IMPROVING SOCIAL DETERMINANTS OF HEALTH: A CASE STUDY OF NATIVE AMERICAN COMMUNITIES BENEFITING FROM FEDERAL FUNDING

Abstract

Rural Indigenous communities face multiple challenges, including limited economic opportunities, insufficient healthcare, inadequate access to education, poor infrastructure and living conditions, and a lack of social support and structure. The American Rescue Plan Act (ARPA) grant has offered a unique opportunity to address these issues by providing substantial funding to measurably and sustainably improve the social determinants of health (SDOH), informing future strategies in similar grant management and homeland security efforts. This thesis integrates a comprehensive literature review, research, and interviews with high-ranking government officials to analyze the impact of ARPA grants on the SDOH of Native American populations using case studies of the three most populous tribes: the Navajo, Cherokee, and Choctaw Nations. The findings assert that while ARPA grant funding might be improving SDOH, such impacts are largely unmeasurable under the current U.S. Treasury guidelines for reporting expenditures and encumbrances. The information and analysis presented in this thesis show that many of the tribes are trying to comply with the grant’s requirements while improving SDOH for their population. This thesis includes a call to action for reform in the grant allocation process to emphasize outcome-based reporting, as opposed to the prompt spending of funds, and ensure that financial investments yield measurable, real-world impacts that adhere to quantifiable societal metrics.