Indigenous American and Alaska Natives lost 6 years life expectancy during pandemic

Indigenous American and Alaska Native life expectancy dropped by six and a half years during the worst of the coronavirus pandemic in 2020 and 2021. Other Americans faced around a two year decrease in life expectancy. Why was this section of the population hit so hard, and how can we take steps to fortify their health moving forward?

The Social Determinants strike again

As with most health equity problems, the root causes are deeply entrenched in how we’ve chosen to run our society. The social determinants of health, as the name suggests, determine the likelihood of health outcomes. Right now, our system is harming Indigenous American and Alaska Native (IAAN) people through social factors like racism, environmental pollution, shaky access to clean water, and limited access to nutritious foods. In fact, Indigenous American and Alaska Natives are 400% more likely to face food insecurity as compared to peers, and an estimated 20% lived in poverty before the pandemic made conditions even worse. 

Prior to COVID-19, there was already a 2 year life expectancy disparity between Indigenous American and Alaska Native populations as compared to non-hispanic white Americans. Some of the leading causes of death amongst this population include heart disease and diabetes and risk factors with high rates include obesity, mental health, and substance overuse. obesity, mental health, and substance overuse. These conditions require access and regular contact with the healthcare system – however, these populations also tend to have less access to healthcare due to the rural nature of most reservations. The Indian Health Service (IHS), meant to fix this exact problem, is chronically underfunded, leaving those who don’t live in urban areas without many options. And despite high rates of health disparities, IHS spending for patient health services per person is just a third of the national average. Many of the states with reservations have chosen not to expand Medicaid, which compounds the financial barrier to healthcare access.

Health Equity Impacts are Exponential

Going into the COVID-19 pandemic, these disparities already existed and were impacting the health and wellbeing of the Indigenous American and Alaska Native populations. When the pandemic hit, it became clear that personal health was a major factor in health outcomes. It also upended everyone’s lives and threatened the status of many people’s income, stress, housing, and food security. Given the disadvantages faced by the Indigenous American and Alaska Native populations, it’s clear to see how these issues influenced death rates and have snowballed into a drastically different life expectancy for these populations.

Few escaped COVID-19 unscathed. With the data that we have now, it’s easy to trace the link between diminished quality of social determinants and decreased life expectancy – the more healthcare hardships faced in general life, the more impactful COVID-19 is on health outcomes and death rates. 

“There is nothing weird or unusual about our population. This is simply what happens biologically to populations that are chronically and profoundly stressed and deprived of resources.”

Dr. Ann Bullock, former director at IHS and member of the Minnesota Chippewa Tribe to The New York Times

As depressing as these health inequities are, there is a clear leverage point for change. We know that the lack of investment in  Indigenous American and Alaska Native communities creates harm every day. To start, Congress could adequately fund the IHS. Congress also just passed up the opportunity to curb insulin prices for everyone, which could have had a huge impact on the 14.5% of Indigenous American and Alaska Native adults who live with diabetes. Ensuring clean water would be a huge step, especially given recent challenges around the lack of piped water in Navajo communities specifically. Easy access to affordable, nutritious foods could help with high rates of diabetes. Increasing mental health care through an increased workforce and utilization of telehealth could help bring down rates of substance overuse and, eventually, cirrhosis through counseling while simultaneously fortifying mental health and resiliency. 

We have the means to help the Indigenous American and Alaska Native population not just survive but thrive – it’s well past time that we improve on the social determinants of health that ultimately determine our lifespan.