COVID hit hardest Montana’s poorest counties with high percentage of non-White residents

By: - April 14, 2022 3:31 pm

A screenshot of Montana Data from the Poor People’s Campaign report on COVID deaths, poverty and race, published in April 2022 (Screenshot via Poor People’s Campaign.)

A national report by the Poor People’s Campaign that tracks the intersections of race, poverty and the effects of COVID-19 shows that nationally, counties with more poverty and more people of color suffered the effects of the pandemic more severely than other wealthier, White communities.

The statistics for Montana largely support that trend, showing that many rural counties with a higher percentage of people of color sustained a higher COVID death rate than comparable counties. Six counties demonstrated a higher percentage of people of color and a higher death rate, compared to just one county, Lake County, which bucked that trend.

The “intersectional data analysis” took information on income, race, population density and COVID, and created a county-by-county map of the United States that demonstrated several patterns. First, those living in poorer counties died at a rate of nearly two times those in richer counties.

“The 300+ counties with the highest death rates have a poverty rate of 45%, which is 1.5 times higher than in counties with low death rates,” the report’s conclusion said. “Median incomes are on the average $23,000 less than counties with lower death rates.

“In the poorest tenth percentile counties, more than half of the population lives under 200% of the poverty line.”

Those trends largely held true for Montana, where counties with a higher percentage of people of color also experienced more poverty and higher death rates.

Montana Counties with both
a high percentage of people of color
and a high percentage of COVID death rate

Big Horn County
Cumulative Deaths: 89
Death rate/100,000: 668
% less than 200% of poverty line: 56
% of American Indians: 64

Blaine County
Cumulative Deaths: 29
Death rate/100,000: 434
% less than 200% of poverty line: 50
% of American Indians:50

Glacier County
Cumulative Deaths: 67
Death rate/100,000:487
% less than 200% of poverty line: 56
% of American Indians:64

Hill County
Cumulative Deaths: 71
Death rate/100,000: 431
% less than 200% of poverty line: 42
% of American Indians: 22

Roosevelt County
Cumulative Deaths: 70
Death rate/100,000: 649
% less than 200% of poverty line: 36
% of American Indians: 37

Rosebud County
Cumulative Deaths:58
Death rate/100,000: 649
% less than 200% of poverty line: 36
% of American Indians: 37

The only county to show opposite of the trend

Lake County
Cumulative Deaths: 94
Death rate/100,000: 309
% less than 200% of poverty line: 41
% of American Indians: 23

Everything against them

The study’s results did not come as a shock to Laura Larsson, a professor of nursing and public health at Montana State University in Bozeman. Her research and outreach focuses on public health and getting more providers into Montana’s Indian Country.

She said the pandemic was a textbook example of all the things that could go wrong, resulting in high death rates.

One of the largest problems was that Indian Health Service, the national healthcare program designed for Native Americans, located in Bethesda, Maryland, closed and some parts of the service remain closed. That may make sense for densely populated urban areas where healthcare is more plentiful, but in rural, remote places in Montana, closing IHS was often turning off the only healthcare option.

She said the decision to close IHS turned what is already termed a “health care desert” into an even larger desert.

Furthermore, many who live in rural, impoverished areas lack reliable, affordable transportation, making it that much more onerous to get to a doctor or healthcare provider during times of illness. Then, the provider has to be willing to accept insurance and has to have an opening.

“And that doesn’t even begin to cover the larger issue of mistrust,” Larsson said.

Many Native communities have had poor healthcare or negative interactions even after traveling long distances to get to healthcare providers.

“So now you see that healthcare isn’t just urban-centric, it’s also Eurocentric, so the provider may not be aware of understand the cultural differences or how much it takes just to get access,” Larsson said.

She said most people living in some of the more urbanized areas of Montana don’t realize that often to get a rural child into a pediatric dentist can take more than 100 miles of one-way travel.

“We see how complicated that is,” Larsson said.

That often involves needing reliable transportation, a doctor willing to accept a specific type of health insurance, and then taking time off work or school, often resulting in lost wages for those already struggling to pay the bills and steeply rising gasoline prices.

Larsson said one thing that is nearly impossible to capture in the report is the social impacts of COVID. Often, smaller rural communities are close-knit and so a death, by COVID or other disease, is amplified.

One of the trends that did start with COVID and the corresponding shut-down of the federal IHS was tribes beginning to take control of more health services. For example, the Northern Cheyenne community enforced a nighttime curfew that limited the number of visitors to try to keep interactions at a minimum and the disease from spreading to vulnerable populations.

The Blackfeet Nation also closed its borders during the pandemic in an attempt to stop the spread of the disease.

“You are seeing the tribal communities begin to take care of services as they are able to from IHS which is what we mean when we talk about ‘healthcare sovereignty,” Larsson said.  “Of course, that didn’t help with isolation or the healthcare deserts, but it did try to keep those vulnerable people healthy.”

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Darrell Ehrlick
Darrell Ehrlick

Darrell Ehrlick is the editor-in-chief of the Daily Montanan, after leading his native state’s largest paper, The Billings Gazette. He is an award-winning journalist, author, historian and teacher, whose career has taken him to North Dakota, Minnesota, Wisconsin, Utah, and Wyoming.