ADVANCEMENT OF THE PRACTICE
and the emerging connections between air quality and COVID-19 risks, more research; improved air quality; and a focus on address- ing social, environmental, and health justice concerns are warranted (ITEP, 2021). Indoor air quality (IAQ) is also a concern for Indigenous public health, as many homes burn wood for heat. The resulting exposure to PM 2.5 and volatile organic compounds (VOCs) has been associated with respira- tory illness (Morris et al., 1990; Robin et al., 1996). From 1998–2008, AI/AN children younger than 5 years had 1.6 times the hos- pitalization rate for lower respiratory tract infections than the same age group in the general U.S. population (Foote et al., 2015). In Alaska, a few home-based interven- tions have been researched to improve IAQ in Alaska Native households (Short et al., 2024; Singleton et al., 2017). Singleton et al. (2017) provided education about IAQ and collabo- rated with these households to improve leaky wood stoves and increase ventilation in the houses and then monitored changes in IAQ and respiratory symptoms of children who had lung conditions. They found that parents reported fewer occurrences of runny nose, cough between colds, wet cough, wheezing with colds, wheezing between colds, and school absences. In 2019, the Yukon-Kus- kokwim Health Corporation introduced a pilot program that provided education and HEPA air purifiers to families with children who had chronic lung issues (Short et al., 2024). By interviewing representatives from participating households, the researchers assessed how well the HEPA purifiers were accepted and used. All respondents noted health improvements in their children. The results suggested that in-home air purifiers were a sustainable and feasible option for Alaska Native households. Although air quality in general has improved in the U.S., AI/AN communities continue to experience higher pollution lev- els and slower rates of improvement. These communities face additional challenges due to outdated equipment and limited air quality monitoring in rural areas. Eorts to address IAQ (e.g., providing home- based interventions) have shown promise in improving health outcomes for children with respiratory conditions. There remains a major need, however, for more epidemio- logical and exposure research, better moni-
toring, and targeted interventions to address these environmental and health concerns in Indigenous communities. Water Quality For many AI/AN communities, water is inte- gral to their cultural and community prac- tice. “Water is life” is a common view among many AI/AN people (Tanana et al., 2021). Prioritizing access to water in Indian Coun- try is a key public health measure. Decreased water quality and quantity aect the tradi- tional way of life due to the combined eects on drinking water, food, culture, and the abil- ity to perform traditional ceremonies (U.S. Climate Resilience Toolkit, n.d.). Addition- ally, contaminated water and poor sanitation are linked to the transmission of various dis- eases and expose individuals to preventable health risks (WHO, 2023). According to a U.S. EPA study (2022), 95% of the U.S. population receives at least some of their drinking water from a community water system, and 92% of those water sys- tems did not report standard violations. His- torical and contemporary breaches of treaty rights with tribal water rights have resulted in insu¦cient infrastructure (Powell, 2024; U.S. Climate Resilience Toolkit, n.d.). Access to safe running water is a major challenge for many tribal jurisdictions in the Southwest. One study found that 13% of Alaska Native people and approximately 25–40% of people from the Navajo Nation still rely on haul- ing water, which is inconvenient and makes water more susceptible to waterborne dis- eases (Gilio-Whitaker, 2019). For example, a study that examined infectious disease rates for several water- borne diseases in Alaska Native homes found higher respiratory and skin infection rates in homes without piped water access (Hennessy et al., 2008). According to IHS, approximately 7.5% of AI/AN homes did not have safe drinking water or basic sanitation in 2013 (Tribal Public and Environmental Health Think Tank, 2018). Out of all the freshwater consumed in the U.S., approximately 77% is derived from sur- face waters, including reservoirs, lakes, and streams. Numerous AI/AN lands are in rural areas and are highly dependent on surface water sources. Aside from access to water, contamination is another issue related to water safety. Both environmental contamina-
tion and climate change have largely aected the availability of safe drinking water. Fur- thermore, chemicals such as heavy metals (e.g., uranium, arsenic) and per- and poly- fluoroalkyl substances (PFAS) have con- taminated drinking water sources among Indigenous communities nationally (Erdei et al., 2019; Jones et al., 2020; Tanana et al., 2021). Additionally, a 2017 study revealed that exposure to low-level inorganic arsenic in well water is linked to impaired neuro- psychological functioning among American Indian elders throughout the Western U.S. (Gilio-Whitaker, 2019). The Clean Water Act (CWA) of 1972 was implemented to regulate the discharge of pol- lutants into U.S. waters and set quality stan- dards for surface waters (U.S. EPA, 2024). Existence of this law, however, does not guarantee compliance. In New Mexico, for example, the Pueblo of Isleta is aected by discharges in the upstream entities of Albu- querque, Santa Fe, Rio Rancho, and Kirkland Air Force Base that violate the CWA (Gilio- Whitaker, 2019). These discharges make the water unsuitable for religious ceremonies and everyday use. Toxic contaminants (e.g., arsenic, untreated sewage water, aluminum, PCBs, lead) raise questions about the health of people who eat crops irrigated with the same contaminated water. Another example is the San Juan River, which flows through the Navajo Nation in northern New Mexico. The river was con- taminated when an abandoned gold mine spilled 3 million gallons of acidic wastewa- ter containing iron, aluminum, manganese, lead, copper, and other heavy metals into the Animas River, which is a tributary of the San Juan River (Gilio-Whitaker, 2019). The spill turned the water a yellow-orange color and contaminated underground wells used for drinking water. The Navajo Nation and other communities need these rivers for ranching and irrigation purposes. As a result of the spill, crop damage to Navajo Nation farms was widespread and approximately 2,000 Navajo people were aected. The Gold King Mine, which was managed by U.S. EPA, admitted responsibility and agreed to pay $4.5 million in emergency costs to state, local, and tribal governments. In 2017, however, U.S. EPA claimed that a legal analysis determined that they had no obligation to pay damage claims due to sovereign immunity (Finley, 2017).
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Volume 87 • Number 10
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