– Executive Summary –
Native American tribes have found themselves in the midst of many challenges, encompassing old and outdated infrastructure, a scarcity of viable employment opportunities, and the widespread concerns of poverty and compromised health conditions. This mixture of adversities is not merely a reflection of modern socioeconomic dynamics but deeply connected to the historical issues these communities have faced. The onset of the coronavirus disease 2019 pandemic starkly amplified these challenges, shedding light on the vulnerabilities and difficulties Indigenous populations face and underscoring the need for decisive and substantive intervention. In an era marked by unprecedented global health challenges, the American Rescue Plan Act (ARPA)’s funding stream emerged as a driving force for assistance, particularly for the Native American tribes that have long grappled with deep-rooted social and health disparities.[1]
This thesis investigates the intricacies of ARPA funding allocation for Native American governments, focusing on enhancing social determinants of health (SDOH)—economic stability, education access and quality, healthcare access and quality, the neighborhood and built environment, and the social and community context—within their communities.[2] Adopting a qualitative case study methodology, it delves into the issues surrounding ARPA grant funding for three Native American tribes—the Navajo, Cherokee, and Choctaw Nations—comprising the largest Indigenous populations in the United States and leveraging the greatest amount of U.S. Treasury funding through ARPA. This thesis scrutinizes both historical and current tribulations of these tribes, particularly in their strategic use of ARPA funds to alleviate the SDOH of their members.
This thesis illustrates the ongoing economic difficulties experienced by Native American reservations. These communities face generational poverty, marked by high unemployment rates, rampant food insecurity, and housing instability. As shown in this thesis, ARPA funds may be channeled strategically to mitigate these economic adversities and foster sustainable community development.[3] This financial infusion is not merely about supplying more money but about laying the groundwork for a future in which economic success and self-sufficiency become the cornerstones of tribal communities already focused on self-determination.
Education serves as another SDOH cornerstone in this thesis, as disparities in educational access and quality generate profound health inequities.[4] This thesis highlights how Native American nations have directed ARPA funding toward educational infrastructure and accessibility, based on the understanding that educational empowerment is intimately linked to health outcomes.[5] When Native American nations make such investments, they develop communities in which educated and informed individuals make healthier choices, access better employment opportunities, and, in turn, uplift one another.
This research attributes Native Americans’ disproportionate susceptibility to a range of diseases to adverse SDOH, including poverty and healthcare inadequacies.[6] Thus, when ARPA funding is allocated to enhance healthcare facilities and services on tribal lands, it not only expands physical infrastructure but also addresses critical accessibility issues, quality of care, and cultural responsiveness. Such funding helps to build a healthcare system equipped both to treat illnesses and to prevent them, all the while showing sensitivity to these communities’ unique cultural and social contexts.
Furthermore, this thesis demonstrates the pivotal influence of the neighborhood and built environment in health outcomes. It illustrates how ARPA has funded interventions aimed at revitalizing neighborhoods, combating housing crises, and promoting healthy living environments—reinforcing the idea that how people live greatly influences their health.[7] Indeed, safe, clean, and nurturing environments might be as crucial as hospitals and clinics to people’s health.
The role of social cohesion, civic participation, and community engagement in overall well-being is also a central theme in this thesis. Accordingly, ARPA funds have been allocated to programs that bolster community resilience and confront social challenges—recognizing that health is profoundly social and that tight-knit, supportive, and engaged communities are better equipped to deal with health challenges.[8]
However, this thesis does not shy away from addressing the contentious issue of equitable fund distribution. It brings to light the legal and scholarly debate surrounding the fairness of the allocation process, with smaller tribes advocating for greater support.[9] This debate is emblematic of the more significant challenges of policy implementation in diverse and complex social landscapes. ARPA was not the first grant under scrutiny for its distribution, and it certainly will not be the last. In conclusion, this thesis stands as a comprehensive and critical examination of ARPA funding as a pivotal moment in the history of Native American tribes, pointing out the grant’s strategic importance in enhancing health outcomes and bridging the various gaps within these communities. It also acknowledges the challenges in ensuring equitable distribution and effective fund management, which are crucial for these initiatives’ lasting success and impact. This thesis offers a snapshot of a historic moment and serves as a roadmap for future policy interventions and scholarly inquiries into grant administration and sustainability.
[1] “Coronavirus State and Local Fiscal Recovery Funds for Tribal Governments,” Department of the Treasury, July 28, 2023, https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/state-and-local-fiscal-recovery-fund/tribal-governments.
[2] Office of Disease Prevention and Health Promotion, “Social Determinants of Health,” Healthy People 2030, accessed June 22, 2023, https://health.gov/healthypeople/priority-areas/social-determinants-health.
[3] Department of the Treasury, “State and Local Fiscal Recovery Funds Final Rule Tribal Government Fact Sheet” (Washington, DC: Department of the Treasury, 2022).
[4] Catherine E. Ross and Chia-ling Wu, “The Links between Education and Health,” American Sociological Review 60, no. 5 (1995): 719, https://doi.org/10.2307/2096319.
[5] Ross and Wu, 740.
[6] Monika Kakol, Dona Upson, and Akshay Sood, “Susceptibility of Southwestern American Indian Tribes to Coronavirus Disease 2019 (COVID‐19),” Journal of Rural Health 37, no. 1 (2021): 197, https://doi.org/10.1111/jrh.12451.
[7] Sara Heath, “Understanding Neighborhood, Redlining as Social Determinants of Health,” Patient Engagement HIT, June 22, 2022, https://patientengagementhit.com/features/understanding-neighborhood-redlining-as-social-determinants-of-health.
[8] Paula Braveman, Susan Egerter, and David R. Williams, “The Social Determinants of Health: Coming of Age,” Annual Review of Public Health 32 (2011): 382, https://doi.org/10.1146/annurev-publhealth-031210-101218.
[9] Eric C. Henson et al., Assessing the U.S. Treasury Department’s Allocations of Funding for Tribal Governments under the American Rescue Plan Act of 2021 (Tucson: Harvard Kennedy School and the University of Arizona), 1, https://ash.harvard.edu/files/ash/files/assessing_the_u.s._treasury_departments_allocations_of_funding_for_tribal_governments.pdf?m=1635972521.
