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Title: RESPONDING FROM A FRACTURED FOUNDATION: An Analysis of the COVID-19 Response on the Navajo Nation, to Explain Observed Elevated COVID-19 Mortality Rates
Authors: Leggat-Barr, Katherine
Advisors: Yashar, Deborah
Department: Princeton School of Public and International Affairs
Certificate Program: Global Health and Health Policy Program
Class Year: 2021
Abstract: In a global pandemic that has killed millions, one of the more sobering impacts is the disproportionate impact on vulnerable populations. The COVID-19 mortality burden has been particularly acute among Native Americans. Reservation status is correlated with higher COVID-19 mortality rates in the existing literature. This thesis aims to answer the question: “How have Native American reservations, particularly the Navajo Nation, responded to the COVID-19 pandemic? Have reservation responses contributed to higher COVID-19 mortality rates associated with reservation status?” Given data limitations making it difficult to understand how COVID-19 is impacting this population, literature on Native Americans in this context is limited and mostly focuses on quantifying the mortality disparity compared to other racial groups. Thus, this thesis attempts to uncover some of the reasons why we observe these disparities, which existing literature has not done. Specifically, this thesis examines three elements of an effective COVID-19 response: the health system response, the governmental response, and the community member behavioral response. It explores how these elements can or cannot explain the higher, observed mortality rates on reservations. Utilizing a mixed-method approach, this thesis both evaluates reservation responses broadly and then specifically focuses on the Navajo Nation. This thesis first presents original survey data collected from February 19-March 19, 2021, which compares important elements of the individual behavioral responses and access to health care among reservation Native Americans in contrast to non-reservation Native Americans and the general population. Logistic regression models are used to compare the responses among the three groups listed above. The qualitative analysis, which represents the majority of the thesis, centers around semi-structured interview data with both health care providers and community members of the Navajo Nation, to understand how these responses have manifested from the perspective of both of these stakeholders. The results of the quantitative analysis somewhat support that reservation Native Americans behave in a more protective fashion in the context of COVID-19 than other groups, however, calculated odds ratios are not always statistically significant. That reservation Native Americans appear to behave in more protective ways is unexpected, given the higher, observed mortality rates among Native Americans. The qualitative analysis finds that the response of the Navajo Nation has been impressively strong, with a strong focus on public health practices, lockdown policies, and protective individual behavior decisions. However, the response itself has been limited by institutional, ‘pre-existing’ factors, that are largely historical in nature and in part originate from lasting Federal policy predating the pandemic. Thus, this thesis underscores that as a result of the historical origins of reservations, tribal lands remain interconnected to the actions and decisions of these institutions, even though they are their own distinct sovereign. This interdependence in many ways has increased mortality. However, the COVID-19 pandemic has also demonstrated the impressive autonomy of the Navajo Nation, as they have enacted stronger public health responses, passed stricter distancing and stay-at-home policies, and had broader citizen compliance than the general United States. The general US public can learn many lessons from the way the Navajo Nation has responded to COVID-19, while also recommitting to supporting these tribal lands.
Type of Material: Princeton University Senior Theses
Language: en
Appears in Collections:Princeton School of Public and International Affairs, 1929-2022
Global Health and Health Policy Program, 2017-2022

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