How the pandemic shortened life expectancy in indigenous communities

In 2020 and 2021, as the coronavirus swept across the United States, life expectancy for Native Americans and Alaska Natives fell by 6 1/2 years — a decline that left the researchers aghast.

The comparable figure for all Americans was about 3 years, itself a terrible milestone not seen in nearly a century.

What could have left Native Americans and Alaska Natives so vulnerable to the pandemic? There is no simple diagnosis, nor is there an easy fix, experts say.

The suffering is inextricably bound to a long history of poverty, inadequate access to health care, poor infrastructure and crowded housing, much of it the legacy of broken government promises and centuries of bigotry.

At least 1 in 4 Native Americans lives in poverty, the highest rate of any racial or ethnic group in the United States, according to the Department of Health and Human Services. Discrimination and racism have been linked to the erosion of mental and physical health, as has exposure to polluted air and water, studies have found.

If researchers were surprised by the findings, many who live and work in Indigenous communities were not.

“There is nothing weird or unusual about our population,” said Dr. Ann Bullock, a former director of diabetes treatment and prevention at the federal Indian Health Services agency and a member of the Minnesota Chippewa Tribe. “This is simply what happens biologically to populations that are chronically and profoundly stressed and deprived of resources.”

Among ethnic and racial groups tracked by the Centers for Disease Control and Prevention, Native Americans and Alaska Natives were the most disproportionately affected by COVID. The case rate has been 50% higher among the groups than among white Americans.

Native Americans and Alaska Natives have been nearly three times as likely to be hospitalized with COVID and more than twice as likely to die of it.

Nonetheless, federal researchers were slow to comprehend the outlines of the disaster. After a yearlong delay, officials announced in early August that Native Americans and Alaska Natives have seen a four-year drop in life expectancy in 2020 alone.

The additional 2-1/2 year reduction in 2021 that was reported Tuesday brought the total to more than six years, meaning that life expectancy had shortened to 65 years during the first two years of the pandemic.

“We had the death rates and knew they were high, but it hadn’t been translated into life expectancy,” said Dr. Noreen Goldman, a professor of demography and public affairs at the Princeton School of Public and International Affairs.

Given that life expectancy in parts of the developing world is roughly the same, “it’s easy to understand how drastic it is,” she added.

But while excess deaths — those greater than would be expected in a normal year — during the first year of the pandemic were primarily a result of viral infections in these communities, drug overdoses and chronic liver disease played a comparable role to COVID’s in driving up deaths in 2021.

Still, these causes are not unrelated. The pandemic exacerbated health risks that were already deeply embedded in Native American and Alaska Native populations, according to the new government report.

The groups struggle with high rates of obesity as well as extraordinarily high rates of diabetes, for example: Some 14.5% of adults have the disease, a higher percentage than that of any other ethnic group. Both conditions raise the odds of severe illness and death from COVID.

An abundance of such risk factors made it possible for the virus to spread widely, exacting a terrible toll.

Schumacher, who works as a tutor coordinator at a high school in Madison, Wisconsin, said that grappling with the deaths had affected her own health.

“I was already dealing with diabetes, but in addition to that, I just wasn’t mentally prepared to deal with so much loss,” she said.

Many Navajo people die relatively young from other causes, Schumacher noted, including her mother, who died at 65 of pulmonary disease, and her father, who died at 65 in a car crash caused by a drunken driver.

“COVID was just the tip of the iceberg,” Schumacher said. “People die too young because they are abandoned. Their access to better health care is nonexistent.”

Patricia Sekaquaptewa, a member of the Hopi Tribe in Arizona and a former justice on the Hopi Appellate Court, lost her aunt, Marlene Sekaquaptewa, the matriarch of a large family and a political leader, who died at 79 after contracting COVID.

But Sekaquaptewa emphasized that other long-festering problems, such as arsenic-laced well water and exposure to uranium spills, also contributed to poor health among the Hopi.

“And that’s without even talking about alcohol abuse, which has been around since the day I was born,” Sekaquaptewa said. She said she had lost at least three close family members, all of them men, from alcohol-related diseases over the past two years.

Dr. Jennie R. Joe, a professor emerita of family and community medicine at the University of Arizona’s Wassaja Carlos Montezuma Center for Native American Health, cited entrenched poverty along with chronic disease contributing to the shortening of average life spans among Native Americans and Alaska Natives.

But Joe cautioned that the decline might be even deeper than the latest figures indicated because death certificates in some regions sometimes misclassify race.

“It is not uncommon for a Native person to be identified as Native on their birth certificate but listed differently on their death certificates, usually listed as white,” said Joe.

“It is therefore safe to say that the current life expectancy reported for Native Americans is probably a case of undercounting,” she said.

Despite aggressive vaccination drives, in which some tribal nations at first outpaced the rest of the country, the pandemic laid bare other factors that made Native Americans especially vulnerable to the virus.

In the Navajo Nation, which stretches 27,000 square miles across Arizona, New Mexico and Utah, the scarcity of running water in some communities made it harder for people to wash their hands to prevent the spread of the virus. Respiratory problems caused by indoor pollution — the result of wood and coal used to heat many Navajo homes — also increased COVID’s risks.

And while close-knit families have long helped the Navajo deal with hardships, circumstances in which several generations lived under the same roof made it easier for the virus to spread and harder to isolate patients who tested positive.

Another challenge has been the woefully underfunded Indian Health Service, a government program that provides health care to the 2.2 million members of the nation’s tribal communities.

Even before the pandemic, the agency had to contend with aging facilities, shortages of funding and supplies and an insufficient number of health care providers and hospital beds.

These weaknesses contributed to disproportionally high infection and death rates among Native Americans, fueling new anger over what critics describe as decades of neglect from Congress and successive administrations in Washington.

A New York Times analysis found that in states with Indian Health Service hospitals, the death rates for preventable diseases — such as alcohol-related illnesses, diabetes and liver disease — are 3 to 5 times higher for Native Americans, who largely rely on those hospitals, than for other groups combined.

Stacy A. Bohlen, CEO of the National Indian Health Board, said the most pressing vulnerability of Native Americans is invisibility. “This is a result of a violent system that was eloquently designed to eradicate us,” she said.

This article originally appeared in The New York Times.