First Nations Response to Covid‐19 Pandemic

Abstract

Stanley et al. describe the successes of the Aboriginal and Torres Strait Islander (TSI) communities as global exemplars of controlling the COVID-19 pandemic.1 Despite challenges similar to those facing Indigenous populations world-wide, the authors conclude that the remarkably low morbidity and mortality in these communities due to COVID-19 can be attributed to rapid implementation of best practices and Indigenous leadership alongside transparent communication and collaboration with governmental partners.1, 2 Unfortunately, American Indian/Alaska Native (AI/AN) communities in the United States have suffered disproportionately from COVID-19. According to the Centers for Disease Control, AI/AN people were three to five times more likely to be diagnosed with COVID-19, with twice the mortality rate of non-Hispanic white people.3 This demonstrates the impact of suboptimal health-care delivery due to decades of severe social inequities and limited access to resources.1 Although there is no uniform Indigenous experience, some factors that consistently predispose AI/AN people to health inequity include living in food deserts, crowded, multi-generational households, unemployment, lack of access to technology, distance from health centres and distrust of health-care systems and governments due to historical traumas.3 While data describing COVID-19 in paediatric patients in AI/AN communities are currently limited, extrapolation of the literature allows us to conclude that the burden of the disease may also disproportionately affect the AI/AN children relative to their non-Hispanic white counterparts. Stanley et al. contend that permitting First Nations communities' decision-making power to improve outcomes and effectively partner with governmental and other resources was critical in the success of the Aboriginal and TSI response to COVID-19.1 Based on the achievements of Australian First Nations communities, one may reasonably infer that granting similar trust and control of resources and leadership to AI/AN populations may serve to improve health outcomes in the context of COVID-19 and beyond. All providers who serve AI/AN children must also seek opportunities to partner with local tribes to better understand the priorities, needs and historical experiences of the population, ensure adequate training in culturally sensitive care, thoroughly evaluate the social determinants of health, and leverage cultural assets and resilience to preserve Indigenous identity while improving overall health.4 The Aboriginal and TSI response to COVID-19 offers a stellar example of the strength and success of permitting decision-making by First Nations communities which may provide a means to improve the health of Indigenous populations across the globe.