What We Learned from CDC Funding Allocations in the Native American Navajo Reservation that Could Inform the "America First" Global Health Strategy
- EvaluCraft Global LLC
- 1 day ago
- 5 min read
by Ayla Orona and Mary Wong
December 3, 2025 ~
Introduction & Background
The Center for Disease Control and Prevention (CDC) allocates large amounts of public health and health-services funding to U.S. state, local, and tribal governments. However, due to recent budget cuts, downsizes, and grant freezes, U.S. communities are increasingly at risk because many of the organizations that were already operating on lean budgets to implement these essential services can no longer operate to meet growing needs.
In the case of the Navajo Nation, a Native American Reservation primarily located in Arizona with portions extending into New Mexico and Utah, could be especially affected by these reductions. As a historically underserved region with poor public health services due to chronic underfunding, medical staffing shortages, and geographical challenges, the Navajo Nation could see its community health further strained by the recent reductions in CDC funding.
To better understand how CDC funding influences local health outcomes, we reviewed and analyzed how CDC funding allocations in Arizona compare to total disease cases across the state’s counties. Because recent funding data was limited, we used the CDC Grant Funding Profile for Arizona from fiscal years 2017 to 2023. Disease case data came from the Arizona Department of Health and Services’ Communicable Total and Probable Disease Summary reports, covering January 1 to December 30 for the same years.
Direct disease data for the Navajo Nation was not available, so Apache County and Navajo County serve as proxies. Approximately 73% of Apache County’s population is American Indian, and in Navajo County, about 47% of residents are American Indian while roughly 66% of the land lies within the Navajo Nation. Together, these counties provide the closest available representation of the region.
In light of the September 2025 released America First Global Health Strategy, we are also interested in how our insights might inform how this strategy is carried out and evaluated over time. The America First Global Health Strategy states its goal is to focus on Americans above all else, however, our findings show we are failing to meet the needs of our own communities, specifically Navajo Nation. Without changes, we risk continuing the same pattern. We conclude our analysis with key learnings and a few recommendations.
Data Analysis & Results:
To explore what CDC funding delays might mean for public health in the Navajo Nation, we used R programming language to analyze CDC grant data for Arizona (2017–2023) alongside statewide and county-level disease case reports from the Arizona Department of Health Services. Using line graphs, we examined patterns in total Arizona funding and disease trends, as well as county-level differences, with a specific focus on Apache and Navajo counties.
Chart 1
Chart 1 above shows the Rates of Adults who Reported Fair or Poor Health by Race and Ethnicity. The data, provided by KFF, is based on the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized civilian adults aged 18 years and older. The Asian/NH/PI group starts in 2021 because estimates are not provided if the relative standard error exceeds 30% or if the denominator is based on fewer than 50 respondents in the unweighted sample. This graph illustrates just how much higher the response rate is for American Indians and Alaskan Natives. These results could reflect two possibilities: Indigenous communities may be more likely to report fair or poor health when surveyed, or they may truly experience poorer health outcomes due to long standing gaps in healthcare access. Both interpretations point to concerning public health challenges within Indigenous communities.
Charts 2, 3 and 4 above show a comparison of CDC grant funding allocations for Arizona as a whole, for individual counties, and specifically for Apache and Navajo counties. Arizona’s total funding peaks in 2021 at over $1 billion, a surge that aligns with the height of the COVID-19 pandemic. Maricopa County follows a similar pattern and accounts for the majority of the state’s funding, which is expected given that Phoenix, the state’s capital and most populated area, is located there. In contrast, Apache and Navajo counties reach their highest funding levels in 2020 rather than 2021, with Apache receiving close to $7 million and Navajo around $2.5 million. These much smaller amounts highlight how little funding reaches the regions surrounding the Navajo Nation compared to Arizona’s urban centers.
When comparing Arizona’s total CDC funding allocations with statewide disease case reports, the data in charts 5 and 6 above shows a clear upwards trend for disease cases from 2017 to 2023, while funding peaks in 2021. The statewide totals do not show a deeper relationship between funding amounts and disease cases, so we turn to county level data for deeper insight.
Maricopa's dominance in Arizona's overall numbers continues when looking at disease cases in Charts 7, 8 and 9. In the middle graph (Chart 8), Maricopa records the largest number of disease cases with Pima and Pinal County following behind. This is to be expected as Maricopa, Pima, and Pinal are the three largest counties of Arizona respectively.
In the right most graph (Chart 9), Navajo County displays about double the amount of disease cases than Apache County. While Navajo County does have a larger population than Apache county, the differences still raise important questions. To understand these trends more clearly, we will explore how Apache and Navajo Counties CDC funding aligns with their disease burden.
The above two final graphs (Charts 10 and 11) highlight the relationship between total CDC funding and disease cases for Apache and Navajo Counties. Apache county receives more funding with reports of fewer disease cases, while Navajo County receives significantly less funding yet has nearly double the number of cases. Taken together, this pattern suggests a possible connection between lower public health funding and higher disease burden in these communities.
Summary & Conclusion
These findings raise important questions on many levels. Why does Navajo County receive less CDC funding than Apache County despite having a larger population? Why is there such a clear gap between funding amounts and disease burden in these communities? Another point to consider is the timing. Both counties received their highest funding in 2020 rather than in 2021, when most of Arizona’s COVID-19 related funding peaked. Could the vast support differences have played a role in the severe COVID-19 outbreaks experienced in Navajo Nation?
Overall, the relationship between funding and disease outcomes shown here highlights how continued cuts or freezes to CDC grants could disproportionately affect the health of Navajo Nation and other Native American communities.
Recent federal actions reveal a broader pattern of deprioritizing public and global health institutions. In 2020 and in 2025, the U.S. initiated steps to withdraw from the World Health Organization and several United Nations programs. While this shift is related to global institutions rather than domestic and tribal ones, it signals a shift away from investing in public health organizations. This along with the dramatic budget cuts and freezes targeting the U.S. public health agencies raises significant concerns on how this will later affect tribal communities that are historically underfunded, like Navajo Nation. A continued pattern of lack of investment in health infrastructure risks increases of health disparity, including Navajo Nation and other tribal communities.
Turning back to the America First Global Strategy, truly putting “America First” must start with addressing the needs of U.S. communities that have been long overlooked. Strengthening support for tribal nations to better align with needs, potentially expanded programs to bring medical staff and supplies to rural and tribal areas, health infrastructure, and better data reporting systems. The Strategy emphasizes “robust performance monitoring” and insists that foreign aid be driven by data to prevent waste. Yet, domestic data reveals shortcomings in applying these principles at home. Without these investments, the Strategy seems to be set up to put last the very population it claims to prioritize.
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