Morbid and Mortal Inequities among Indigenous People in Canada and the United States during the COVID-19 Pandemic

Critical Review of Relative Risks and Protections

Abstract

The COVID-19 pandemic focused the world’s attention on gross racialized health inequities and injustices. For political and scientific reasons much less is known about the plight of Indigenous peoples than about other ethnic groups. In fact, some of the early pandemic evidence suggested that Indigenous peoples, while clearly experiencing prevalent structural violence probably also experience certain cultural protections. Aiming to begin to clarify their relative risks and protections, we conducted a rapid critical research review and sample-weighted synthesis or meta-analysis of the published and gray literature on four COVID-19-relevant outcomes in Canada and the United States between January 1, 2020 and August 1, 2021: vaccination, infection, severe infection, and death rates. Twenty-nine Indigenous-non-Indigenous comparative surveys or cohorts that observed 33, typically age-standardized, incidence or mortality rates or their proxies were included. Consistent with structural violence theory, we found that Indigenous peoples were significantly more likely to be infected, to experience severe COVID-19 illness, or to die as a result of their illness, Indigenous mortal risks (RR = 2.45) being significantly greater than Indigenous morbid risks (RR = 1.40). Consistent with cultural strengths theory, vaccinations seemed equitably distributed (RR = 1.02) with a suggestion of greater vaccine willingness among Indigenous peoples in some places. Clearly, much work remains to be done to decolonize Indigenous research and ultimately practices and policies in North America. Indigenous knowledge user-researcher teams and their allies have much to teach about cultural and ultimately, policy protections.