A Historical Perspective of Healthcare Disparity and Infectious Disease in the Native American Population

Abstract

The incidence and severity of COVID-19 infections have been disproportionately high in Native American populations. Native Americans are a high-risk group for COVID-19 because of a variety of healthcare disparities. Historically, these populations suffered excessively during previous epidemics in the United States (US). Several epidemics occurred when disease-naïve indigenous peoples were exposed to European settlers with herd immunity. Native American populations had four times higher mortality in the 1918 Spanish flu epidemic. Deaths from H1N1 infections were higher in Native Americans and most cases and deaths from the Hantavirus pulmonary syndrome (HPS) occurred in Native Americans. Other infectious diseases, including HIV, hepatitis A and hepatitis C are more also common. Diabetes, alcoholism and cardiovascular diseases, all risk factors for severity and mortality in COVID-19 infection, are also more common in this group. Addressing the root causes of enhanced risk in Native American populations will improve outcomes from COVID-19 and future pandemics.

Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review

“…Although few studies included populations such as refugees, ethnic minorities, lesbian, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) individuals and adolescents, our findings suggest that the COVID-19 pandemic has disproportionately impacted SRH access and utilisation for groups with specific SRH needs. The SRH needs of these groups differ only slightly from women in general; however, distinct barriers to accessing care engender unique needs in order to achieve sexual and reproductive justice 118–121. For instance, displaced people and refugees are at a heightened risk of sexual assault and gender-based violence in crisis settings105 but face increased barriers to access to SRH services during humanitarian emergencies; this is characterised by discontinuation of contraceptive services, increased rates of unsafe abortion and substandard STI and HIV care 122.…”

“…The SRH needs of these groups differ only slightly from women in general; however, distinct barriers to accessing care engender unique needs in order to achieve sexual and reproductive justice. [118][119][120][121] For instance, displaced people and refugees are at a heightened risk of sexual assault and gender-based violence in crisis settings 105 but face increased barriers to access to SRH services during humanitarian emergencies; this is characterised by discontinuation of contraceptive services, increased rates of unsafe abortion and substandard STI and HIV care. 122 It can be assumed that these challenges were aggravated during the pandemic; however, more evidence is necessary to properly inform the extent of harm to refugee populations.…”

“…Indigenous people are another population with distinct SRH needs who have and continue to face disempowerment, discrimination and erasure and have consistently been insufficiently addressed in healthcare policies and programmes, particularly during infectious disease outbreaks. [118][119][120][121] Indigenous women worldwide are at an increased risk of GBV including sexual and physical abuse 125 ; as global rates of sexual assault and violence increase during pandemics, it is imperative to understand and address access to SRH care including GBV services for Indigenous women. Only a small number of studies looked at the impact of the COVID-19 pandemic on sex workers, 65 71 94 95 who require consistent access to contraceptives and STI/HIV services.…”

Explaining COVID-19 related mortality disparities in American Indians and Alaska Natives

“…More research is needed to identify other obstacles to timely treatment that AI/AN individuals are more likely to encounter than their NHW counterparts 42 . In particular, transportation barriers 43 and lack of internet access 17 , 18 may also impede timely treatment.…”

“…For instance, social and economic conditions in which AI/AN populations live (i.e., area socioeconomic deprivation) may drive inequities in infection and mortality 12 . Historically, US government policies, including forced removal from lands, perpetuated the severity of infectious epidemics by causing starvation, severe crowding, and “historical trauma” 17 . Today, due to these inequities, AI/AN individuals are more likely than NHW individuals to live in neighborhoods characterized by poverty and by housing that is overcrowded and without plumbing 18 , 19 .…”