COVID-19 in the Navajo Nation Without Access to Running Water
Creators: name: Purvis Lively, Cathy
Publisher: name: Voices in Bioethics
Year: 2021

description: Photo by Imani on Unsplash INTRODUCTION Although COVID-19 affects everyone, its impact on the Navajo Nation, which calls COVID-19 Dikos Nitsaaigii Ndhast’eits’aadah, or “Big Cough 19,”[1] is more profound. Efforts to contain and stop the virus include the three W’s: wear (masks), wait (social distancing), and wash (handwashing). These three actions become onerous for people without the financial resources to purchase masks or hand sanitizer or living in overcrowded conditions. The lack of adequate water for personal hygiene exacerbates water-washed infections like COVID-19.[2] For indigenous communities within the Navajo Nation in Arizona, preventing infectious disease by handwashing is difficult as there is not adequate access to reliable running water. As a community with over 309,000 members, half of whom reside in multi-generational households,[3] addressing the systemic challenges limiting the Navajo Nation’s access to water would reduce the disparate impacts of COVID-19. ANALYSIS A. COVID-19 in the Navajo Nation &amp; Statistics on Poverty Several factors contribute to higher mortality rates in indigenous populations, making them especially vulnerable during a health crisis. Demographic characteristics, socioeconomic status, availability of epidemic-appropriate resources, differential immunity related to health status and prior disease experience, variations in social distancing practices, community organization, and communication infrastructure influence the outcomes of COVID-19 patients in the Navajo community.[4] The Navajo Nation has COVID-19 infection rates three and a half times higher than those of white Americans[5] As of January 27, 2021, the Navajo Department of Health identified 53 communities with uncontrolled spread. [6] Today, the Navajo Nation has a poverty rate of over 40 percent.[7] Sixty percent of the Navajo Nation’s residents lack fixed internet access. The broadband access that does exist is sporadic with limited connectivity. .[8] Lack of internet impedes the provision of critical public health announcements, limiting the Navajo Nation’s emergency health care. Research describing health inequities often excludes Native American communities.[9] The Tribal authorities gather information only about people on the Tribal Lands and minimal information is available about those living off the reservation.[10] Racial misclassification of Native Americans as “other” by researchers further obscures health emergencies within indigenous communities,[11] leading to the exclusion and misrepresentation of Native Americans in the public health dialog.[12] B. History of Settler Colonialism Early settlers from Europe introduced pathogens and diseases, like measles, influenza, and smallpox to indigenous populations. Many Native Americans, lacking immunity to European-borne pathogens, succumbed to diseases.[13] Between 1781 and 1782, the smallpox mortality rate in the Native American population ranged from 50 percent to 90 percent.[14] Later, during the Spanish Flu epidemic in 1918 and 1919, Native Americans had mortality rates four times higher than those of the general population, many of whom lived in poverty.[15] During the 1860s, Navajo people were extracted and placed in captivity by the US for several years before returning to their homelands, entering into treaties with the US Government through duress and false promises.[16] Eventually, the settlers seized and established property rights from Native Americans through genocide, forced removal, and confinement on reservations supported by the US government.[17] Testifying before the House Energy and Commerce Committee Hearing on July 8, 2020, Jonathan Nez, President of the Navajo Nation, attributed the high per capita COVID-19 infection rate to the federal government’s breach of responsibility arising from treaties.[18] The government failed in its responsibility to protect tribal treaty rights, lands, assets, and resources, including healthcare and infrastructure development guarantees.[19] Today, the Navajo Nation continues to encounter broken promises and attacks on their inherent sovereignty.[20] Over 40 percent of Navajo Nation households do not have running water in their homes and must rely on hauling water to meet their daily needs. Thirty percent of families lack access to reliable, clean drinking water. [21] The ACS data shows that Native American households are 19 times more likely to lack complete plumbing than white households.[22] Using the limited water reserves for regular hand washing forces the family to decide between safe drinking water and personal hygiene, including frequent handwashing. For generations, the Navajo people have lived in arid regions, such as Apache County, Arizona. They have confronted increased water scarcity associated with more frequent and intense droughts on the Colorado River and water quality challenges caused by decades of uranium mining in the region. [23] Water levels are so low that the average use is two to three gallons per day compared to 88 gallons per day in most American households. [24] It can be argued that the affected individuals can resolve the dilemma by relocating rather than demanding assistance. In this instance, financial restraints and poverty would limit relocation. They were forcibly removed from their homes and, ultimately, relocated to reservations by the actions of settlers supported by the US government. It becomes unreasonable to expect individuals who were forced into a location by US officials to bear the burden of relocation to obtain essential resources. Relocation would also significantly disrupt Navajo lives and tear down deep-rooted cultural networks. The history of forced relocation to reservations and intentional intervening actions by the US, resulting in either direct or indirect damages and diverted water, created a circumstance in which the US government must supply basic provisions for survival, such as water. While this essay focuses on the Navajo Nation, the lack of clean water and working plumbing is not unique to this region or population. As of November 2019, two million people living in the US were without access to running water, indoor plumbing, or wastewater services.[25] The government must not ignore the lack of access to an essentialresource or the governmental actions of environmental racism that have created the situation. C. Recommendations As in prior pandemics, the devastating rates of COVID-19 in the Navajo Nation reflect systemic racism and inequities.[26] An ethical breach is responsible for the current condition of the Navajo population and its exposure to COVID-19. The term environmental racism[27] emerged in the 1980s to describe contaminated air, soil, and water segregated along racial and class lines.[28] Environmental racism, arising from settler colonialism, exists in the Navajo Nation, resulting in the subsequent failure of the federal government to act fairly and justly to honor its established treaties and to provide housing assistance and water to the Navajo people. The federal government maintains its responsibility to uphold its treaty obligations, to ensure equal access to health care, and to provide clean water and access to adequate COVID-19 testing and vaccination. The federal government should ensure that all programs designed to alleviate poverty are accessible to the Navajo people. The COVID-19 crisis should not be used as an excuse to ignore systemic challenges. Solutions including proper plumbing for water and sewage systems, compatible with the natural environment, should be provided immediately. An ethical obligation exists to provide state or federally funded reparations or programs to remedy the inhumane living conditions resulting from settler colonialism. Justice compels the government to address the needs of this overlooked minority. CONCLUSION The conditions within the Navajo reservations highlight the structural inequality exacerbated by the COVID-19 pandemic. To address these issues, federal and state officials must ensure the protection of tribal treaty rights, land, assets, and resources that will guarantee healthcare and infrastructure development within Navajo communities. The Navajo Nation’s circumstances point to the need for immediate action to address proximal factors such as providing personal protective equipment, COVID-19 testing, and treatments while concurrently addressing distal factors, including access to clean running water.[29] [1] U.S. House Energy and Commerce Committee Hearing; Addressing the Urgent Needs of Our Tribal Communities, Testimony by Jonathan Nez, President, Navajo Nation. Congressional Documents and Publications. (July 8, 2020). https://advance-lexis-com.ezproxy.cul.columbia.edu/api/document?collection=news&amp;id=urn:contentItem:609T-MX01-DYVR-P1BK-00000-00&amp;context=1516831. [2] Larson, R., &amp; Larson, R. “Water law and the response to COVID-19,” Water International, Vol. 45, Issue 7-8, 716-721(2020) https://www.tandfonline.com/doi/full/10.1080/02508060.2020.1835422 [3] U.S. House Energy and Commerce Committee Hearing (July 8, 2020), p.1.; Hlavinka, Elizabeth. “CDC Confirms Soaring COVID-19 Rate Among Native Americans.” MedPage Today, 19 Aug. 2020; Yellow Horse, A.J., Yang, TC. &amp; Huyser, K.R, “Structural Inequalities Established the Architecture for COVID-19 Pandemic Among Native Americans in Arizona: a Geographically Weighted Regression Perspective,” J. Racial and Ethnic Health Disparities (2021). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s40615-020-00940-2 [4] Brady, B. R., &amp; Bahr, H. M. Mortality, and the Implications of Some Neglected Eyewitness Accounts. American Indian Quarterly,Volume 38, Issue 4, (Fall 2014)459-491. p. 461. [5] Hlavinka. [6] Hlavinka. [7] House Energy and Commerce Committee Hearing, p.1. [8] House Energy and Commerce Committee Hearing, p.1. [9] Yellow Horse, et al, p.2. [10] Yellow Horse, et al. [11] Yellow Horse, et al., p.2. [12] Yellow Horse, et al., p.2. [13] M. Carlos, Frank D. Lewis, “Smallpox and Native American mortality: The 1780s epidemic in the Hudson Bay region,” Explorations in Economic History, Volume 49, Issue 3, 2012, Pages 277-290, https://doi.org/10.1016/j.eeh.2012.04.003 (2012, April 27) [14] Carlos and Lewis, p.278. [15] Brady and Bahr. [16] Glenn, E. N. (2015). Settler Colonialism as Structure: A Framework for Comparative Studies of U.S. Race and Gender Formation, Sociology of Race and Ethnicity, 1(1), 58-72. doi:10.1177/2332649214560440 [17] Glenn, E. N. [18] House Energy and Commerce Committee Hearing, p.2. [19] House Energy and Commerce Committee Hearing, p.2. [20] House Energy and Commerce Committee Hearing, p.1. [21] House Energy and Commerce Committee Hearing. [22] The 2019 report considered Census Bureau data and other quantitative and qualitative studies. The American Communities Survey (ACS) is part of the US Census Bureau. [23] Larson and Larson. [24] McGraw, G., &amp; Fox, R., “Closing the Water Access Gap in the United States: A National Action Plan,” US Water Alliance, (November 18, 2018). http://uswateralliance.org/sites/uswateralliance.org/files/Closing the Water Access Gap in the United States_DIGITAL.pdf. [25] McGraw and Fox, p.2. [26] Rosenthal, E., Menking, P., &amp; Begay, M., Fighting the COVID19 Merciless Monster: Lives on the Line-Community Health Representatives' Roles in the Pandemic Battle on the Navajo Nation. Journal of Ambulatory Care Management, Volume 43, Issue 4 (Oct/Dec 2020) 301-305. doi:00004479-202010000-00007 [27] DIGDEEP, P.O. Box 26779, Los Ángeles, CA 90026, info@digdeep.org, https://digdeep.org [28] Lee, T., “Cancer Alley: Big Industry, Big Problems.” MSNBC, http://www.msnbc.com/interactives/geography-of-poverty/se.html. [29] Yellow Horse, p.8.
description: Voices in Bioethics, Vol. 7 (2021)