Transforming Health in Tribal Communities

By Amy Winterfeld | Vol . 22, No. 13 / April 2014

NCSL NewsDid you know?

  • Chronic diseases account for 75 percent of the $2.5 trillion spent annually for health care in the United States.
  • Nearly half of American adults have at least one chronic disease.
  • A new federal program, Community Prevention Grants, will award grants of $100,000 or more to tribes, local governments and nonprofits to fight chronic disease.

Community Transformation Grants support targeted efforts to prevent chronic diseases such as heart disease, diabetes and cancer, and to narrow gaps in health across population groups. Among 101 grants awarded to state and local governments, tribes, territories and nonprofits in 2011 and 2012 by the Centers for Disease Control and Prevention (CDC), 10 tribal communities received funding: the Sault Ste. Marie Tribe of Chippewa Indians (Michigan), Southeast Alaska Regional Health Consortium, Confederated Tribes of The Chehalis Reservation (Washington), Great Lakes Inter-Tribal Council, Inc. (Wisconsin), Sophie Trettevick Indian Health Center-Makah Tribe (Washington), Toiyabe Indian Health Project (California), Yukon-Kuskokwim Health Corporation (Alaska), Benewah Medical Center (Idaho), Cherokee Nation (Oklahoma) and Tohono O’odham Community Action (Arizona).

The grant recipients are working to prevent chronic diseases by promoting behaviors such as:

  • Tobacco-free living,
  • Active living and healthy eating, and
  • Controlling high blood pressure and cholesterol with clinical and preventive services.

Preventable chronic diseases take a higher toll in Native American communities. Tobacco use, the leading cause of preventable disease and death in the United States, affects Native Americans disproportionately, costing Indian Health Services $200 million annually. In 2012, 18.1 percent of all U.S. adults were current smokers, while 21.8 percent of American Indians and Alaska Natives smoked.

American Indian and Alaska Native adults are more than twice as likely to be diagnosed with diabetes as non-Hispanic whites. Native American youth, ages 10 to 19, have the highest prevalence of type 2 diabetes among all U.S. ethnic groups—1.74 per 1,000 children, compared to .42 per 1,000 children for all other groups.

A comprehensive 2009 study of obesity among 4-year-olds found that 31.2 percent of Native American youth were obese—compared to 18.4 percent for youth in the general population. Current USDA estimates suggest that between one-third and one-half of all Native American children are either overweight or obese, raising their long-term risk for cardiovascular disease, type 2 diabetes and some cancers.

State and Tribal Actions

Since 67 percent of Native Americans reside outside of tribal reservations, both sovereign tribes and state legislatures can help address chronic disease in Native American communities.

With its Community Transformation Grant, the Cherokee Nation has built on its Healthy Nation program, which is not reservation-based, but serves the entire community in a 14-county, 7,000- square-mile area in northeastern Oklahoma. Grant funds bolstered implementation of a smoke-free parks policy previously adopted by the City Council in Tahlequah, the Cherokee Nation capital, and tribal recognition of 25 schools with school health leadership awards. In 2012, grants helped support walking and bicycling to school, farm-to-school programs and community access to local, healthy food. Successful tribal businesses fund eight community health centers and a hospital with a new grant-funded breast-feeding support initiative, collectively providing 1.2 million patient visits annually. Concurrently, Oklahoma legislators created similar policies, including Healthy Certified Schools and Communities programs, a smoke-free restaurant law and a healthy corner store financing initiative sponsored by Representative Seneca Scott, a member of the Choctaw tribe.

With its grant, the Sault Tribe of Chippewa Indians partnered with local communities and schools to foster active living, healthy eating choices and tobacco-free environments in a seven-county area in Michigan’s Upper Peninsula. Among other initiatives, the tribe trained local high school teachers in a nutrition, physical activity and tobacco prevention curriculum in 2013, and passed a smoke-free ordinance covering all enclosed areas of public and tribal housing in 2010. Michigan’s Intertribal Council leads the National Native Network for tobacco prevention. Michigan lawmakers also enacted a statewide smoke-free law effective in May 2010.

To combat a higher rate of heart disease among American Indians in Washington, the Makah Community Transformation Grant developed a Leadership Team and Coalition and assessed the community’s nutrition, physical activity and walkability environments. Based on study results, the tribe prioritized culturally relevant strategies that included lowering the speed limit and installing crosswalk signs in front of the senior center. Coinciding with tribal efforts, the Legislature passed a Neighborhood Safe Streets act that allows local communities—without conducting expensive traffic engineering studies—to lower speed limits so that walkers, bicyclists and transit riders can move more safely on streets. Legislators also restored funding for Washington’s Tobacco Quitline, calling back more than 6,500 people waitlisted after 2011 cuts.

Federal Action

Community Transformation Grants awarded in 2011 were designed to operate for five years and those awarded in 2012 for two years. Congress recently created a new, similar $80 million program, Community Prevention Grants, which will award three-year grants of $100,000 or more to tribes, local governments and nonprofits to implement evidence-based chronic disease prevention strategies.

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