Western Tribal Diabetes Project Women in Government Kerri Lopez, Director

Transcription

1 Western Tribal Diabetes Project Women in Government 2012 Kerri Lopez, Director Western Tribal Diabetes Project Northwest Tribal Comprehensive Cancer Project Northwest Portland Area Indian Health Board Northwest Portland Area Indian Health Board Indian Leadership for Indian Health Special Diabetes Program for Indians (SDPI) 1997 (Balanced Budget Act 33 million) 2001 (second round funding 100 million) 2003 (third round 150 m 5 years) $27.4 million going to competitive grants RFA summer of programs funded 2007 (extended 150 m 2 years) Funding is allocated for community SDPI Competitive become demonstration grants Funding remains at the same level 2009 (extended 150 m 2years) 2 1

2 SDPI current Funded until 2013 Bill has been extended twice Has not been reauthorized Have not been increases since 2003 NCAI, NIHB, all Area Indian Health Boards have resolutions for increase and reauthorization 3 Issues Current political climate Budget constraints / realities Has been attached other legislation Improve program hiring qualified staff Ask is 5 years 200m IHS, ADA, JDRF 4 2

3 Health Funding Disparity 2005 IHS Expenditures Per Capita Compared to Other Federal Health Expenditure Benchmarks $8,000 $7,000 $847 $6,000 $753 Grow th Forecast Through 2005 $5,000 $581 $682 $4,000 $3,000 $2,000 $1,000 $6,784 $5,670 $4,653 $4,328 $743 $3,242 $923 $2,980 $2,130 $498 $0 Medicare Natl Hlth Expend. Veterans Admin. Medicaid Medical for Federal Prisoners FEHB Medical Benchmark 2005 IHS Expend. IHS non-medical Historical Events for Tribes Loss of traditional life style Fur trappers, mountain men Resource Exploitation Westward expansion Oregon Trail Rogue Indian wars Reservations Boarding Schools Termination of tribes Exclusion laws Tribes reinstated in 1980 s 3

4 Current Issues Sovereignty Treaty Rights Health Reform IHS budget Medicaid CCO s health insurance exchanges Health Disparities Administrative Issues Top Heavy U.S. AMERICAN INDIAN AND ALASKA NATIVE POPULATION 3.3 million Number of American Indians and Alaska Natives in 2007 (according to the U.S. census) 564: federally recognized American Indian and Alaska Native Tribes 4

5 GENERAL DIABETES Number of years by which diabetes can shorten a person s life span 15 Average annual medical care cost for a person with diabetes $13,243 Average annual medical care cost for a person without diabetes $2,560 AI/AN Diabetes 16.5% Percent of American Indian and Alaska Native adults who have diagnosed diabetes (compared with 8.7% of non-hispanic whites) 1,758 Number of American Indian and Alaska Native youth under the age of 19 who have diagnosed diabetes (2005) 68% Percent increase in diabetes from 1994 to 2004 in American Indian and Alaska Native youth aged years 95% Percent of American Indians and Alaska Natives with diabetes who have type 2 diabetes (as opposed to type 1 diabetes) 30% Estimated percent of American Indians and Alaska Natives who have pre-diabetes 2.4 times higher Likelihood of American Indians and Alaska Natives to have diabetes compared with non-hispanic whites 5

6 AI/AN diabetes 58% Increase in diabetes prevalence among American Indians and Alaska Natives aged from 1990 to 1998, as compared with 9.1% in the U.S. general population 3 times higher Death rate due to diabetes for American Indians and Alaska Natives compared with the general U.S. population (2004) 3.5 times higher Rate of diabetes-related kidney failure in American Indians and Alaska Natives compared with the general U.S. population (2004) 18.5% Percent reduction in new cases of kidney failure in American Indians and Alaska Natives from 1999 to times higher The risk for developing cardiovascular disease in American Indians and Alaska Natives with diabetes compared with American Indians and Alaska Natives without diabetes 66% Percent of American Indians and Alaska Natives with cardiovascular disease that had diabetes first Why SDPI is important AI/AN suffer disproportionate rate of diabetes AI/AN have 2.4 times higher diagnosis 16.5% AI/AN diagnosed with diabetes Diabetes is fourth leading cause of death Diabetes mortality is 4 times that on non-indians Heart disease is leading cause of AI/AN mortality 82% of AI/AN adults have diagnosed hypertension 6

7 Northwest Portland Area Indian Health Board 13 SDPI National Successes 7

8 SDPI National Successes We know what works Lifestyle intervention classes in tribal communities Emphasis on the role of the coach and support Education was essential Groups had substantial weight loss With that lower triglycerides, blood pressure, cholesterol Participants have carried message to family Participants were able to incorporate into life 8

9 Best Practices (20 IHS Diabetes) Weight loss (adult and child) Breastfeeding Nutrition Physical Activity Diabetes Screening IHS Let s move in Indian Country Michelle Obama s kickoff AI/AN youth obesity task force School Health, head start, day care 5 easy steps Action plan 9

10 IHS Best Practices Healthy weight for life Youth and type 2 Diabetes School Health and Diabetes Diabetes Education in Tribal Schools (DETS) Life in balance K-12 AI/AN Students Increase understanding of health and diabetes Increase understanding of science and health A balancing act All life is connected Exploring the food groups Balancing the bodies needs Harvesting our mother earth Northwest Portland Area Indian Health Board 20 10

11 IHS Physical Activity Kit Staying on the Active Path Modified Indian Games Non competitive youth Adults and elders Strength and flexibility Teaching cues and set up 21 Northwest Portland Area Indian Health Board Portland Area Demonstrations (14 tribes) Healthy Heart Project Yakama Diabetes Prevention Projects 3 consortiums Southern Oregon (Klamath, Cow Creek, Coquille) NW WA Health Board (Lummi, Swinomish, Samish, Nooksack, Upper Skagit) SPIPA (Skokomish, Squaxin Island, Chehalis, Shoalwater Bay) Warm Springs 22 11

12 Portland Area 49 grant community directed grant programs NPAIHB 3 Urban (SIHB, NARA, Spokane) Western Oregon Service Unit 23 Native Fitness IX- Youth Focus August 8 th and 9 th 2012 Youth Focus Spotlight successful youth programs Youth fitness activities 24 12

13 Native Fitness participants Motivational Interview Daryl Tonemah Native specific Resource CD Best practice, toolkits, fact sheets Fitness activities Boot camp Aerobics Walk Strong SPARQ Native games Nike Play on Native Land N-7 products Native Fitness: Background The Idea from NARA DM Coordinator Initial Meeting WTDP event at Nike Met with Sam McCracken / Nike Tour Committee Formed The plan was formulated 26 13

14 Templates and Tools Fitness activity flow sheet PCC overlay PAR-Q Participant Consent Modified Par Q Activity tracker Community standards for fitness BRFSS Diabetes and Exercise Benefits of Walking Be Fit - Be Healthy Lifestyle changes increasing physical activity Balancing your life Fitness curriculum Risky Business NPAIHB projects 2011 Tobacco, Diabetes, Cancer, STD s HIV, Suicide Prevention, Injury Prevention, Immunizations, MCH 3 trainings per year tribal participants 28 14

15 Take away - resources Tribal Tobacco Policy Workbook Cancer 101 and Resource guide DST and childhood obesity curriculums Injury Prevention AI/AN Toolkit STD/HIV advocacy toolkit CARS resources child safety seat 29 WTDP Tools and Resources Short cut and reference manual Health Status Report Tribal diabetes comparison report Tribal diabetes trends report NW Diabetes Aggregate Report Diabetes Screening Toolkit 15

16 Health Status Report HSR comparison Tobacco Use 100 % 80 % 60 % 40 % 20 % 0 % Portland Area All Areas Tobacco use not documented 12 % 11 % Current Tobacco User 31 % 22 % Not a current tobacco user 57 % 67 % 32 16

17 HSR comparison 100 % Weight Distribution 80 % 60 % 40 % 20 % 0 % Portland Area All Areas Normal (BMI < 25.0) 5 % 8 % Overweight (BMI ) 17 % 22 % Obese (BMI 30.0 or above) 77 % 67 % 33 Trends 8000 Patients in the Diabetes Register FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 Charts audited Total active on register

18 NW trends 100 Tobacco Cessation Referrals FY2004 (n=1202) FY2005 (n=1427) FY2006 (n=1445) FY2007 (n=1519) FY2008 (n=1685) FY2009 (n=1821) Counsel rate/users NW trends 100 Tobacco Use FY2004 (n=3877) FY2005 (n=4579) FY2006 (n=4661) FY2007 (n=4696) FY2008 (n=5266) FY2009 (n=5824) Current tobacco user Not a current tobacco user Tobacco use not documented

19 NW trends Weight Control FY2005 (n=4579) FY2006 (n=4661) FY2007 (n=4696) FY2008 (n=5266) FY2009 (n=5824) Normal (BMI < 25.0) Overweight (BMI ) Obese (BMI 30.0 or above) Overweight or obese (BMI 25 or above) Height or weight missing Body Works 7 steps to success for teens Males and female Tweens Train the trainer model 5/17/ Northwest Portland Area Indian Health Board 19

20 Northwest Tribes Meet the Challenge 10,000 STEPS Youth screening in schools Aerobics/Water Aerobics Video Mile Moccasin Club Yoga Fitness centers/personal trainers Golf tournaments Community Gardens Biggest Loser Health Fairs Walk to Smithsonian Nike Native Fitness 7 th Cooking classes/healthy eating Pre-diabetes Screening Just Move It Youth and Adult Diabetes Camps Tribal Diabetes Conferences Lifestyle Intervention Classes 20