Water Scarcity on Navajo Nation Worsens COVID-19 Disparities

Widespread water scarcity is exacerbating the impact of COVID19 on members of the Navajo Nation. As of 2021, one in five of the territory's residents—an estimated 37,000 people—lack access to running water or indoor plumbing [1]. Poor sanitation infrastructure coupled with recurring droughts and water contamination [2, 3]. have created barriers to hand-washing and the ability to follow other CDC guidelines intended to reduce virus transmission [4]. Therefore, addressing the systemic challenges that limit access to clean water for Navajo residents will be essential to reducing the morbidity and mortality of Dikos Nitsaaigii Ndhast’eits’aadah, or “Big Cough 19”, within this population [5, 6].


While communities of color across the United States have shouldered a disproportionate burden of COVID-19 cases, hospitalizations, and deaths, the overrepresentation of these among Non-Hispanic American Indians and Alaska Natives (AI/AN) is especially profound. According to a report from the CDC, AI/AN persons comprise just 0.7% of the U.S. population, but account for 1.3% of laboratory reported infections nationally [7]. Moreover, AI/AN persons has experienced 3.5 times higher cumulative incidence of COVID-19 and 1.8 times higher mortality compared to non-Hispanic whites [7]. In the Navajo Nation specifically, COVID-19 cases per capita surpassed those of all other states in the country by early summer [8]. As of April 2021, more than 10% of the territory’s population has tested positive, although actual numbers are likely to be higher, given that AI/AN health statistics are chronically underreported [4, 7, 8].


Health disparities observed among AI/AN groups largely stem from structural racism and discrimination [9]. For example, a 2019 report from the U.S. Water Alliance identified race as the strongest predictor of water access in the country. Compared to whites, Black and Latinx households are twice as likely and AI/AN households are 19 times more likely to lack access to indoor plumbing [10]. The Navajo water crisis, in particular, can be linked to federal policies from the 19th and early 20th century that relegated these tribes to the Southwest, which is among the driest regions in the country [9]. To cope with recurring droughts exacerbated by climate change, Navajo residents are reducing their household water consumption to between two and three gallons per day. In comparison, most American households use about 88 gallons per day [9].


As underdeveloped infrastructure and chronic underfunding for improved water sources persist across the territory, the U.S. government has offered minimal support [9]. Consequently, Navajo residents often haul water from unregulated sources, such as livestock wells and natural springs, which are not routinely tested in accordance with the Safe Drinking Water Act [3]. These unregulated water sources are susceptible to bacterial contamination and sometimes exceed standards for uranium and other chemicals, which poses serious health risks to the population [3].


To address water scarcity challenges during the pandemic, the Indian Health Service (IHS) has partnered with the Navajo Nation and other organizations to implement the Navajo Safe Water project. Using the $5.2 million in IHS support received from the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Brown, 2020), the project aims to improve clean water access by installing temporary water access points, paying associated water fees, and supplying water storage containers and disinfection tablets [1]. Funds will also cover outreach efforts to increase public knowledge of these services [1].


Since its roll-out in late 2020, the project has achieved modest success. For example, residents report that the distance traveled to access water has decreased from an average of 52 to 17 miles, with a drive time savings of 38 minutes [1]. While these short-term solutions represent progress, rough terrain and sparse population in many areas impede traditional piping and pose challenges to long-term water access [3]. According to IHS estimates, expanding safe drinking water and basic sanitation to all Navajo homes will cost over $700 million [3].


In the meantime, grassroots efforts such as THE WATERED: Water Acquisition Team for Every Resident & Every Diné, are supporting sustainable solutions at the community level [11]. Founded by Navajo resident Yoland Tso, THE WATERED builds and delivers fully portable washing stations to those in need, free of charge [11]. The hands-free technology is powered by a foot-pedal in order to reduce transmission risk and also comes with liquid hand soap, a five-gallon water reservoir, storage container, and two wheels for portability [11]. According to an interview with Tso, the station’s design is intended to optimize safety and accessibility, especially for the elderly or those with disabilities [12]. To date, THE WATERED has installed over 100 hand-washing stations, providing over 300 families with clean water access. The organization plans to build an additional 150 stations using funds secured through a GoFundMe campaign [12].


While no single solution exists to close the water access gap in the Navajo Nation, raising awareness of its linkage to systemic racism is a critical first step. By empowering Navajo leaders through increased financial resources and leveraging political will through media coverage and advocacy, we can support capacity-building for more sustainable water systems managed by and for indigenous communities. Such efforts, coupled with additional attention to housing, healthcare, and other social determinants of health can help mitigate the disparities observed during the COVID-19 pandemic and improve Navajo resilience to future crises.


References:

1) Navajo Safe Water: Protecting Your Health and Your Family’s Health. (2021, April 6). Navajo Nation COVID-19 Water Access Coordination Group. Retrieved April 12, 2021, from https://maps.ihs.gov/portal/apps/StoryMapBasic/index.html? appid=5411113222c74d23bf09d6fa8c5909fd

2) Navajo Nation Manages a Scarce Resource: Water. NASA Applied Sciences. Retrieved April 13, 2021, from http://appliedsciences.nasa.gov/our-impact/story/navajo-nationmanages-scarce-resource-water

3) Providing Safe Drinking Water in Areas with Abandoned Uranium Mines. (2016, June 15). US Environmental Protection Agency. Retrieved April 12, 2021 from https://www.epa.gov/navajo-nation-uraniumcleanup/providing-safe-drinking-water-areas-abandoned-uraniummines

4) Brown, C. Increasing Access to Safe Water on the Navajo Nation during the COVID-19 Pandemic. (2020, December 9). Indian Health Service. Retrieved April 13, 2021, from https://www.ihs.gov/newsroom/ihsblog/december2020/increasing-access-to-safe-water-on-the-navajonation-during-the-covid-19-pandemic/

5) Lively, C. P. (2021). COVID-19 in the Navajo Nation Without Access to Running Water: The lasting effects of Settler Colonialism. Voices in Bioethics, 7. https://doi.org/10.7916/vib.v7i.7889

6) Dikos Ntsaaígíí-19 (COVID-19). 2021. COVID-19 Dashboard. Navajo Department of Health. Retrieved April 12, 2021 from https://www.ndoh.navajo-nsn.gov/covid-19

7) Hatcher, S. M. (2020). COVID-19 Among American Indian and Alaska Native Persons—23 States, January 31–July 3, 2020. MMWR. Morbidity and Mortality Weekly Report, 69. https://doi.org/10.15585/mmwr.mm6934e1

8) Silverman, H., Toropin, K., Sidner, S., and Perrot, L. Navajo Nation surpasses New York state for highest Covid-19 infection rate in the US. (2020, May 18). CNN. Retrieved April 13, 2021, from https://www.cnn.com/2020/05/18/us/navajo-nation-infection-ratetrnd/index.html

9) Gold, A., & Shakesprere, J. (2020, September 29). Four Ways to Improve Water Access in Navajo Nation during COVID-19. Urban Institute. Retrieved April 13, 2021 from https://www.urban.org/urbanwire/four-ways-improve-water-access-navajo-nation-during-covid19

10) U.S. Water Alliance and Dig Deep. Closing the Water Access Gap in the United States: A National Action Plan. (2019). Retrieved April 22, 2021 from http://closethewatergap.org/wp-content/uploads/2020/03/DigDeep_Closing-the-Water-Access-Gap-in-the-UnitedStates_EXECUTIVE-SUMMARY-1.pdf

11) THE WATERED – Water Acquisition Team for Every Resident & Every Dine. (2020). Retrieved April 13, 2021, from http://www.thewatered.org/

12) Bezahdi, K. (2020, December). Combating Water Scarcity on the Navajo Nation. Food Tank: the think tank for food. Retrieved April 13, 2021 from https://foodtank.com/news/2020/12/combating-water-scarcityon-the-navajo-nation/

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