he U.S. government has a storied tradition of neglect, erasure, and genocide of vulnerable communities such as the American Indian/Alaska Native (AI/AN) population. COVID-19 has magnified challenges involving drastic underfunding, inefficient coordination of resources, and heightened socio-economic disparities within Indian healthcare systems. Some health experts have proposed an enhanced digital strategy utilizing blockchain to minimize inequities within AI/AN populations.
Historical and Contemporary Issues Impacting AI/AN Community Health and Wealth
The epoch of European settlement that led to drastic declines in indigenous populations and the foundation of detrimental social determinants of health created rampant food insecurity and poverty. Due to the litigation of the Dawes Act of 1887, self-governance and the potentiality for healthier socio-economic living conditions disbarred the growth of economic and social opportunities in AI/AN communities. Trends in unemployment and regulations in tribal activities amassed another emergent disparity. With 50% of the workforce concentrated within the casino and hospitality industries, many experienced immediate job loss due to COVID-19, which starved tribal revenue.
AI/AN healthcare System
The healthcare delivery system used by AI/AN communities is called the IHS/Tribal/Urban (I/T/U) System. Integral legislation that includes the Snyder Act of 1921, Transfer Act of 1954, Indian Self-Determination and Education Assistance Act (ISDEAA) of 1975, and Indian Healthcare Improvement Act (IHIA) of 1976 shaped the Indian Healthcare System (IHS). The funding process of the IHS, which is authorized through ISDEAA, stem from the Snyder and Transfer Acts, which funnel through the congressional appropriations budget. Additionally, Urban Indian Organizations (UIO) are funded through Title V of the IHIA. Although the evolution of policy resulted in improved delivery of healthcare to the AI/AN communities there exist numerous challenges from this complex system.
Problems with Health Service Delivery
Underfunding is the largest problem facing Indian healthcare. IHS funding is discretionary which is subject to external political shocks that may impact funds. Funds allocated to UIO account for less than 1% of U.S. health expenditures, while urban Indians account for 71% of the AI/AN population. A survey conducted in March of 2020 identified that 84% of UIO were forced to reduce services. Tribal governments receive additional funding through grants and third-party revenue. However, according to Rear Admiral Michael Weahkee, Director of IHS, during a natural disaster or market shock like COVID-19, small tribes are too underfunded and understaffed to apply for grants resulting in a reduction of revenue by as much as 80%. As a result of ISDEAA, IHS requires an extensive, redundant bilateral amendment process with tribes to distribute funds allocated through the Paycheck Protection Program and the Healthcare Enhancement Act.
Potential Solutions from Leaders
Leading organizations have proposed several solutions for improving Indian healthcare. Among these are suggestions for improving grant processes, increased funding, and mutual aid projects. Some key proposals are discussed below.
Francys Crevier, Director of the National Council of Urban Indian Health, proposed that Congress allot $80 million to UIO to help renovate buildings. This solution points to ending massive underfunding of UIO. Weahkee suggested that potential solutions to the grant process and distribution of funds could include:
- Appropriating funds directly to the IHS, authorizing the agency to place funds directly into existing contracts.
- Enabling direct transfers from the Center for Disease Control or the National Institutes of Health.
Finally, the Decolonizing Wealth Project worked to distribute $1 million in mutual aid to AI/AN community members. This solution offset inefficiencies within the CARES Act.
Blockchain Use-cases to Enhance Leadership Solutions
Blockchain can create opportunities for increased security, transparency, efficiency, speed of delivery and traceability of assets recorded on the blockchain. Two blockchain technologies, cryptocurrencies and tokenization, can be utilized to enhance the proposed solutions above.
The tokenization of grants, such as the pilot conducted by the Treasury Department could ensure that the terms of grants are secure and followed. The primary benefit to federal agencies included improved decision making through better transparency, quality, and timeliness of financial information. The primary benefit to grant recipients included reduced redundant reporting to grant-making entities and auditors. Payment efficiency presented as a secondary benefit. This use-case could improve direct payments to tribal governments and UIO from U.S. agencies and reduce operational inefficiencies identified by Weahkee and Crevier.
Crypto/digital currencies also provide an opportunity for the peer-to-peer (P2P) transfer of funds to individuals and organizations. Members of Congress urged Mnuchin to use blockchain to deliver treasury payments instead of direct-deposit and paper checks. Speed and not needing a bank account were the two primary justifications, however; the scale of the project made it unlikely. One impediment to this project is the need for the US to create a digital dollar and infrastructure for digital wallets. However, mutual aid projects such as Decolonizing Wealth are capable of using existing cryptocurrencies and ancillary technologies. In particular, due to a large number of un/underbanked marginalized Americans, the use of cryptocurrency and cryptocurrency wallets, a software or hardware tool similar to an online bank account, can be used to receive and store aid directly and quickly. With growing access to bitcoin atm’s and cryptocurrency debit and credit cards, recipients of crypto delivered aid can convert the cryptocurrency into USD without access to a bank account. The delivery of P2P mutual aid can also benefit the AI/AN communities not recognized by the federal government, which limits resources available to them.
The systemic issues present in AI/AN communities have made AI/AN individuals particularly vulnerable to COVID-19 with per capita cases in some tribes exceeding the combination of 7 states in May 2020. The I/T/U system has allowed for better healthcare, but continued underfunding and contractual inefficiencies still persist. Several proposed solutions to the delivery of healthcare services included better grant processes and mutual aid funding. Better grant processes and mutual aid solutions could provide secondary benefits through increasing funding; which was additionally highlighted as needed to improve Indian health. Blockchain can be used to improve the transparency and efficiency of the grant process through tokenization. Moreover, it can improve the efficiency, speed, and access of mutual aid by using cryptocurrencies and crypto wallets to extend banking solutions to un/underbanked AI/AN individuals.
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Blockchain and COVID-19 in Indian Country
August 31, 2020
An exploration of contemporary and historical issues impacting the delivery of American Indian/Alaskan Native health services and how Blockchain may help.
T
he U.S. government has a storied tradition of neglect, erasure, and genocide of vulnerable communities such as the American Indian/Alaska Native (AI/AN) population. COVID-19 has magnified challenges involving drastic underfunding, inefficient coordination of resources, and heightened socio-economic disparities within Indian healthcare systems. Some health experts have proposed an enhanced digital strategy utilizing blockchain to minimize inequities within AI/AN populations.
Historical and Contemporary Issues Impacting AI/AN Community Health and Wealth
The epoch of European settlement that led to drastic declines in indigenous populations and the foundation of detrimental social determinants of health created rampant food insecurity and poverty. Due to the litigation of the Dawes Act of 1887, self-governance and the potentiality for healthier socio-economic living conditions disbarred the growth of economic and social opportunities in AI/AN communities. Trends in unemployment and regulations in tribal activities amassed another emergent disparity. With 50% of the workforce concentrated within the casino and hospitality industries, many experienced immediate job loss due to COVID-19, which starved tribal revenue.
AI/AN healthcare System
The healthcare delivery system used by AI/AN communities is called the IHS/Tribal/Urban (I/T/U) System. Integral legislation that includes the Snyder Act of 1921, Transfer Act of 1954, Indian Self-Determination and Education Assistance Act (ISDEAA) of 1975, and Indian Healthcare Improvement Act (IHIA) of 1976 shaped the Indian Healthcare System (IHS). The funding process of the IHS, which is authorized through ISDEAA, stem from the Snyder and Transfer Acts, which funnel through the congressional appropriations budget. Additionally, Urban Indian Organizations (UIO) are funded through Title V of the IHIA. Although the evolution of policy resulted in improved delivery of healthcare to the AI/AN communities there exist numerous challenges from this complex system.
Problems with Health Service Delivery
Underfunding is the largest problem facing Indian healthcare. IHS funding is discretionary which is subject to external political shocks that may impact funds. Funds allocated to UIO account for less than 1% of U.S. health expenditures, while urban Indians account for 71% of the AI/AN population. A survey conducted in March of 2020 identified that 84% of UIO were forced to reduce services. Tribal governments receive additional funding through grants and third-party revenue. However, according to Rear Admiral Michael Weahkee, Director of IHS, during a natural disaster or market shock like COVID-19, small tribes are too underfunded and understaffed to apply for grants resulting in a reduction of revenue by as much as 80%. As a result of ISDEAA, IHS requires an extensive, redundant bilateral amendment process with tribes to distribute funds allocated through the Paycheck Protection Program and the Healthcare Enhancement Act.
Potential Solutions from Leaders
Leading organizations have proposed several solutions for improving Indian healthcare. Among these are suggestions for improving grant processes, increased funding, and mutual aid projects. Some key proposals are discussed below.
Francys Crevier, Director of the National Council of Urban Indian Health, proposed that Congress allot $80 million to UIO to help renovate buildings. This solution points to ending massive underfunding of UIO. Weahkee suggested that potential solutions to the grant process and distribution of funds could include:
- Appropriating funds directly to the IHS, authorizing the agency to place funds directly into existing contracts.
- Enabling direct transfers from the Center for Disease Control or the National Institutes of Health.
Finally, the Decolonizing Wealth Project worked to distribute $1 million in mutual aid to AI/AN community members. This solution offset inefficiencies within the CARES Act.
Blockchain Use-cases to Enhance Leadership Solutions
Blockchain can create opportunities for increased security, transparency, efficiency, speed of delivery and traceability of assets recorded on the blockchain. Two blockchain technologies, cryptocurrencies and tokenization, can be utilized to enhance the proposed solutions above.
The tokenization of grants, such as the pilot conducted by the Treasury Department could ensure that the terms of grants are secure and followed. The primary benefit to federal agencies included improved decision making through better transparency, quality, and timeliness of financial information. The primary benefit to grant recipients included reduced redundant reporting to grant-making entities and auditors. Payment efficiency presented as a secondary benefit. This use-case could improve direct payments to tribal governments and UIO from U.S. agencies and reduce operational inefficiencies identified by Weahkee and Crevier.
Crypto/digital currencies also provide an opportunity for the peer-to-peer (P2P) transfer of funds to individuals and organizations. Members of Congress urged Mnuchin to use blockchain to deliver treasury payments instead of direct-deposit and paper checks. Speed and not needing a bank account were the two primary justifications, however; the scale of the project made it unlikely. One impediment to this project is the need for the US to create a digital dollar and infrastructure for digital wallets. However, mutual aid projects such as Decolonizing Wealth are capable of using existing cryptocurrencies and ancillary technologies. In particular, due to a large number of un/underbanked marginalized Americans, the use of cryptocurrency and cryptocurrency wallets, a software or hardware tool similar to an online bank account, can be used to receive and store aid directly and quickly. With growing access to bitcoin atm’s and cryptocurrency debit and credit cards, recipients of crypto delivered aid can convert the cryptocurrency into USD without access to a bank account. The delivery of P2P mutual aid can also benefit the AI/AN communities not recognized by the federal government, which limits resources available to them.
The systemic issues present in AI/AN communities have made AI/AN individuals particularly vulnerable to COVID-19 with per capita cases in some tribes exceeding the combination of 7 states in May 2020. The I/T/U system has allowed for better healthcare, but continued underfunding and contractual inefficiencies still persist. Several proposed solutions to the delivery of healthcare services included better grant processes and mutual aid funding. Better grant processes and mutual aid solutions could provide secondary benefits through increasing funding; which was additionally highlighted as needed to improve Indian health. Blockchain can be used to improve the transparency and efficiency of the grant process through tokenization. Moreover, it can improve the efficiency, speed, and access of mutual aid by using cryptocurrencies and crypto wallets to extend banking solutions to un/underbanked AI/AN individuals.
