As a result of social, economic, cultural, and political inequalities, access to healthcare on the Navajo Reservation has historically been scarce. The Navajo Nation is one of 573 federally recognized tribes in the United States, located in Arizona, New Mexico and Utah, and claiming 300,000 enrolled tribal members as the second-largest tribe in population. In past epidemics such as the 1918 flu and H1N1 in 2009, we have seen devastating impacts on reservations as Native American communities fare worse in health outcomes and mortality rates compared to their non-Native American counterparts. Accordingly, in the wake of COVID-19, access to health care across Native American communities is of particular urgency. Without parity and equity through sufficient resources and funding to support public health, there is potential for history to repeat itself to irreversible proportions
While many tribes across the United States are at high risk for contracting COVID-19 and lacking sufficient access to medical care, the Navajo Nation is at particular risk as a result of historical inequalities producing severe poverty, lack of access to running water and electricity, living conditions of overcrowded multigenerational homes, insufficient access to healthy foods from forced removal from lands, and pre-existing health conditions including heart disease, diabetes, and obesity. The particular circumstances of the Navajo Nation compound the threat of spreading COVID-19 and realizing the destructive health outcomes. However, while there are parallels between COVID-19 and past epidemics for the potential of loss, there are also parallels between how the Navajo Nation has responded with resiliency and innovation to uphold communities through culturally adapted public health responses.
One such public health response in the Navajo Nation has been the expansion of Telehealth, which is the distribution of health-related services and information via electronic information and telecommunication technologies. While the implementation of Telehealth technologies has been gradually expanding in the last decade, the advancements in technology have not been felt on Native American lands, where many reservations lack access to electricity, sufficient broadband, a health care structure to reimburse services through the Indian Health Services (IHS), and appropriate technological infrastructure in order to connect patients to physicians. Nonetheless, the Navajo Nation has begun expanding Telehealth services through recent funding from the Federal Communications Commission. The Navajo Nation Department of Health, based in Window Rock, AZ, was awarded $954,990 to provide home healthcare and RPM services throughout the Navajo Nation. In observing the development of innovation and resilience on the reservation, community and individual level, the objective of my ongoing research is to capture and highlight resilience on the Navajo Nation through the expansion of Telehealth services.
Through conducting a series of interviews with public health officials representing clinics in the Navajo Nation as well as tribal council members, I hope to understand how the landscape of Telehealth and healthcare delivery is changing within the Navajo Nation during the COVID-19 pandemic. In particular, my research and analysis will examine the following questions: How is Telehealth in the Navajo Nation evolving during COVID-19? How are the barriers to healthcare access the same or different from before COVID-19? What are the limits of Telehealth in COVID-19 times? And, how does Telehealth work in conjunction with other public health initiatives to support access to health care in the Navajo Nation?
In conducting research surrounding the Navajo Nation, I must consider my positionality not belonging to the Navajo Nation, as well as an undergraduate of Stanford University. Additionally, from a geographical perspective, I have not been in the Navajo Nation so some inherent limitations and biases surround my research from conducting research and interviews remotely. On another animinity, my analysis and conclusions will not specify particular clinics or hospitals in the Navajo Nation. Additionally, I will only utilize transcribed responses from participants that approve of their interview being used on the Bill Lane Center website, and podcasts will only present speakers that have consented to be presented on the Bill Lane Center website format as well. I hope that the findings can be used in order to contribute to awareness of the standing barriers and opportunities for access to health care in the Navajo Nation.
The inquiries surrounding Telehealth and COVID-19 will likely evolve as others document the public health responses and health care access in the Navajo Nation during the COVID-19 pandemic. There are currently non-profits, communities, and individuals across the country that are supporting the public health response in the Navajo Nation. The Johns Hopkins Bloomberg School of Public Health in partnership with Indian Health Services have been working to expand public health communications to reach families that lack consistent access to the internet. One method of communication has been through public health announcements on the radio, spoken by elders, as the most trusted figures in the community. Amongst the distress of COVID-19, there is hope through resiliency and innovation in the Navajo Nation of community efforts and the expanding access to healthcare through technology.