on December 2nd, 2014 2 Comments
For the sake of history in the making, not another Tobacco Settlement disaster, please.
A month ago, the Obama Administration released the $554 million of “no-strings-attached” money to the Navajo Nation — the largest settlement to a tribe in history — as part of the resolution to a long-running land dispute. The Navajo Nation, with its size and political connections, is perfectly poised to demonstrate best practices for how tribes can leverage such funds after years of inadequate support. I know I’m not someone who’s in the place to suggest what would be best for the Navajo Nation, but I hope to see this community benefit from settlement money catalyzing positive change.
I write as a first-year medical student who lived on the Navajo reservation in Sanders, Arizona for the past two years as a high-school teacher. In Sanders, I’ve seen how access to preventive services, behavioral health services, and assistance navigating health-care service provision can have life or death implications. In our small school, every few weeks at least one of my students would miss class because of a funeral that could have been avoided. The 2014 report on a proposed Medicaid expansion for the Navajo Nation cites that for Navajos on the reservation, 60 percent have no phones, 32 percent live without plumbing, 28 percent without kitchen facilities, and many without electricity. Seventy-eight percent of roads are unpaved, so air emergency transport is used, and there is no accredited residential substance abuse treatment program. The Navajo Nation mortality rate is 31 percent higher than in the U.S.
If the Navajo Nation wants a lesson in what not to do with the money, it can look at the poor outcomes of another historic settlement for the U.S. back in 1998: The Tobacco Master Settlement Agreement. Recent reports indicate several states chose to invest in bonds when using settlement money from the tobacco industry, though the funds were intended to fuel prevention initiatives. Only 1.9 percent of funding per year was devoted to preventive services; unsurprisingly, today preventable tobacco-related deaths remain high in the U.S. Tempting as it may be for the Navajo Nation to use this money for miscellaneous expenses, this is a chance for the Navajo to set the precedent for other indigenous groups who might find themselves similarly empowered with a large sum of unmarked money.
Navajos are in the spotlight and could seize this timely chance to show how spending on one focused initiative implemented with outside partnerships could positively affect outcomes of societal welfare. Using settlement funds to more seamlessly integrate services that are starting to be provided by other health resources (like from a new potential Navajo Medicaid) into a navigable health infrastructure could enhance an entire sector of life on the Navajo Nation in measurable ways.