Health in All Policies: An Approach to Advancing Health Equity in Indian Country Melanie Plucinski, MPH Bad River Band of Chippewa Policy Projects Coordinator
Presentation Overview American Indian Cancer Foundation (AICAF) background Cancer disparities What impacts our health? Policy, systems and environmental change Tools and recommendations
AICAF Story The American Indian Cancer Foundation (AICAF) was founded in 2009 and became operational in 2011. A registered 501(c)(3) non-profit organization, AICAF was established to address tremendous cancer inequities faced by American Indian and Alaska Native communities. AICAF s board members and employees are American Indian, with an array of expertise and experience serving the health needs of our people.
Our Vision Our vision is a world where cancer is no longer a leading cause of death for American Indian and Alaska Natives. Through hard work, culturally appropriate community-based programs, and policy change that affords Native people access to the best prevention and treatment strategies, we see a day where American Indian communities are free from the burdens of cancer.
American Indian Cancer Data American Indians face alarming inequities in cancer incidence and mortality. Cancer incidence rates vary by tribe, region and gender but are often alarmingly higher than non-hispanic whites. Every other population has celebrated decreasing cancer mortality rates in the past 20 years but American Indian cancer mortality rates are still increasing.
Why Cancer Rates Are Higher Among American Indians Tobacco abuse (smoking and chewing) Cigarette smoke exposure Alcohol abuse Diets high in animal fats and lower in fiber, lack of fresh fruit and vegetables Lack of regular physical activity Obesity & Diabetes Family genes that may increase risk Family genes that increase cancer risk
Cancer Incidence Rates among American Indian and Alaska Native Men, 1999-2009 Source: White M et al. Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States. Am J Public Health 2014;104(S3):S377 S387.
Cancer Incidence Rates among American Indian and Alaska Native Women, 1999-2009 Source: White M et al. Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States. Am J Public Health 2014;104(S3):S377 S387.
Cancer Death Rates among American Indian and Alaska Native Men, 1999-2009 Source: White M et al. Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States. Am J Public Health 2014;104(S3):S377 S387.
Cancer Death Rates among American Indian and Alaska Native Women, 1999-2009 Source: White M et al. Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States. Am J Public Health 2014;104(S3):S377 S387.
Our reality is determined by history.. Health inequities are directly linked to determined and deliberate efforts of American federal, state, and local governments to uproot American Indians from their lands, eradicate their languages and destroy their ways of life.
Our Approach We believe Native communities have the wisdom to find the solutions to health inequities, but are often seeking the organizational capacity, expert input and resources to do so.
What AICAF Brings as a Partner Policy drafting workshop/policy template creation Presentations, education, resources on cancer prevention Ongoing and available support in coalition building work (T/A, resources, trainings) Community engagement strategy sessions Making the case for change (providing fact-based data and information on health, prevention and wellness) Grant writing support to assist with sustainability of initiatives A policy versus programs presentation and discussion to facilitate effective action planning
Creating the Framework for Change Health- The World Health Organization defines health as- a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. Health Equity- to achieve the conditions in which all people have the opportunity to realize their health potential- the highest level of health possible for that person without limits imposed by structural inequalities.
Social Determinants of Health The 40%
Health in All Policies: An Approach to Decision Making An approach to policy that systematically takes into consideration the health implications of a decision and avoids potential harmful health impacts, in order to improve population health and health equity. The approach includes an emphasis on the consequences of public policies on health systems, determinants of health, and well-being. It also contributes to sustainable development.
Policy, System & Environmental Change
Policy Systems and Environmental Approach for Sustainable Change A framework for creating positive change We can relate the concept to our Indigenous worldviews Policy: Guiding principles for ways of living Systems: Family, clan, and food systems Environmental: Seasonal practices for harvesting foods and taking care of the earth
Applications of PSE Common Approach
Policy Change Policy- Are laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Examples of Policy Changes: Tribal tobacco policy example: No commercial tobacco use at ceremonies and events Tribal foods policy example: A human resources, departmental policy that requires healthy foods to be served at all meetings, gatherings and events
System Change System - a set of connected things or parts forming a complex whole System change involves change in the way things are done in a department or organization. Often focuses on changing infrastructure within a school, park, worksite or health setting. Shakopee Mdewakanton Sioux Community Mobile Unit.
Environmental Change Environmental - Where we live, learn, work, play, shop and go to school. Strategies that involve physical or material changes to the economic, social or physical environment. Example: Creating walking/biking paths through the community to promote physical activity and also connect people to resources.
HiAP: PSE school-based example A tribal school wants to address the rising obesity crisis among the student population. To do this, they decide to improve the nutritional quality of their school lunches through a farm to school program. This type of program directs school nutrition services to increase fresh and locally grown produce to use in school lunches (policy change). Nutrition services, local farmers, and health stakeholders then work together to incorporate this locally grown produce into school lunches (systems change). Access to healthy menu options helps students learn about healthy eating, and as a result, improves their eating habits (environmental change).
Tools and Recommendations
Tool: Planning and the Policy Drafting Process Research Engage Invite Revise
Recommendations Community coalition building to develop community-based priorities, solutions, strategies and that will influence policy. Provide opportunities for community engagement on issues and opportunities for community to offer input on policy. Utilize tribal sovereignty to create and enact policy that will have powerful positive impact on community health. Seek opportunities to collaborate to advance health equity.
Closing Question Tribal Sovereignty is the power and authority to govern How is sovereignty impacting the health of our communities?
Contact Information MELANIE PLUCINSKI 615 FIRST AVENUE, N.E. MINNEAPOLIS, MN 55413 MPLUCINSKI@AICAF.ORG PHONE (612) 314-4854 www.americanindiancancer.org