Indigenous Elders: Mapping Populations for Equitable COVID-19 Prevention & Care

Dr Maya Magarati - IIRC20
Wednesday, November 18, 2020

Historically, indigenous communities have experienced higher rates of infection, severe symptoms, and death than the general population due to the social and cultural determinants of health and institutionalized racism (Power et al., 2020). While much about the novel coronavirus (COVID-19) is unknown, early data and observations from 23 states shows that the virus is exacerbating pre-existing inequities. A recent report from the United States Centers for Disease Control and Prevention (CDC) found a higher rate of infection (1.3%) among non-hispanic American Indian and Alaska Native (AIAN) persons and a cumulative incidence of laboratory-confirmed COVID-19 among AIAN persons at a rate of 3.5 times that of non-Hispanic white persons (Hatcher, 2020). Within the U.S., The Navajo Nation, for example, has received much national attention for this inequity, experiencing 9,593 positive cases as of August 27, 2020 - a positive rate of 5523 per 100,000 (Navajo Department of Health, 2020).
Elders - persons above age 55 - are more susceptible to respiratory infections and more likely to experience severe cases requiring hospitalization (CDC, 2019). AIAN communities are diverse in beliefs and traditions, but for many indigenous communities, elders are important keepers of knowledge, including but not limited to history, language and ceremonies. The social ecological model of resiliency considers the resilient individual as part of a larger social system, drawing upon culture and identity to promote resilience, which itself achieves balance through adaptation to changing circumstances. Community resilience relies on the relational and collective process, yielding protective factors to counter adversities (Reinschmidt et al., 2016). Within this model of resiliency, the elder plays an important role in providing perspective and cultural grounding.
The aim of our research is to provide the first interactive mapping tool of the distribution and density of AIAN elders across the U.S. in order to inform equitable resource distribution. By informing distribution and the optimization of resources, this mapping tool will enable communities to foster greater resilience and strengthen prevention efforts by distributing resources, like effective COVID-19 vaccinations once available, where it is most needed and appropriate.
This mapping tool is helpful for public health authorities. It may further be used to advocate for state or federal distribution of resources, early vaccine access
and support in public health education and outreach efforts - aiding in the larger effort to save lives, limit community trauma and the loss of cultural knowledge.
Though this tool has been developed for use within the U.S. context it may be adapted for use internationally with indigenous groups, as data allows.
The interactive map was created in a geographic information system (ArcGIS) using American Community Survey (ACS) data at the smallest geographical
extent possible to visualize population density. The selected ACS demographic geocoded data visualizes the population density of self-identified AIAN
individuals (race alone or in combination), age 55 and older. The smallest data extent can be combined to look at population density across counties, municipalities and tribal nations.