Between 2020 and 2021, Native Americans and Alaskan Natives saw a two-year decrease in their life expectancy - the biggest drop among demographic groups, according to the Centers for Disease Control and Prevention. One Arizona group is working to reverse the trend.

COVID-19 took a big toll on this population, and a more recent CDC report said Native Americans are also more likely to be hospitalized if they get the flu.

In Flagstaff, Shay Brown, a COVID-19 resource nurse with Native Americans for Community Action, said she isn't surprised by the findings.

"A lot of these families are living in multigenerational housing, and many of them do not have running water, don't have electricity," she said. "It's like compounding effects that cause a lot of these infection rates to rise."

While NACA provides medical attention to limit the spread of disease, the group said this issue goes beyond access to health care for the more than 311,000 Arizonans who are Native American. Poverty and lack of basic services on reservations also are factors.

In northern Arizona, NACA is in close proximity to several tribal nations, but the Navajo Reservation is one of the largest in terms of size and population. NACA's interim director, registered nurse Verity Quiroz, said the reservation struggles with insufficient housing and ready access to health-care facilities, which affects the overall health of the community. She said they're still seeing COVID cases.

"Most of the people that are significantly sick are being evaluated and treated in the hospital," she said. "At NACA we do our best to prevent, first of all - and then, for those milder cases, we refer to our COVID resource nurse."

The CDC said about 41% of Native American and Alaskan Native adults are immunized. Public health officials say if health-care providers work to build trust in the communities they serve, it will be easier to teach disease-prevention strategies and fight misinformation.

Next week, Native American leaders from the Midwest will go before a United Nations panel with their concerns over a controversial oil pipeline they say is trespassing on tribal lands.

Enbridge's Line 5 operation in the Great Lakes region is expected to be a topic when the Permanent Forum on Indigenous Issues convenes Monday in New York.

In the Midwest, the law firm Earthjustice represents some Tribes contesting the rerouting of Line 5 in Wisconsin. There, managing attorney Debbie Chizewer said climate change is affecting the region and tribal nations' ability to exercise their treaty rights.

"The perpetuation of this fossil-fuel infrastructure will only worsen that," she said, "and will affect their special tribal resources, like sugar maple and loons, and whitefish and other species that are an integral part of Bay Mills and other tribal nations."

The pipeline runs through Wisconsin and Michigan, traversing the treaty-reserved territory of tribal nations, including the Bay Mills Indian Community and Bad River Band of Lake Superior Chippewa. Enbridge rejects those claims and has said it isn't trespassing on tribal lands.

Similar cases have been filed in other parts of the Midwest. In Michigan, opponents have said they're worried about Enbridge's plan to construct an oil tunnel beneath the Great Lakes. The company has claimed it would be safer than the existing pipeline, but Native American Rights Fund senior staff attorney Wes Furlong said he sees it as a disaster waiting to happen.

"There is a likelihood that if a leak happened within that tunnel, it would cause a catastrophic failure," he said. "Essentially, the tunnel could explode underneath the Straits of Mackinac, pumping crude oil into the strait and into the Great Lakes."

Furlong said pushing back against Line 5 aligns with calls to reduce the use of fossil fuels, citing its connection to climate change and the impact on treaty-reserved resources in the Midwest, on which Tribes rely.

"There's pending litigation over the State of Michigan's order to shut down the pipeline, and ordering Enbridge to vacate the state-owned bottomlands of the Strait of Mackinac," he added. "So, that would spell, I think, the end of Line 5 as we know it."

The Nebraska Winnebago Tribe's Ho-Chunk Community Development Corporation, or HCCDC, has been awarded $2 million through MacKenzie Scott's Yield Giving company.

Some 6,300 nonprofits applied to Yield Giving's open call for grants. The HCCDC was among 279 to receive a top tier rating. In the next-highest tier, 82 organizations each received $1 million.

Kristine Earth, executive director of the corporation, said the Tribe has a lot to be proud of but a lot of work left to do.

"We're so excited and are so thankful for this generous gift for our community," Earth stated. "We do have a lot of issues; we have a lot of health disparities. And so, a donation like this really is going to make an impact for our entire Tribe as a whole."

HCCDC marks its 20th anniversary this year, working to improve economic, educational and social opportunities for tribal members. Earth pointed out they have five key initiatives: housing development, commercial development, financial services, quality of life and food sovereignty.

The Winnebago Tribe has experienced huge growth in its middle class in the past few decades but roughly 30% of its members still live in poverty. HCCDC created a farmer's market, which Earth says is helping them address both health disparities and food sovereignty.

"Through our farmers market, now we're able to touch on not only agriculture and tribal farming, but also our health care system," Earth outlined. "Offering the fresh fruits and vegetables and the Indian corn; things that will restore the health of our people."

Earth added Winnebago is in a "food desert," making food security a major focus for the Tribe.

"It's hard for people to access fresh fruits and vegetables, and we have such a growing community," Earth stressed. "We are all coming together to grow our own food and to feed ourselves, so we can be sustainable in the future."

On the website, MacKenzie Scott called all the open call grant winners "vital agents of change." Scott's Yield Giving organization has donated more than $17 billion to 2,300 nonprofit organizations since 2019.

Billings-based Western Native Voice is holding its annual membership conference in Great Falls starting tomorrow, and members are discussing democratic participation but also cultural issues affecting tribes.

The conference is called No Vote Left Behind and will focus on helping Indigenous people register to vote and know where and when to cast ballots.

Just as importantly, workshops will discuss cultural identity and what it means to be Native.

Western Native Voice communication's director Tracie Garfield is a member of the Assiniboine tribe, and said more than 50% of Indigenous people in Montana live off reservations - which leaves many wondering where and how they fit it with their culture.

"Participants and members of the workshop will be able to talk to each other - talk about what it means to be Native, how they grew up," said Garfield. "Some grew up on a reservation. We'll have people who grew up in urban areas. We'll also have people who grew up in rural Montana - off the reservations."

Cultural identity was the number one topic requested by members for this conference. Western Native Voice has over 13,000 members from Montana and across the U.S.

The conference starts tomorrow morning in Great Falls.

Garfield said Western Native Voice will hold its Expanding Horizons: Beyond Survival youth conference next Monday and Tuesday in Bozeman - where they will be learning about native history, traditional knowledge and cultural identity.

The conference will bring together students from both urban and reservation high schools. She said true native history and cultural identity weren't always taught when she was young.

"When we were growing up, we weren't really taught the true history of our tribes," said Garfield. "Say I'm Assiniboine. I didn't know my own tribal history. Even though I felt Native I didn't really know what it meant to be Native."

Garfield said cultural identity is a complex issue with so many people living in urban areas, and Western Native Voice wants to create a space for people to talk about it by training youth early on so they understand what it means to be Native in today's world.