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THE SPOKANE people have an unusual way of saying “he got sick”: in their form of the Salish language it translates literally as “he was greeted by an illness”, using the ordinary verb for one person greeting another. In Spokane culture, illnesses are considered entities, like animals or humans. Though they may be enemies, they are to be treated with respect, not fear.
Barry Moses, a member of the tribe who researches its language and culture, describes how his uncle’s face lit up when explaining this linguistic quirk. Elders represent not only the last few fluent speakers of the language. They are also among the last few who can put its intricacies into cultural context. Recently the queen of Spokane Salish’s cultural and linguistic memory, Pauline Flett, died at 93. The precise illness was unclear, as she was not tested for covid-19. But her passing nevertheless represents the fragility of Indian culture as Native Americans are being greeted by the coronavirus, a very powerful enemy indeed.
It is hard to find exact covid-19 death rates for America’s more than 5m Native Americans, because the groups are classified differently in different states, and some states do not gather data by race or ethnicity. But in two of the states with the biggest native populations, Arizona and New Mexico, the official Native American share of the dead from covid-19 is about three to four times their share of the population—and that is likely to be an undercount.
According to the Kaiser Family Foundation, a health-research outfit, this is partly because 34% of Native Americans aged 18-64 have pre-existing health conditions making coronavirus infection likely to be serious or fatal. That is the highest rate of any ethnic or racial group, compared with black Americans at 27% and whites at 21%. Diabetes and heart disease are particularly big problems in native populations. Many natives live in “food deserts”—much more literally so than the urban food deserts described by health-policy wonks: the Navajo nation, covering a territory the size of the smallest five states combined, on arid land spanning Utah, New Mexico and Arizona, has just 13 grocery shops.
And it is indeed the Navajo nation that has been hit particularly hard, with more than 3,000 cases and at least 140 deaths. If it were a state, it would have the highest infection rate in the country. As Arizona, where much of the nation’s territory lies, opens up from lockdown, experts believe that Navajo infection rates are peaking only now. Jonathan Nez, the nation’s president, recently extended its strict lockdown, and the Navajo have joined other tribes in a lawsuit against the Department of the Treasury for a greater share of relief funds.
Many Native Americans get their health care from their own providers. For the Navajo it is the Navajo Department of Health, funded by the federal government. For many other tribes, the chief provider is the Indian Health Service (IHS). Like the Department of Veterans Affairs or Britain’s National Health Service, it runs its own facilities and providers. In this it is unlike Medicare or Medicaid, the programmes primarily for the elderly and poor, who can see a range of providers, with the government paying the bills.
Crucially, the IHS is not a mandatorily funded benefit like Medicare or Medicaid. That means its spending does not grow automatically with its client population’s needs. Instead it depends on direct annual grants from Congress. Unlike many parts of the federal budget, these have grown gradually since 2009, but advocates still say they have been insufficient for decades: in 2015 annual spending per patient was around $3,700, compared with $5,700 under Medicaid.
To add to the problem, many native Americans who live outside reservations are not covered by the IHS or another tribal provider. Some of these are insured, either by Medicaid, Medicare or through their jobs. But those not insured—22% of the non-elderly, according to the Kaiser Family Foundation—represent a higher proportion than for any other American ethnic category.
The nature of native society has compounded ills born of the pandemic. Small communities in rural areas are harder to reach. Specialist doctors are hard to recruit and keep at these locations. That means IHS pays for specialist care outside the system, which it cannot afford for all its patients. Disruption of traditional ways of life, discrimination and isolation have led to poverty, poor diets and addiction.
These and other factors made the native population especially vulnerable to the arrival of pandemics. Native societies are often highly communal, making infections spread faster. So do the small homes with multigenerational families where many live. Adults travel to shop at the few supermarkets, spreading the infection and then bringing it back to their tight-knit communities. But with less access to the internet than typical Americans, they have been late to hear and disseminate news about the coronavirus.
Verlon Jose of the Tohono O’Odham Nation says that elders were slow to believe the news of the pandemic when it came, but in his community, as in most, compliance with lockdown orders has taken hold. He and his son, however, worry about the loss of the knowledge of the elders in their community, where five have died. Mr Jose says that though the language is not at death’s door, its cultural embedding is weakening. Someone fluent in the language texted him recently to seek advice about the proper words to be used in a sacred annual ceremony, without which the world will end. At 52 he is reluctantly taking on an elder’s role he is not quite sure he is ready for.
His son Kendall describes his grandmother teaching him how to gather and prepare the buds of the calcium-rich cholla cactus, long a staple of the tribe, and how to skin a rabbit, a skill that came in handy when the pandemic led to runs on the supermarkets. The elders represent thin threads connecting native communities to their identity, rooted in the past. Those threads were already fraying; the pandemic threatens to snap many of them. Or, as Verlon Jose puts it: “Every time we lose an elder, another chapter of our history closes.”