GRAND FORKS — The COVID-19 pandemic is shining a light on the lack of infrastructure to deal with wide-ranging health concerns among American Indians across the country, Dr. Donald Warne said in a teleconference Thursday.

Warne, associate dean of diversity, equity and inclusion at the University of North Dakota School of Medicine and Health Sciences, says American Indian tribes lack the capability to effectively establish the “Three T’s” of fighting the pandemic: testing, contact tracing and treatment: They lack the labs to administer adequate testing, they lack the manpower to conduct time-consuming contact tracing, and they lack the hospital facilities, intensive care units and ventilators to treat those with the virus.

“American Indians are dying of neglect,” Warne said. “We haven’t had adequate attention placed on our circumstances and not adequate resources to address the challenges. We need non-Indian advocates. We have small populations, many of whom are impoverished and don’t have much political clout. We need non-indians to recognize the Indigenous health crisis that is occurring in the United States.”

Warne says he doesn’t view the coronavirus pandemic as a biomedical issue for American Indians as much as he views it as a social justice issue. He says while American Indians are among the only population in the United States born with a legal right to health services, via Indian Health Services, those services are often inadequate and underfunded.

“I look at the IHS as the largest prepaid health plan in history because we exchanged so much in the way of resources for those services,” Warne said. “Unfortunately, IHS is terribly underfunded. If you look at the data, Medicare is funded at over $12,000 per person per year; IHS is around $4,000. Even in the bureau of prisons — more money is spent for American prisoners than American Indian children.”

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Factors of social inequality, behavioral risk and health disparities put American Indians at high risk of contracting and dying from COVID-19, Warne says.

Poverty rates, measured at 25% among American Indians and Alaska Natives in a Pew Research Center study, cause more people to live in the same house. It is common for three or more generations of a family to share a residence, Warne says. This density in one household makes it almost impossible for other members to avoid the virus once one has contracted it.

In North Dakota, positive rates among Native American residents are roughly in line with their share of the population. But disparities exist in other states.

Last week, the Arizona health officials reported that American Indians account for 16% of the state’s COVID-19 related deaths, and 6% of its population. And in New Mexico they account for more than a third of deaths while making up less than 10% of the population.

“Unfortunately now we’re starting to see exponential growth in cases in the northern Plains tribes,” Warne said. “Where I’m from in South Dakota and now working in North Dakota, our tribes are now starting to see significant increases in cases.”

Known health disparities among the American Indian population put it at greater risk of death than the general population. The Centers for Disease Control and Prevention reported that the AI/AN population has the highest rate of Type 2 diabetes and the highest rate of cigarette smokers among all racial/ethnic groups tested. Both have been shown to increase the mortality rate of the coronavirus.

More than 16% of American Indians tested had Type 2 diabetes, nearly twice the rate of 8.7% among non-Hispanic whites, and 33.9% of AI/AN people smoked cigarettes, compared with 13.7% among the whole United States population.

“I think part of that is because historically we had a relationship with tobacco, but our tobacco is very different from commercial tobacco,” Warne said. “So people would use a blending of herbs for ceremonies and smoking with a sacred pipe for prayer and ceremony. I joke with my uncles who are medicine men that we never chain smoked with a sacred pipe.”