The Navajo Nation, the largest Native American reservation with one of the largest tribal populations in the United States (around 170,000 people across 27,000 square miles crossing Four Corner state lines), has the third highest per capita infection rate of COVID-19 after New York and New Jersey. This fact in itself is remarkable – and alarming – given the conspicuous absence of the factors that (we reasonably might think) contributed to the high infection rates in New York and New Jersey. Specifically, the Navajo Nation does not have a robust public transport system with high ridership (there is no subway in the desert), does not have a large heterogeneous “international” population (96% of tribal members identify, unsurprisingly, as American Indian or Alaskan Native), and has a relatively low population density (around 6 persons per square mile, against, for example, New York State’s 420 persons per square mile or New York City’s 26,000 persons per square mile).
A high infection rate on the Nation is alarming because of a perfect storm of circumstances that may translate into an overwhelmed hospital system or a high fatality rate: prevalence of preexisting conditions (such as respiratory illness caused by both indoor pollution (coal and wood used to heat homes) and outdoor pollution (oil and gas development concentrated in “hotspots” on the Nation); high rates of diabetes and obesity; extended family cohabitation (often three generations, including vulnerable immuno-compromised elders, living under a single roof); a lack of provision of public goods (such as access to water); a lack of the right sorts of private goods (such as access to grocery stores – the Nation is a “food desert” in a literal sense); a haggard public health infrastructure of the sort that would be required for a robust “test-and-trace” strategy; and a high poverty rate (around 38% on persons on the Nation live in poverty). These factors are, of course, interrelated and self-enforcing: high poverty rates mean a lower tax base, and a lower tax base means less funds to provide requisite public goods and healthcare facilities and makes extended family cohabitation more advantageous relative to the alternatives, for example.
Some of these factors also contribute to the high infection rate as well. Cohabitation with extended families means a more people under one roof in close contact with each other; not having access to clean water makes hygiene and sanitation procedures impossible (and also means you need to leave the house to get water); poverty means employment that is typically non-conducive to remote work, already out of the question in some areas that lack even basic cell reception; and “food deserts” mean having to drive to border towns like the one I am in — Gallup, New Mexico — to get basic provisions from a single (and therefore crowded and possibly infectious) WalMart.
One contributing factor for the high infection rate must also be some degree of non-compliance with social distancing guidelines. Asking a community to practice social distancing runs into familiar collective action problems since social distancing is costly for any given individual, not only in economic but also in sociopsychological terms. We are “by nature” social, so common sense, old Aristotle, and new social science tells us, and going without social interaction for weeks or months on end generates significant psychological costs – a fact that some of us are becoming acutely aware of. Relationships, familial or otherwise, give our lives meaning, and are of particular significance in the close-knit communities on the Nation. Moreover, the benefits of social distancing are more-or-less invisible to the individual asked to bear its economic and psychological costs – at least immediately – given the delay between compliance and subsequent reduction in infection rate, as well as the counterfactual imagination required to appreciate the costs of non-compliance (horror stories of overwhelmed hospital systems happen “over there, but it could not happen here.”)
Group characteristics will also play a crucial role in whether compliance is achieved and whether the benefits of that compliance accrue. For example, age demographics – the majority of individuals on the Navajo Nation are young – contribute to the visibility of costs and invisibility of benefits, since the young are less vulnerable to the more acute and direct effects of the virus (a fact that would be reflected in their risk perceptions regarding contraction but, significantly, perhaps not in their perceptions of their own propensity for transmission). But whether they are less likely to “feel” the effects of the virus is irrelevant, of course, since the point of social distancing is to stop the spread to specifically vulnerable populations and, therefore, stop overwhelming an already poor healthcare system. A healthy young person infected with COVID-19 may not feel it, but their grandma probably will. And a final point worth mentioning here, of course, is that the vulnerable population of the Nation extends beyond older individuals, given the comorbidity of COVID-19 with certain preexisting conditions and the high prevalence of these very conditions in the Navajo population.
One way to ensure compliance with social distancing guidelines is to use the force of the state – formal institutions, most obviously in this case, the law – to make sure that everybody stays home. For its part, the Navajo Nation has tried to do precisely that through a (by all indications, heavily enforced) curfew every weeknight between 8pm and 5am, and a complete curfew over the weekend. But it would be near impossible (and undesirable, I might add) to ensure compliance through the heavy hand of the law given the Navajo Nation government lacks basic state capacity (as evidenced by the 30% of its tribal members who lack reliable access to clean drinkable water) and the costs involved in monitoring and enforcement across such a geographically sparse rural population.
Moreover, since the Navajo Nation has not (for good reason) restricted freedom of movement to neighboring towns – which, as of writing, do not have curfews – individuals are free to leave and “meet up” elsewhere. Several local hoteliers in the border towns surrounding the Nation (such as Gallup) have told me of an increase in demand for hotel rooms from “locals,” a category that includes those on the Navajo Nation, relative to “non-locals,” namely travelers heading east or west on I-40 contrasted with comparable expected demand given the time year. This is, of course, anecdotal evidence, but anecdotal evidence that is nonetheless suggestive: people who prefer not to live under a strict curfew can simply move across the Nation’s border, undermining the point of the curfew itself. Unsurprisingly, McKinley County, which sits adjacent to the Navajo Nation, has the highest number of COVID-19 cases in New Mexico and its medical resources are being stretched thin, prompting the outgoing Mayor of Gallup (Jackie McKinney) to ask New Mexico Governor Michelle Lujan Grisham to declare a state of emergency and lock the city down on April 30, 2020.
Without the possibility of formal enforcement of the sort of restraint that social distancing guidelines exemplify – stay home, leave only when necessary, cancel social events, practice appropriate hygiene and the like – policymakers (and community leaders) must be sufficiently sensitive to the role that informal institutions (such as expectations, beliefs, social norms, and so on) play in generating policy-relevant outcomes. This is especially important in cases like this, where the benefits (unlike the costs) of cooperation are not immediately visible or delayed, and preference for compliance is unavoidably interdependent on expectations about others’ behavior (holding social events involves expectations that others will show up; not holding them for fear of social sanctioning from friends involves expectations that others will not show up). Compliance with social distancing will not turn on whether we can formally enforce curfews (though this certainly does not hurt); rather, compliance will require, especially in the long run, the presence of particular community-wide expectations that others will also show “conscientious restraint” – bear initial costs of social distancing as much they can in a manner consistent with our best scientific evidence – so that community wide benefits might accrue at some later time.
Changing informal institutions is challenging, even in the best of times. Doing so on the Navajo Nation during a pandemic is even more difficult. This stems partly from a credibility problem, exacerbated in this case for at least two reasons. The first is the response from the US Federal Government. Trump’s go-to strategy of thinly veiled dog-whistles aimed at riling up an angry white base through deliberately egregious rhetoric while masking policy actions that are usually (brown-children-in-cages notwithstanding) a degree removed from that rhetoric has been disastrous. The tragic point here is that this strategy predictably does not work, since public health policy admits of no neat separation between rhetoric and policy when behavior change the end goal. In other words, Trump’s modus operandi of saying a really bad thing, but doing something less bad, does not work because speech (official communication) and action (administration of policy) converge in this policy context.
Rather than incongruity and chaos, coordination of expectations requires harmony and consistency between rhetoric and action to preserve the credibility of the source of coordination – in this case, the Federal Government – since individuals will take heed of, and comply with, the public health messaging if they expect others to do so too. What, for example, should we be complying with in this case? Should we socially distance and stay at home, as Dr. Fauci, Dr. Birx, and, at times, Trump tell us to? Or should we rise up against the tyranny of social distancing policies, and, to quote Trump, “liberate” Michigan and Virginia?
Or… maybe we should “liberate” the Navajo Nation? That’s an interesting idea. This point calls attention to a deeper credibility problem, one that precedes Trump and thus extends beyond his (and the Federal Government’s) response to the crisis. Tribal members have good reasons to distrust the US Government for what are obvious historical reasons, reasons that turn on the historical treatment of the Navajo and other indigenous populations. This is a history that includes forced sterilization of Native women, routine and systematic violation of Native property rights, and violence against Native persons. The general point here is that this history is particularly germane to the policy outcomes here, since success turns on the degree of voluntary compliance of an entire community – “conscientious restraint” – which in turn requires coordination from a source which has in-group credibility in the absence of robust state capacity. There’s no reason anyone would – or should – take agents of the state (and their public health messaging) seriously when they have historically been little more than predatory bandits.
As should be clear, the “behavioral” aspect to this problem is but one part of it, but one that will become increasingly important in the long run. No amount of coordination efforts on the part of any government will change the cold, hard fact of a lack of appropriate public and private infrastructure; but then again, no amount of policing and formal laws and regulations will stop people from breaking social distancing (at least not any amount of policing we are comfortable with).