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.