Patricia Nez Henderson, MD, MPH. Black Hills Center for American Indian Health Rapid City, South Dakota

Transcription

1 Patricia Nez Henderson, MD, MPH Black Hills Center for American Indian Health Rapid City, South Dakota

2 Disclosure Disclosed no conflict of interest

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4 OBJECTIVE Discuss how policies can address inequities in prevention, diagnosis and treatment of people living with diabetes in Indian Country

5 DIABETES IN INDIAN COUNTRY 2.2 times higher Likelihood of American Indians and Alaska Natives to have diabetes compared with non-hispanic whites 68% Percent increase in diabetes from 1994 to 2004 in American Indian and Alaska Native youth aged years 30% Estimated percent of American Indians and Alaska Natives who have pre-diabetes Source: American Diabetes Association

6 Prevalence of Diagnosed Diabetes AIANs compared to U.S. population: AIAN US Percent Year Source: IHS Program Statistics and National Diabetes Surveillance System. Age-adjusted to the 2000 US standard population with the exception of data for AIAN, which was age-adjusted to the 1980 US standard population.

7 Prevalence of diagnosed diabetes among AIAN children and young people, by age group, per % increase % increase 128% increase 77% increase < Year Source: IHS Diabetes Program Statistics

8 Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among U.S. Adults Aged 18 Years or older 2 Obesity (BMI 30 kg/m ) 1994 No Data <14.0% % % % >26.0% Diabetes 1994 No Data <4.5% % % % CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at >9.0%

9 Risk Factors Having prediabetes Being 45 or older Having a family history of diabetes Being overweight Not exercising regularly Having high blood pressure Having low HDL, also known as "good cholesterol and/or high levels of triglycerides Certain racial and ethnic groups Women who had gestational diabetes

10 ENVIRONMENT

11 ENVIRONMENT

12 ENVIRONMENT

13 Special Diabetes Program for Indians (SDPI) Congress established SDPI through the Balanced Budget Act of SDPI provides grants for diabetes treatment and prevention services to 404 IHS, Tribal, and Urban Indian health programs. Focused on reducing risk of diabetes in high risk individuals. $30 million per ( ) $150 million per ( ) _Sheet_SuccessInterv_508c.pdf

14 Increase Access to Diabetes Treatment and Prevention Services 1997* 2010 Diabetes clinics 31% 71% Diabetes clinical teams 30% 94% Diabetes patient registries 34% 94% Nutrition services for adults 39% 89% Access to registered dietitians 37% 77% Culturally tailored diabetes education programs 36% 99% Access to physical activity specialists 8% 74% Adult weight management programs 19% 76% ctsheets/2012/fact_sheet_successinterv_508c.pdf

15 TRIBAL POLICY EFFORTS Few tribes have passed policies for breastfeeding at workplaces and public places. Navajo Nation Council tabled a legislation that would have increased excise taxes on junk food. Tribes have passed tobacco-free policies throughout the country BUT most casinos are exempted. Some tribes have passed wellness policies to give their employees an hour plus for exercise during lunch time.

16 TRIBAL POLICY EFFORTS

17 TRIBAL POLICY EFFORTS Facebook Friend s Views Smoke-free policies Banning > 24 oz soda drinks and limit 12 packs of soda at grocery store Policy for breastfeeding Increasing taxes on junk food Health food/snack in work sponsored meetings and tribal sponsored events No more fry bread policy Work wellness policy Share use policies that allow school or church properties for physical activities for communities.

18 TRIBAL POLICY EFFORTS

19 STEPS TO INTRODUCING POLICY Documenting the problem Needs assessment Educate, Educate, Educate Educate yourself become the expert Educate the Community, Tribal Leaders Media, presentations, surveys, polls, readiness assessment Build Coalition Passing Policies Learn how local laws are passed Build your core team Find your champion Take head count of elected officials early and often Keep an eye on the opposition If you don t have the votes, stop and regroup and EDUCATE

20 TEAM Navajo

21 Bilagáana bi Na toh ba át e hóló

22 Towards A Healthier Navajo Nation Promoting Community Tobacco free events Pow-wows Rodeos Ceremonial gatherings Walks/Runs Radio shows Billboards Newspapers/Radio Ads Art Contest

23 Towards A Healthier Navajo Nation 91% of the Navajo Nation Supports a Commercial Tobacco-free Nation" in all work places and public places with no exemptions. How Do Our ELECTED Leaders Reflect our Views When It Counts?

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26 TRIBAL POLICY EFFORTS Bates number

27 Protect People from Secondhand Smoke The Navajo Nation Commercial Tobacco Free Act 2008 The Navajo Nation Commercial Tobacco Free Act 2009 The Navajo Nation Commercial Tobacco Free Act 2011

28 TRIBAL POLICY EFFORTS Increased taxes on tobacco products: 2006 ($1.00) and 2011 (60 cents) Educating leaders on increasing taxes again and changing tax structure for products.

29 TEAM Navajo With the rates of obesity and diabetes rapidly increasing on the Navajo Nation, runners of Team Navajo are dedicated to addressing this health epidemic one mile at a time. Team Navajo dedicated countless hours to train for this life changing event with a goal to inspires our communities to live a healthy lifestyle and be in harmony. HOZHO

30 TRIBAL POLICY EFFORTS Breast feeding in public and workplaces Healthier school lunches Grocery and convenient stores food placement Increasing excise taxes on junk food Ban of biggie size soda drinks Limit EBT purchases to healthy foods

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32 With Sovereignty Comes Responsibility, Responsibility of the Health of Our People Contact Information: Patricia Nez Henderson