How the COVID pandemic shortened life expectancy in Indigenous communities

Carol Schumacher, 56, who was raised in the remote community of Chilchinbeto in the Navajo Nation, has lost 42 family members to COVID-19 over the past two years. The dead included two brothers aged 55 and 54, and cousins as young as 18 and 19.

Schumacher returned to the Navajo Nation from her home in Wisconsin this summer to grieve with family. She knew what to expect, having grown up on the reservation in Arizona. But what she saw left her reeling.

The nearest hospital was a long drive away on dirt roads, she said, “and there’s no guarantee about the quality of care there even if you make it in time. Some families don’t even have transportation or running water. Imagine dealing with that.”

Now federal health researchers have put a number to the misery that Schumacher and so many other families in Native communities experienced in the first two years of the pandemic.

In 2020 and 2021, as the coronavirus swept across the United States, life expectancy for Native Americans and Alaska Natives fell by 6 1/2 years — a decline that left the researchers aghast.

The comparable figure for all Americans was about 3 years, itself a terrible milestone not seen in nearly a century.

What could have left Native Americans and Alaska Natives so vulnerable to the pandemic? There is no simple diagnosis, nor is there an easy fix, experts say.

The suffering is inextricably bound to a long history of poverty, inadequate access to health care, poor infrastructure and crowded housing, much of it the legacy of broken government promises and centuries of bigotry.

At least 1 in 4 Native Americans lives in poverty, the highest rate of any racial or ethnic group in the United States, according to the Department of Health and Human Services. Discrimination and racism have been linked to the erosion of mental and physical health, as has exposure to polluted air and water, studies have found.

If researchers were surprised by the findings, many who live and work in Indigenous communities were not.

“There is nothing weird or unusual about our population,” said Dr. Ann Bullock, a former director of diabetes treatment and prevention at the federal Indian Health Services agency and a member of the Minnesota Chippewa Tribe. “This is simply what happens biologically to populations that are chronically and profoundly stressed and deprived of resources.”

Among ethnic and racial groups tracked by the Centers for Disease Control and Prevention, Native Americans and Alaska Natives were the most disproportionately affected by COVID. The case rate has been 50% higher among the groups than among white Americans.

Native Americans and Alaska Natives have been nearly three times as likely to be hospitalized with COVID and more than twice as likely to die of it.

Nonetheless, federal researchers were slow to comprehend the outlines of the disaster. After a yearlong delay, officials announced in early August that Native Americans and Alaska Natives have seen a four-year drop in life expectancy in 2020 alone.

The additional 2-1/2 year reduction in 2021 that was reported Tuesday brought the total to more than six years, meaning that life expectancy had shortened to 65 years during the first two years of the pandemic.

“We had the death rates and knew they were high, but it hadn’t been translated into life expectancy,” said Dr. Noreen Goldman, a professor of demography and public affairs at the Princeton School of Public and International Affairs.

Given that life expectancy in parts of the developing world is roughly the same, “it’s easy to understand how drastic it is,” she added.

But while excess deaths — those greater than would be expected in a normal year — during the first year of the pandemic were primarily a result of viral infections in these communities, drug overdoses and chronic liver disease played a comparable role to COVID’s in driving up deaths in 2021.

Still, these causes are not unrelated. The pandemic exacerbated health risks that were already deeply embedded in Native American and Alaska Native populations, according to the new government report.

The groups struggle with high rates of obesity as well as extraordinarily high rates of diabetes, for example: Some 14.5% of adults have the disease, a higher percentage than that of any other ethnic group. Both conditions raise the odds of severe illness and death from COVID.

An abundance of such risk factors made it possible for the virus to spread widely, exacting a terrible toll.

Many Navajo people die relatively young from other causes, Schumacher noted, including her mother, who died at 65 of pulmonary disease, and her father, who died at 65 in a car crash caused by a drunken driver.

“COVID was just the tip of the iceberg,” Schumacher said. “People die too young because they are abandoned. Their access to better health care is nonexistent.”

Patricia Sekaquaptewa, a member of the Hopi Tribe in Arizona and a former justice on the Hopi Appellate Court, lost her aunt, Marlene Sekaquaptewa, the matriarch of a large family and a political leader, who died at 79 after contracting COVID.

But Sekaquaptewa emphasized that other long-festering problems, such as arsenic-laced well water and exposure to uranium spills, also contributed to poor health among the Hopi.

“And that’s without even talking about alcohol abuse, which has been around since the day I was born,” Sekaquaptewa said. She said she had lost at least three close family members, all of them men, from alcohol-related diseases over the past two years.

Dr. Jennie R. Joe, a professor emerita of family and community medicine at the University of Arizona’s Wassaja Carlos Montezuma Center for Native American Health, cited entrenched poverty along with chronic disease contributing to the shortening of average life spans among Native Americans and Alaska Natives.

But Joe cautioned that the decline might be even deeper than the latest figures indicated because death certificates in some regions sometimes misclassify race.