Addressing COVID Mortality in Native Families by Investing in Child Well-Being
by Patrice Kunesh
Amidst a raging global pandemic that has claimed over 800,000 American lives, we need to pause to consider the question, “How are the children?” Children are the silent sufferers of some of the most devastating impacts of COVID-19. While recent studies show that COVID-19 seems to be less common and less severe in children, the pandemic has upended the lives of thousands of U.S. children who have lost parents or primary caregivers in the pandemic. Among these COVID “orphans,” a staggering number of Native children have lost parents and caregivers. These children face an “epidemic of mental health challenges,” but only partly because of the COVID-19 pandemic—their well-being should be our top policy priority.
According to a recent study led by the Center for Disease Control and Prevention (CDC), as of June 2021, at least 140,000 American children have lost a parent or caregiver because of the coronavirus. With new variants emerging and surges in COVID cases, the number of COVID orphans is now more than 167,000 children. The Covid Collaborative, a national team of public health and policy experts, predicts these numbers will get worse with each passing day. How many more children will be orphaned due to a COVID-related death of a parent or caregiver? That number is impossible to predict, but we know that every surge in COVID cases corresponds to an uptick in COVID orphans.
When children’s lives are permanently altered by such devastating losses, their families risk becoming socially and economically destabilized, and the children themselves become more vulnerable to other adverse experiences. The trauma engendered by these circumstances may result in a range of distressing mental health, behavioral, and developmental outcomes. And for non-White children, who account for 65% of those who lost a primary caregiver and who are also at higher risk of trauma exposure regardless of the effects of COVID, such losses are more likely to result in complex traumas that can dramatically alter the course of a life and family. For these non-White children, and particularly for Native youth who have experienced the highest level of caregiver loss, addressing the cascading effects of this trauma will require a host of social supports and interventions that get at the root causes of these disparities.
Native children experience the highest COVID-related caregiver loss
The COVID-19 pandemic has disproportionately affected Native populations across the country, with infection rates over 3.5 times higher than White Americans and over four times the likelihood of being hospitalized. Overall, Native Americans die from COVID-19 at twice the rate of White Americans. While these reference points of infection and mortality rates describe the general severity of the pandemic, the deeper consequences of COVID are less visible—the children left behind. Native youth have suffered the highest rate of caregiver loss from the pandemic—4.5 times higher than that of White children. This means that 1 of every 168 Native children have lost their primary caregivers to COVID, as compared with 1 of every 310 Black children, 1 of every 412 Hispanic children, and 1 in every 753 White children.
Geography tells another grim story. A recent analysis of American Indian reservations and COVID rates finds “a strong positive correlation across states between the share of Native Americans living on reservations and the SMR [standardized mortality ratio].” Socioeconomic factors related to this vulnerability include poverty, poor living conditions, inadequate health care, and the prevalence of multi-generational families. As a result, a higher percentage of Native children in rural reservations face greater risks of losing a parent or caregiver. For example, in South Dakota, Native children represented 55% of the children who lost a caregiver. The story is similar in other states. Native children represent 39% of total children who have lost primary caregivers in New Mexico, 38% in Montana, 23% in Oklahoma, and 18% in Arizona.
Who are these caregivers? Native families value kinship care, where extended family members such as cousins, aunts and uncles, and grandparents share responsibility for child-rearing, along with their parents. This cultural practice is confirmed in the demographic data, which show that “single-race Native Americans are the group most likely … to live in multigenerational and crowded households. In these “grandfamilies,” Native grandparents were most likely to be responsible for raising their grandchildren (51.1% of all Native kinship-care families). Of course, Native grandparents are at higher risk of being immunocompromised due to older age and poor health factors, putting them at great risk of severe illness and death from COVID.
Single mothers also are the primary caregivers in many Native families, both to their children and to their parents. Moreover, more than half of Native mothers (55%) are the sole household earners, compared to 37% of White mothers. Considering Native women in the context of their families and communities, the concern here is their risk of getting COVID due to their work environment and health issues. Jobs on most reservations are highly concentrated in casino and administrative sectors, basically frontline and public-facing positions with greater exposure to COVID. In addition, Native women are disproportionately susceptible to chronic illnesses, such as cardiovascular disease (American Indian and Alaska Native women die from heart disease at a rate 20-30 percent higher than non-Native women, and Native Hawaiian women at a rate 100 percent higher).
The loss of these caregivers can be tremendously destabilizing. Most children who lose a parent or grandparent during the pandemic will continue living in the same home, but some may need a new family. Native children already have disproportionately high out-of-home placements and face greater risks for foster care or homelessness. New guardians and caregivers of Native children will likely shoulder additional burdens of navigating imposing legal institutions and complex social welfare systems in multiple jurisdictions (tribal, state, and federal) in order to access services and safeguard family connections. Creating a healthier and safer post-pandemic future for these children will require confronting the historic conditions that led to such a tragic health crisis in Indian Country.
Health challenges and fragile infrastructure in Native communities
Since the beginning of the pandemic, Indian Country has suffered devastating human and economic impacts. Well before the virus ripped Native families apart, however, the conditions that gave rise to such dire consequences were clearly evident. COVID-19 has amplified health inequities in American Indian communities because of underfunded and under-resourced health systems, limited access to health services, poor infrastructure, and underlying health disparities. The sticky residue of settler colonialism—hostile policies aimed at disempowering tribal governments and crushing Native culture—produced generations of economic inequities and precarious housing conditions, as well as egregious health disparities, particularly in Native youth.
One of the main contributors to the high rates of COVID infection and death in Indian Country is the substandard state of housing in many Native communities. According to the Department of Housing and Urban Development, the overcrowding and physical housing problems of American Indians and Alaska Natives living on reservation lands remain strikingly more severe than those of other Americans. The housing crisis became a health crisis in Indian Country, and the pandemic took its toll on Native families. Without more safe and secure housing, Native communities will remain vulnerable to the ravaging consequences of viral diseases.
Where do we begin to tackle this complex array of challenges? Investing in child well-being is the single most powerful lever we have to create healthier communities, stronger economies, and more flourishing futures for our children.
Orientation toward people and place for hope and healing
The pandemic has revealed serious vulnerabilities in the social fabric and built infrastructure of Native communities across Indian Country. What is needed is a bold strategy and a comprehensive action plan that will reduce the health risks of the community and vulnerabilities of the children. In this way, the best public health strategy is actually a community development approach.
As tribal leaders establish new post-pandemic priorities and strategies, a good guide to follow are the recommendations of the Pediatrics and COVID Collaborative studies. Not surprisingly, the most significant suggestions for creating community well-being focus on improving outcomes for children. These strategies should include:
Ensuring tribal and federal policies and budget prioritize the health, well-being, and education of Native youth.
Advancing equity and eliminating disparities among services and programs.
Maintaining children in their families and supporting kinship care.
Providing and bolstering child resilience through quality childcare programs.
Alleviating childhood poverty and ensuring equality of opportunity, for example by making sure families have access to the Child Tax Credit and Earned Income Tax Credits.
For decades, tribes have steadfastly pursued self-governance to provide basic services to their citizens, including education, health care, public safety, food, and housing. In creating a post-pandemic vision for community strength and wellness, tribal governments will have a critical role in deciding how to build on their unique assets and where to make strategic investments in their people and the places where they live. Two remarkable Indigenous approaches to community investment demonstrate both the legal foundation and integrated social framework needed to execute such a strategy.
For example, the “Inuvialuit Family Way of Living Law,” or Inuvialuit Qitunrariit Inuuniarnikkun Maligaksat, was recently enacted by the Inuvialuit Regional Corporation (IRC), an Inuit community located northeast of Fairbanks, Alaska, in the Northwest Territories of Canada, with the long term goal of the Family Way of Living Law of supporting cohesive Inuvialuit families. Likewise, the Dena’ina Wellness Center, built by the Kenaitze Indian Tribe in Kenai, Alaska, is an integrated healthcare facility that follows the Dene’ Philosophy of Care, a whole-person approach toward wellness that incorporates physical, spiritual, emotional and social health as contributing factors to overall well-being. These holistic approaches to wellness, rooted in Indigenous traditions and ways of being, remind me of my own family’s Lakota way, in which children are called wakanyeja, “little sacred ones” who are nurtured and protected.
With an orientation toward place, tribal governments can address economic disparities by investing in community infrastructure such as housing, broadband, schools, and roads. Equally important, Native nations should be preparing now to deploy their $1.75 billion allocation from the American Rescue Plan Act fund, and their part of the $1.2 trillion Infrastructure Investment and Jobs Act signed into law last month. This means that tribes will have to consider how to balance and serve their communities and citizens across a spectrum of need and readiness, ensuring that cross-cutting issues such as equity are woven into projects to improve facilities and infrastructure, expand business opportunities, and mitigate impending climate changes. Used wisely, this massive investment opportunity could not only ensure a strong economic recovery, it could change the social and economic trajectory for the next seven generations.
As the long-term implications of the pandemic are being revealed, we can actually shape those outcomes by the actions that we take today. This challenge is as much a moral imperative as it is a public health mandate. We can honor the lives lost to the pandemic, especially the parents and caregivers, by focusing community investments on child well-being and fostering their optimal healing and resiliency.
About PATRICE
Of Standing Rock Lakota descent, Patrice H. Kunesh is the founder of Peȟíŋ Haha Consulting, a social enterprise committed to fostering social and human capital and pursuing economic equity in Native communities. Previously, Patrice established and led the Center for Indian Country Development at the Federal Reserve Bank of Minneapolis, and has held appointments as the Deputy Under Secretary for Rural Development at the US Department of Agriculture and as the Deputy Solicitor for Indian Affairs at the US Department of the Interior. In addition, she served as in-house counsel to the Mashantucket Pequot Tribe and on the faculty at the University of South Dakota School of Law. Patrice began her legal career at the Native American Rights Fund and recently returned to NARF as the major gifts officer.
This essay was commissioned by the National Native Children’s Trauma Center with support from Casey Family Programs, a national operating foundation dedicated to improving the lives of America’s most vulnerable children. The findings and conclusions presented are those of the author alone, and do not necessarily reflect the opinions of Casey Family Programs.