I remember when COVID just began to hit New Mexico. It was disheartening to watch the Navajo Nation get redder and redder on the map as more and more cases of COVID sprang up. Each shade darker represented more sickness and more death. As demonstrated by COVID, the health care systems that are available to the Native American people are woefully underfunded, understaffed, and do not fulfill the needs of the people relying on these systems to work. Introducing policy that incentivizes a proficient work force and helping to decrease the burden placed on already stretched hospitals will over time lend itself to better health outcomes in the Native American Nations.
Maintaining the current policies will continue to threaten the Native American tribes. According to the CDC, Native Americans/ Alaskan Natives are 3.5 times more likely to be infected with COVID than white people (CDC, 2020). While funding from the CARES Act, Indian Health Service funding, and CDC grants have helped overcome some barriers, there are several obstacles that are systemic that need to be addressed such as financial barriers, the ability to access health care, limited access to technology, and low amounts of COVID related education.
Native Americans rely on a service provided by the United States Government called the Indian Health Service (IHS) for their health coverage. The Center for American Progress (2020) estimates that an additional $32 billion dollars are needed to fully fund IHS. In fact, each patient within the IHS system is getting care that is equal to ¼ of those who utilize the veteran’s care system (Doshi, 2020). This underfunding limits the number of staff, medical supplies, chronic health programs such as the Special Diabetes Program for Indians (SPDI), and facilities. According to the GAO in 2019, the IHS have had an average of 25% of their open positions vacant chronically. This amounts to Native American patients having an average life span 5.5 years shorter than the rest of the U.S. population (CDC, 2020).
A long-term policy option that addresses the chronic staffing problem is Expanding the IHS Loan Repayment Program (LRP). In order to entice physicians to accept a job at the IHS, they currently offer up to $40,000 in student loan repayment in exchange for a 2-year contract (IHS, n.d.). I recommend expanding this program to $80,000 in exchange for a 4-year contract. This expansion would entice more physicians to the department as most medical student loans are approximately $200,000. Additionally, this program will prioritize accepting the professionals with a Native American background to keep staff culturally competent and encourage more Native Americans to go to medical school.
An extension of the LRP policy would be the Medical Education Support for Native Americans. According to the Association of American Medical Colleges (2019), Native American physicians represent less than one percent of total physicians in the United States while contributing 10% to the total U.S. population. Physicians who are a part of the LRP program will offer to mentor a local Native American high school student interested in the medical field throughout their high school career. Additionally, the program will offer a shadowing opportunity for high school to college students. Hopefully, this encouragement will spark excitement for a career in the medical field while additionally providing resume building experience. This will help address the educational inequities faced by the Native American youth while creating a more diverse and culturally competent work force.
Finally, a more short-term policy worth considering is the Oximeter Contact Tracing model. While temporary and vastly different from the two policy options above, this policy already implemented in The White Mountain Apache tribe from Arizona, has helped decrease life threatening complications from COVID and spread (Close and Stone, 2020). Positive COVID patients are called and visited while ill. A staff member collects who and where they visited within the potentially contagious stage days prior to positive testing. Additionally, the staff brings an oximeter. This device, once placed on your finger, can tell the staff member how well you are breathing and how much oxygen is in your blood. If your oxygen level is subpar, the staff will refer you to a provider. This will help decrease strain on the hospitals and ICUs by preventing complications before they happen. This is a fairly inexpensive, temporary policy as oximeters are $15 a unit. However, this policy does not address any of the structural inequities that cause worse health outcomes in Native Americans, but it can provide a temporary band-aid while COVID is still spreading.
References
AAMC. (2019). Diversity in Medicine: Facts and Figures 2019. Retrieved December 11, 2020, from https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
CDC. (2020). COVID-19 Among American Indian and Alaska Native Persons - 23 States, January 31–July 3, 2020. (2020, August 27). Retrieved November 10, 2020, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6934e1.htm
Close, R. M., & Stone, M. J. (2020). Contact Tracing for Native Americans in Rural Arizona. New England Journal of Medicine,383(3). doi:10.1056/nejmc2023540
Doshi, S. (2020, June 18). The COVID-19 Response in Indian Country. Retrieved December 10, 2020, from https://www.americanprogress.org/issues/green/reports/2020/06/18/486480/covid-19-response-indian-country/
GAO. (2018, August). INDIAN HEALTH SERVICE Agency Faces Ongoing Challenges Filling Provider Vacancies. Retrieved from https://www.gao.gov/assets/700/693940.pdf
IHS. (n.d.). Loan Repayment Program. Retrieved December 11, 2020, from https://www.ihs.gov/loanrepayment/