COMMUNITY CHANGE PROJECTKENT COUNTY, MICHIGAN

AMERICAN INDIANS AND OBESITY

Hulwick, B. Johns, A.

Marchenko, O.Ranstadler, L.

Williams, S.

“The power of intuitive understanding will protect you from harm until the end of your

days.” Lao-Tzu

One role of the public health nurse is to address underserved and at-risk populations to remedy health disparities. This PowerPoint will address the health disparity of obesity within the American Indian(AI) community of Kent County, Michigan.

Introduction

Analysis: Statistics• Nationwide epidemic: 35.7% of American adults

and 17% of children are obese (Centers for Disease Control and Prevention [CDC], 2012a)

• State of Michigan: 30.9% of Michigan adults are obese (CDC, 2012b)

• Kent County, Michigan: 30% of adults are obese (Kent County Health Department, 2012)

• American Indian population nationwide: 39.6% of adults are obese (Office of Minority Health [OMH], 2012)

• According to the Kent County Needs Assessment of 2012, Kent County American Indian youth are most at risk for being obese.

Obesity: Contributing Factors

Biological/Cultural

• Genetics “Thrifty gene” hypothesis (Neel, 1962)• Lack of culturally relevant interventions

(Brown, Harris, Harris, Parker, Ricci, & Noonan, 2010)• Loss of cultural identity (Brown et al., 2010)• AI lack of trust of governmental institutions (including healthcare)

(U.S. Commission on Civil Rights, 2004)• Lack of AI mental health practitioners

(U.S. Department of Health and Human Services [USDHHS], 2001)

Obesity: Contributing Factors

Social Determinants

• Sedentary lifestyle (Hodge, Cantrell, & Kim, 2011)• Poverty (CDC, 2010)• Poor eating habits/reduced access to healthy food (Kent County Health

Department, 2011)• Health care access/Services (Kent County Health Department, 2011)• Education:

AI adults are significantly more likely to have below basic health literacy compared to white counterparts (National Indian Health Board, n.d.).AI high school graduation rate is 64.2% (HealthyPeople 2020, 2012)

The Ecological Model

“Based on the belief that all processes occurring within individual people and their environment should be viewed as interdependent. It suggests that behavior change in people needs to be considered in a broader social context, including developmental history, psychological characteristics, interpersonal relationships, physical environment, and culture”

(Harkness & DeMarco, 2012, p. 79)

The Ecological Model (cont.)

AI native land → European colonization →

loss of cultural identity = social determinants:

povertylack of educationmental illnesslack of trustWesternization

(USDHHS, 2001)

Existing Resources

• Kent County Health Department and website. Individual web resources include the following pages: Health Equity, Health Promotion, Health Education, Health Improvement and School Wellness (see https://www.accesskent.com)

• SEVA Foundation (SEVA.org)

• Gun Lake Band Health and Human Services Director: Phyllis Davis(Michigan Diabetes Prevention and Control Program, 2009; Match-E-Be-Nash-She-Wish Band of Pottawatomi: Gun Lake Tribe, 2004)

• Gun Lake Band Diabetes Outreach Worker: Carol Barker (Weick, 2009)

Like the rest of the nation, Kent County resources do not address the complexity of the causes of AI health disparities and do not provide adequate service to this community.

What Other Disciplines are

Involved?

• Schools

• Hospitals

• Social Services

• Community Mental Health

• Tribal governments

PROBLEM STATEMENT

There is increased risk of obesity among the AI population in Kent County, Michigan related to genetic factors, reduced access to healthy food, lack of culturally relevant interventions, and loss of cultural identity, as demonstrated in the 2011 Kent County Health Needs Assessment and Health Profile.

Interventions

Due to the AI mistrust of government institutions most effective interventions have been proven to come from within the tribal community (Tripp-Reimer, Choi, Kelley, Enslein, 2001).

Interventions will be rooted in strengthening the collaboration between governmental institutions and minority populations based upon collaborative models proven to be effective (Trust for America’s Health, 2009).

Interventions: WHO

Tribal Health Leadership

Kent County

Health

Department

Mental Health

Practitioners

Social Workers

Diabetes Educators

and Outreach Workers

Health Departmen

t Nurses

School Nurses

AI or culturally

competent…

Interventions:WHAT & HOW

• Assessment of Community Identify underserved “hidden” AI population

Measurable goal:

Commission report or supplement to next Kent County Health Assessment focusing on AI health disparities

Interventions:WHAT & HOW

• Provide training for cultural competency of Kent County public health workers

Measurable goals:

Attain cultural competency using Office of Minority Health benchmarks (2013)

Study culturally relevant interventions and social/historic factors to address effects caused

by loss of cultural identity

Interventions:WHAT & HOW

• Utilize existing Health Department web resources in context of culturally focused care, for e.g., Kent County Health Department webpages Health Equity, Health Promotion, Health Education, Health Improvement

Measurable goals:

Each of the web pages will address AI health disparities

Provide culturally relevant education to AI population about nutrition, availability and

location of healthy food sources and importance of physical activity

Interventions:WHERE & WHEN

Where:Interventions will be mainly developed and implemented

through the Kent County Health Department by improving the quality of the interactions between health care workers with the community.

When:One year: Changes to the Kent County Health Department web pages to address AI community

Five years: Education and training of Kent County Health Department health care workers and development of culturally relevant interventions

Ten years: Reassessment of Kent County AI population within the framework of subsequent Kent County Health Assessment

Evalution: QuantitativeEvaluation of the one-, five-, and ten-year goals for completion.

One year: • Meet with AI health liasons Carol Barker and Phyllis Davis for evaluation of

changes to Kent County Health Department web pages. • Incorporate survey in web page to ascertain the effectiveness of content

from public site viewers.

Five years: • Submission of staff cultural competency certification to Kent County

Health Department leadership.• Submission to (at 2-year mark), implementation (at 3-year mark), and

evaluation (at 5-year mark) of new culturally relevant interventions.

Ten years: • Review of Kent County Health Assessment data. Comparison of post-

intervention data with current data to measure improvements in reports of access to healthy food, food choices, and activity level.

Evaluation: Qualitative

“The power of intuitive understanding will protect you from harm until the end of your days.” Lao-Tzu

The Ecological Model provides a framework for greater understanding of complex social factors, resulting in intuitive understanding and incorporation of the unknown into one’s consciousness. This brings qualitative improvement in the relationships and communication between cultures.

Qualitative evaluation will include interview assessment of public healthcare workers and the AI community for knowledge and understanding of American Indian history and culture but the extent of true understanding cannot be measured.

ReferencesAmerican Psychiatric Association. (2010). Mental health disparities: American Indians and Alaska Natives. Retrieved from http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_American-Indians.pdf

Brown, B., Harris, K., Harris, J., Parker, M., & Noonan, C. (2010). Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods. Diabetes Education, 36(6), 924-935. doi:10.1177/0145710382582

CDC. (2010). Health disparities affecting minorities: American Indians and Alaska Natives. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/definitions.html#AIAN 

CDC. (2012a). Prevalence of Obesity in the United States, 2009-2010. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.pdf

 CDC. (2012b). Michigan’s response to obesity. Retrieved July 17, 2013, from http://www.cdc.gov/obesity/stateprograms/fundedstates/michigan.html

Harkness, G., & DeMarco, R. (2012). Community and public health nursing practice: Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins. 

Healthy People 2020. (2012). Social determinants. Retrieved from http://healthypeople.gov/2020/LHI/socialDeterminants.aspx?tab=data

Hermann, J., Jackson, T., Miracle, S., Parker, S., & Robertson, D. (2010, June). Utilizing the socioecological model as a framework for understanding elder Native Americans’ views of Type 2 Diabetes for the development of an indigenous prevention plan. Native People’s Technical Assistance Office. Retrieved July 26, 2013, from http:/www.nptao.arizona.edu

 

ReferencesHodge, K., Cantrell, G., & Kim (2011). Health status and socioeconomic characteristics of the morbidly obese American Indians. Ethnicity and Disease, 21, 52-57. Retrieved from http://www.ishib.org/journal/21-1/ethn-21-01-52.pdf

Kent County Health Department (2011). 2011 community health needs assessment and health profile. Retrieved from http://assets1/mytrainsite.com/501187/kentcochna_final.pdf?r=1440

Kent County Health Department (2013). accessKENT.com. Retrieved from https://www.accesskent.com/

Koivusilta, L., Rimpela, A. & Vika, A. (2009). Health behaviors and health in adolescence as predictors of educational level in adulthood: a follow-up study from Finland. Social Science Medicine, 57(4), 577-593. doi:10.1300/J051v13n01_02

Match-E-Be-Nash-She-Wish Band of Pottawatomi: Gun Lake Tribe. (2004). Health & human services director: Phyllis Davis. Retrieved July 23, 2013, from http://www.mbpi.org/hhs/healthandhuman.asp

Michigan Diabetes Prevention and Control Program. (2009). Plan for diabetes prevention and control in tribal communities. Retrieved from http://www.michigan/gov/documents/mdch/Tribal_Plan_rev_4-1-09_274987_7.pdf

National Indian Health Board. (n.d.). Healthy People 2020: Leading health indicators for American Indian/Alaska native populations. Retrieved July 17, 2013, from http://www.nihb.org/public_health/healthy_people_2020_social_determinants.php

Neel, J. (1962). Diabetes Mellitus: A “thrifty” genotype rendered detrimental by “progress”? American Journal of Human Genetics, 14(4), 353-362.

Office of Minority Health. (2012). Obesity and American Indians/Alaska Natives. Retrieved from http://minorityhealth.hhs.gov/templates/content/aspx?lvl=3&lvIID=537

ReferencesOffice of Minority Health. (2013). Educational materials/guide /PTTS/modules. Retrieved July 25, 2013, from http://minorityhealth.hhs.gov/templates/content/aspx?lvl=2&lvIID=107

Seva Foundation. (2013). Retrieved July 15, 2013, from http://www.seva.org Tripp-Reimer, T., Choi, E., Kelley, L., & Enslein. (2001). Cultural barriers to care: Inverting the problem. Diabetes Spectrum, 14(1), 13-22. doi:10.2337/diaspect.14.1.13

Trust for America’s Health. (2009). Examples of successful community-based public health interventions (state-by-state). Retrieved from http://www.cahpf.org/GoDocUserFiles/601/TFAH_Examplesbystate1009.pdf

U.S. Department of Health & Human Services. (2001). Mental health: Culture, race, and ethnicity - A supplemental to mental health: A report of the Surgeon General. Retrieved from http://profiles/nlm/nih/gov/pf/retrieve/ResourceMetadata/NNBBS

U.S. Commission on Civil Rights. (2004, February). Native American health care disparities briefing. Retrieved from http://www.law.umaryland.edu/marshall/usccr/documents/nativeamericanhealthcareids.pdf Weick, C. (2009, May 11). Gun Lake Tribe cares for ‘mind, body, spirit’. MLive.com. Retrieved from http://www.mlive.com/penaseeglobe/index.ssf/2009/05/gun_lake_tribe_cares_for_mind.html