox, cholera, diphtheria, influenzas’, malaria, measles, and scarlet fever. According to Carlos and Lewis (2012), the smallpox epidemic of 1781-82 in the Hudson Bay region of Massachusetts devasted indigenous populations living there. Studies suggest that the smallpox epidemic among tribal populations had a mortality rate of between 20% and 50% (Carlos and Lewis 2012; Fenner et al. 1988). In addition, the U.S. government facilitated a massive genocide by ordering the distribution by the U.S. military of smallpox blankets to indigenous peoples (Valencia Weber 2002). “In the old day blankets infected with smallpox were given to tribes in an effort to decimate Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 119 them” (Deloria 1970). Hopkins (1983) illustrated how colonists fostered the spread of the disease in order to break indigenous resistance and to facilitate land grabs by European settlers. An estimated 90% of the North American tribal population was reduced in the years following the European invasion (Thornton 1987). In more recent years, Native Americans have been impacted by contemporary epidemics such as those related to diabetes, suicide, and HIV, all of which have negatively impacted tribal populations. Such contemporary epidemics illustrate the current state of health among tribal peoples and residual effects of centuries of colonization. In 1955, the Indian Health Service (IHS) was established, and clinics and hospitals were built to address the health of Native Americans. Today, a total of only 26 hospitals, 59 health centers, and 32 health stations exist in the United States to serve 573 tribes and more than 5 million people. Federal funding of the IHS is discretionary, and spending is optional and varies by administration. The program is historically underfunded, making it difficult to serve patients across the country. In 2020, the U.S. Department of Interior announced a 14% cut in funding for tribal programs. According to the IHS chief medical officer, the entire IHS system had only 625 hospital beds, only six ICU beds, and only 10 ventilators (https://www.politico.com/news/ 2020/03/20/c o ronav i r u s - american - i n d i a n - health-138724). According to the Indian Health Board, only 16% of tribal providers reported receiving any type of federal resources, and only 4% received protective equipment since the start of the epidemic. According to the Center for Disease Control and Prevention (CDC 2020) the Coronavirus Preparedness and Response Supplemental Appropriation Act, 2020 (P.L. 116-123) $8.3 billion in emergency funding for federal agencies to respond to the COVID19 pandemic, $40 million which is to be allocated to tribes, tribal organizations, and health service providers. Divided across 573 tribes, this amounts to roughly $70,000 per tribe, barely enough to make ends meet. In the face of the COVID-19 pandemic, the IHS system is not prepared and is not funded to support the needs of everyday populations and offers little support. In this paper, I make several arguments. First, the failure of U.S. and state governments to address the social determinants of health among tribal populations and minorities has placed tribal populations at an elevated risk during this pandemic. Second, the lack of engagement and investment by national and state political leaders and policymakers have exacerbated health conditions across tribes, contributing to a shortage of investments in life-saving resources such as education, healthcare, internet access, and preventative care. Third, and most importantly, the indigenous peoples and tribal nations of North America possess community cultural wealth (Yosso 2005) that encompasses a multitude of strengths and measures that each tribe can call upon to ensure the protection of their communities.
Elevated Risk and Underlying Health Conditions
The current health profile for American Indians and Alaska Natives in the United States demonstrates deep disparities compared to other racial and ethnic groups in the United States. According to the CDC (2014), death rates among Native Americans are 50% greater than those of non-Hispanic Whites. Death records for both Native American men and women combined show that the leading cause of death in the United States is cancer, followed by heart disease (CDC 2014). Heart disease is a leading cause of death in the United States among all populations: Approximately 610,000 people die of heart disease every year (CDC 2017). Heart disease is a leading cause of death among Native Americans in the United States, with the CDC (2018) reporting 3,632 deaths among Native populations between 1999 and 2016. While other racial and ethnic groups have seen a decrease in mortality rates due to heart disease, Native American populations have not seen a substantial decrease in heart disease-related deaths since 1993 (CDC 2016). Between 1993 and 2017, there was an average of 100.4 deaths of Native American males across the United States per 100,000 population (CDC 2016). Heart disease is the second leading cause of death among Native American women (CDC 2017). The CDC (2015) reported that 17% of all deaths among Native American women were related to heart disease (CDC 2015). According to the CDC (2014), Native American men are 20% more likely to smoke cigarettes and are 30% more likely than non-Hispanic Whites to have high blood pressure. Native Americans died from heart disease at younger ages than any other racial and ethnic groups in the United States (CDC 2004). According to the CDC (2004), 36% of heart Eubios Journal of Asian and Int ernational Bioethics 30 (3) (April 2020) 120 disease-related deaths occurred before the victims were 65. Cancer is the No. 1 cause of death among Native American women and the second leading cause of death of men (American Indian Cancer Foundation 2014). While cancer rates decreased for non-Hispanic Whites over the past 20 years, Native Americans have seen a substantial increase (AICF 2014). Disparities in health outcomes vary across tribal nations. Some groups experienced elevated rates of diabetes, heart disease, and mortality rates compared to others. For example, Native Americans in New Mexico died at younger ages and have the highest percentage of children who will not outlive their parents. Native American toddlers between the ages of 1 and 4 have a premature death rate of 55.6 per 100,000, compared to the non-Hispanic White counterparts (-0.5 per 100,000). In South Dakota, the Pine Ridge reservation has one of the lowest life expectancies in the United States: 47 for men and 55 for women, compared to the U.S. life expectancy of 78.69 years for men and 81 for women.
Aging Populations, Knowledge Keepers, and Language Speakers
COVID-19 is attacking--and could decimate --America’s Native American populations in such a violent manner, killing vast numbers of men and women over the age of 25, that the tribes could be at risk of never recovering. More than just lives lost, the virus sweeping across America could wipe out tribal cultural knowledge and heritage, tribal traditions, and tribal languages. All are at a real risk. Especially vulnerable to COVID-19 are tribes’ elders. According to the American Community Survey (ACS), in 2011-2013, there were close to half a million Native American elders 65 and older. Some 35% of all Native Americans were concentrated in Arizona, Texas, New Mexico, Oklahoma, Florida, North Carolina, and New York. Elders are integral to tribal communities. Protecting the knowledge only they possess is at the forefront of tribal efforts everywhere. Ohkay Owingeh Pueblo of New Mexico, along with several other pueblos, have closed their borders and ordered tribal members to stay home. Ohkay Owingeh tribal members are actively assisting the community by distributing masks and cleaning products to the homes of elders. Ensuring their safety and the safety of the community is key. Protecting our elders is essential to sustaining traditions, language, and our cultural knowledge. At the pueblo where I live, Ohkay Owingeh, in New Mexico, the tribal leadership has positioned over the past few days cement barricades and signs, blocking entrances onto pueblo lands. No one from outside of the pueblo is allowed to enter. No one. Stay home, tribal members have been told. Only by self-isolation, tribal leaders believe, can COVID-19 be defeated. Other pueblos have taken the same or similar drastic and decisive measures. Michael Chavarria, governor of Santa Clara Pueblo and chair of All Pueblo Council of Governors describes “our mission is to protect the life and health and safety of all our members and employees of Santa Clara Pueblo, we had to close down our casino, golf course, restaurants, and all our entities” (KSFE, Santa Fe Public Radio 2020). He described the Tinancial hardship that his tribe is going through and the difTiculty of preparing for a threat that cannot be seen. He urged tribal members to not take anything or anyone for granted and reminded the community that no one is immune. President Nez of the Navajo Nation argued in public commentary that tribes once again have been forgotten. The Navajo Nation as of April 2, 2020, had 389 reported cases of COVID-19 (New Mexico Department of Health 2020). The Navajo Nation has since closed its borders and ordered a curfew for the nation. The Navajo Nation is one of the largest tribes in the United States with close to half a million members.
Community Cultural Wealth and Tribal Capital
If decisive action does not take place, COVID-19 has the potential to devastate communities. Yet despite pre-existing health conditions of many members of virtually every tribe, America’s tribes have the potential to buffer the effects of COVID-19 and to Tlatten the curve for their own communities. Tribal populations in the United States are no strangers to scarcity and life-altering pandemics. Tribal peoples of North America possess community cultural wealth. Community cultural wealth focuses on cultural knowledge, skills, abilities, and networks within communities and across communities (Yosso 2005). According to Yosso (2005), many of these skills go unrecognized and unacknowledged. Yosso (2005) described community wealth, an array of capital that exists within marginalized groups, including resistance capital, linguistic capital, navigational capital, and familial capital. Resistance capital refers to knowledge and skills that challenge inequality, where linguistic capital includes the intellectual and social skills gained through communication experience. Navigational capital refers to the skills of maneuvering through social institutions entrenched in structural inequalities. Familial capital refers to the cultural knowledge that’s nurtured among family or kin and community history and to social capital as networks and community resources. Tribal populations possess community cultural wealth that dates back thousands of years--since the creation of the universe and dissention of the Tirst peoples on mother earth. Building on Yosso’s (2005) forms of capital, I add tribal capital. Tribal capital is the strengths and resources that tribal nations possess in addition to other forms of capital that are speciTic to tribal populations that have gained federal recognition. Tribal capital includes but is not limited to sovereignty and federal recognition. Federal Eubios Journal of Asian and International Bioethics 30 (3) (April 2020) 121 recognition signiTies that the U.S. government has recognized the right of an Indian tribe to exist as a sovereign entity and that a government-to-government relationship exists (www.ncsl.org). Tribal sovereignty predates the formation of the United States and is recognized through the U.S. Constitution and numerous federal statutes and court cases. Tribal governments are on equal footing with state governments and have a government-to-government relationship with the federal government (National Conference of State Legislatures). In the case of the COVID-19 pandemic, sovereign nations could request aid from other sovereign nations, including countries such as Cuba, and from organizations such as the World Health Organization. During the American Indian Movement (AIM), members of that group received aid and support from Cuba and built a platform of solidarity around the globe. Where the federal government has failed tribes, tribal capital can be exercised to bring aid and support to the sovereign nations of the United States. In addition to sovereignty, tribal nations have traditional forms of government. Although, many tribes have one government, many have dual forms of government. Dual governments equate to traditional forms of government that follow indigenous governing bodies, separate from governing bodies that deal with the federal government or state governments. Traditional governing bodies can provide protection for communities and have an in-depth knowledge of community members and traditions and stand to protect the well-being and survival of communities. In-depth knowledge of the community allows for the recognition of peoples that may be at higher risk, including knowledge of any preexisting health conditions that community members might have. This allows for the isolation and immediate protection of elders and members whose health may be compromised-- and thus provides an added layer of protection, communication, and togetherness with nations. Since the coronavirus pandemic was declared, many tribes have closed their borders and provide food and medicine to elders. Tribal populations can close their borders to nontribal members. Many have internal resources such as hotels and casinos that could double as makeshift areas to house and protect elders. Others have access to food services that can deliver food and sustenance into tribal areas without members leaving reservation borders. Food services that normally serve tribal education, and adult service centers, and casinos can provide food for tribal members. Eliminating the need to enter crowded towns and urban centers to shop for necessities. There are many other resources available. It is time for tribal leaders to think outside of the box, in an effort to protect their nations at all costs.
Tribal Traditions and the Power to Survive
Tribal traditions and healing practices and a knowledge of medicines are an integral component of tribal nations. Understanding the COVID-19 pandemic from a traditional perspective reduces anxiety and reinforces inner strength. Dr. Rodney Haring, a Seneca tribal community member of New York, describes COVID-19 as creating “a time when people of cultures have an opportunity to reconnect and recreate. Reconnect to identity, person-in-environment, and place and time. A micro yet global self-evaluation. It’s also, perhaps, a sign to slow down, let the Earth rebalance, “take a breath” from the everyday hustle and bustle of human impression.” In some communities, art is being used to promote the use of masks and safety. One nonprofit, Dukes Up of Albuquerque, N.M., placed billboards across the city to promote the use of masks and to direct people to practice social distancing. The intention was to remove the stigma of wearing masks in tribal communities in an effort to protect the health and well-being of family. Together, the indigenous of North America will continue to thrive. Many are using their artistic skills to create awareness. Many communities are using song and dance to create unification and healing. Other communities are organizing prayer groups. Some are offering their art. As traditional people, we have the power to resist and to hold strong to elements that have provided mechanisms for survival for the past 2,000 years.
Conclusion In summary, there is an urgent need to support and protect tribal nations across United States and globally. Indigenous people in the United States and throughout the Americas are at great risk. Centuries of tribal downsizing efforts by the U.S. government and governments across the Americas have made indigenous peoples some the most at risk populations in the world. Until structural racism and the social determinants of health are addressed among tribal peoples their existence will be challenged.
References
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Carmela M. Roybal, M.A., MBGPH
Carmela M. Roybal is a doctoral candidate in the Department of Sociology at the University of New Mexico. Her specialties include: medical sociology, bioethics, and public health with a focus on the study of race, gender, ethnicity, discrimination and health disparities. Her research uses intersectionality as a tool for examining racialized and gendered inequalities in health, with an emphasis on Indigenous peoples of the United States and globally.
In addition, Carmela is a doctoral fellow at the Robert Wood Johnson Center for Health Policy, She is a senior research fellow at the American University of Sovereign Nations (AUSN), where in 2017 she received her second master’s degree in Bioethics and Global Public Health, and is a member of the AUSN Board of Governors. She is currently a research assistant at the Native American Budget Policy Institute at the University of New Mexico, where she takes on critical policy projects that support the health and wellbeing of tribal communities across the state of New Mexico.
Recent publications include a sole-authored piece in the Eubios Journal of Asian and International Bioethics titled “Tribal Communities and Nations in a Time of COVID-19” and a co-authored chapter titled " “Cultivating Intersectional Communities of Practice: A Case Study of the New Mexico Statewide Race, Gender, Class Data Policy Consortium as a Convergence Space for Co-Creating Intersectional Inquiry, Ontologies, Data Collection and Social Justice Praxis,” in the Intersectionality and Policy Handbook, edited by Olena Hanvisky and Julia
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