James and Mary Oral History & Public Health | By Sarah Haile

The Navajo Nation is the largest Native American reservation in the United States, covering approximately 27,000 square miles across northeastern Arizona, northwestern New Mexico, and southeastern Utah. It is home to a rich cultural heritage, breathtaking landscapes, and a deep historical connection to the land, with iconic landmarks such as Monument Valley and Canyon de Chelly showcasing its beauty. The traditions of the Diné people, including their language, art, and ceremonies, remain vibrant and deeply rooted in their ancestral lands. 
​
Medicine people James Etsitty and Mary Blackmountain share their experiences and way of living in the reservation, and shed light on some of the difficulties they face being in a remote area.​

Health outcomes in the Navajo nation are shaped by the social determinants of health. The social determinants of health (SDOH) are the non-medical factors that influence individual and community well-being. These determinants include economic stability, education, healthcare access, social and community context, and the physical environment. They shape health outcomes by affecting access to resources like nutritious food, safe housing, quality education, and job opportunities.

    Access to basic necessities on the Navajo Nation is often limited due to its remote and rugged landscape. Many households lack running water, requiring residents to haul water from public spigots, sometimes miles away. The unpaved roads, which become especially difficult to navigate in bad weather, make travel even more challenging. For groceries, many families must drive long distances to reach affordable supermarkets, as the few local stores often have higher prices and limited fresh food options. 

In our interview with Mary, she says:  “For example, there's a local store that has been opened up…a dozen eggs is eight dollars. And a loaf of bread is five dollars…And of course it's cheaper in town, but you have to drive. You have to go one hour just to get to a Walmart or Safeway.” 
This dilemma forces Navajo residents to choose between spending more on local groceries, or saving money by driving an hour into town. It raises questions about the quality of food residents are getting nearby at a lower cost, and how nutritious they are. 

This same dilemma was once a problem when trying to receive healthcare. James recalls a time where access to healthcare facilities was much more difficult. 
“But it's there, you know. That's how we get help. But before, before, it was kind of hard, because you'd just have to walk all the way to the hospital. Where we used to live. Now they're closer. We're closer to the hospital, and (there's a) big hospital or — they built maybe three of them around different areas.” 
Despite having reasonable access now via cars and multiple hospitals and nearby, there is still the possibility that if you cannot be treated locally, you could be sent to a hospital in Phoenix Arizona, an approximate 5-6 hours away from the reservation.


In response to the food security challenges, the Navajo Nation has taken significant steps to address food insecurity and promote healthier lifestyles through legislation such as the Healthy Diné Nation Act (HDNA) of 2014. This policy introduced a 2% tax on unhealthy foods while eliminating a 6% sales tax on healthier food options, aiming to encourage better dietary habits within the community. The tax revenue generated has been reinvested into local wellness projects, improving recreational infrastructure, education, and community-based health initiatives. Despite the logistical challenges of enforcement, the act has been largely successful in funding health-promoting resources across the reservation. The 2020 reauthorization of the HDNA demonstrates the Navajo Nation’s commitment to self-determined health policy and sustainable community wellness efforts. The revenue from the act has supported various community projects, such as the construction of walking trails, community fitness centers, and wellness programs aimed at reducing rates of diabetes and obesity. Additionally, funds have been used to establish farmers' markets and community gardens, increasing access to fresh, local produce in areas where grocery stores are scarce. However, disparities remain, and continued efforts are needed to ensure these initiatives translate into long-term health benefits. 


James and Mary share that they also just received running water and electricity not too long ago, however, according to a 2021 report, approximately 30% of Navajo households still lack access to running water, some living without electricity. The lack of basic utilities affects nearly every aspect of daily life, from cooking and sanitation to education and healthcare. Without running water, families must often travel long distances to collect and haul water, adding both financial and physical strain. Limited access to electricity means some households rely on expensive or inefficient alternatives, further exacerbating these burdens. These infrastructure gaps highlight the ongoing challenges faced by many residents in the region. The lack of essential infrastructure creates significant hardships, reinforcing cycles of poverty and limiting opportunities for growth and development in the region. 

    Native American traditional and alternative healing practices are used to treat and prevent illnesses in the Navajo Nation. James recalls his experience becoming a medicine man and how he got involved in traditional healing practices.

“I started off as a young man then, (going to the) peyote ceremonies. I remember they prayed for me and they prayed for my brothers and sisters, my dad used to say that. 
I was just listening, and that's how I began to learn. As I was growing up, in high school, I started working the fire in the ceremonies. I would begin to talk. People would talk, and I would begin to raise my hand and introduce myself.”

Traditional healing remains a cornerstone of healthcare in the Navajo Nation, often working alongside—or in place of—Western medicine. Peyote, a sacred plant used in Native American Church ceremonies, is more than just a medicinal remedy. It plays a crucial role in spiritual and emotional healing. These ceremonies, which involve prayer, singing, and ritual purification, focus on restoring balance and harmony—an approach that aligns more with Eastern medicine’s holistic philosophy than Western medicine’s symptom-based treatments. 

James recalls another instance in which traditional medicine and healing was used on Mary, a woman with cancer.

“There's one lady, we call her our daughter. She's from the town over there. Her name was Mary, and she had cancer. She's cancer free. And another one over here in the New York area, too. We helped her out back then, too…We are very grateful, and thankful for the medicine, the prayers, everything. We just have to have faith. Even though it's a long ways we’ve come in travelling. We'll be alright not, and I’ll just say that, because I believe in the prayer. And we’re sharing that everything's okay. We’re short on everything, but believe in yourself. That’s the medicine. Don't give up. Stay on the road. Keep the faith.”

 Many Navajo people rely on traditional healing not just for cultural reasons, but also because hospitals and clinics are often hours away, understaffed, and costly. At the same time, a deep-seated mistrust of Western medicine, rooted in historical mistreatment, makes many hesitant to seek mainstream medical care. 

James and Mary’s stories emphasize the importance of cultural traditions in navigating health and well-being. Their commitment to traditional healing underscores the enduring power of faith, ceremony, and community in overcoming hardship. As the Navajo Nation continues to push for progress, their voices remind us that true health extends beyond physical well-being—it is deeply tied to history, identity, and the strength of the people who call this land home.

​