Updated on: March 25, 2021

SDoH and COVID-19

Original story posted on: June 3, 2020

Navajo Nation: Another new face of the SDoH.

Many populations and communities have been impacted by the social determinants of health (SDoH), and the COVID-19 pandemic has only amplified their challenges. One of the most grossly neglected populations has been those served by Indian Health Services (IHS). Critical funding by the U.S. Department of Health and Human Services (HHS) last week will work to bridge the longstanding gap in health and behavioral health services for the Navajo Nation.

The Coronavirus Aid, Relief, and Economic Stability (CARES) Act will route $500 million to the IHS and tribal hospitals, clinics, and urban health centers in response to COVID-19. At least 233 facilities across the system serve as the only healthcare provider for both IHS beneficiaries and non- beneficiaries. Hundreds of miles can exist between accessible healthcare facilities, a distance that can mean the difference between life and death for patients.  

The Navajo Nation has been significantly impacted by COVID-19. Across New Mexico, Arizona, and Utah, infection rates currently exceed those figures for New York and New Jersey, reflective of the highest per-capita coronavirus infection rates. Over 4,400 confirmed cases and 147 deaths have been reported, with roughly 2,304 cases per 100,000 people. In comparison, New York State has a rate of 1,806 cases per 100,000, and New Jersey sits at 1,668 cases per 100,000.

Native Americans disproportionately suffer from health equity issues that span the SDoH. These challenges make the populations ripe for vulnerability to chronic health conditions, as well as the coronavirus. The environmental impact from pollution is massive, with the water supply frequently contaminated, if not also unusable: 30 to 40 percent of First Americans lack running water.  

Even before the pandemic, the IHS was grossly underfunded. The U.S. Commission on Civil Rights reported that for 2017, service expenditures per person were $3,332, compared to $9,207 for federal healthcare spending nationwide.

The IHS and tribal hospitals will receive:

  • A $2.81 million base payment plus 3 percent of their total operating expenses;
  • IHS tribal clinics and programs will receive a $187,000 base payment, plus 5 percent of the estimated service population multiplied, by the average cost per user;
  • IHS urban programs will receive a $181,000 base payment plus 6 percent of the estimated service population, multiplied by the average cost per user; and
  • Remaining funding will be divided equally between hospitals and clinics.

HHS estimates operating costs of $3,943 per person annually. Combined with previous funding, this distribution will provide the IHS some $2.4 billion, constituting massive and necessary expenditures to enhance care for the Navajo Nation.

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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