Community Context and Challenges

  • An estimated $0.70 of every $1 in personal income is spent off-reservation in border towns, further complicating efforts by Navajo Nation to maximize local sources of revenue; such imbalanced spending results in a decreased tax base.

  • Transportation and infrastructure are key barriers in connecting Navajo Nation residents with services, resources, and opportunities.

  • San Juan County’s uninsurance rate is 26%, which is significantly higher than state (18%) and national (14%) averages.

  • The county’s per capita rate for violent crimes (644 per 100,000 residents) is significantly higher than the national rate (366 per 100,000 residents).

  • American Indian residents have almost half the household income and a lower level of educational attainment than their white counterparts, and much higher rates of unemployment and poverty; they’re also twice as likely as white residents to be uninsured and twice as likely to have used the emergency room in the past year.

Community Actions: A First Look

Collaborative partnerships between on- and off-reservation agencies are working to address disparities and stimulate progress.

Organizations across San Juan County are working to create a blueprint for addressing the ethnic disparities in income, employment, educational attainment, access to care, and exposure to environmental toxins. With increased focus and support, such partnerships may lead the way toward improved community health.


These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

Going Forward: Questions for Consideration

In the face of historic marginalization of the American Indian population and its resulting disparities in health outcomes, San Juan County is taking initial steps to address inequities through focused attention on root causes and cross-sector collaborations that respect Native traditions. Additional surveillance; data and information gathering; analysis; and reporting will determine the extent to which these initiatives address the needs of the community. The resulting data should help identify the most effective methods and partnerships and also help guide the community’s efforts and resource allocations.

Answers to the following questions could provide insights into the degree to which meaningful change is taking place and can be sustained:

  • What type of health outcomes may result from more health equity-focused partnerships?

  • How will these partnerships involve those directly affected by health inequities in addressing the structural causes of those inequities?

  • In what ways can partnerships between San Juan County, local municipalities, and Navajo Nation more effectively coordinate efforts to achieve positive outcomes both on- and off-reservation?

  • How can existing and future partnerships and initiatives better assess, address, and include the Hispanic population?