Native AmericanHealth Promotion for Heart Disease

Timothy Carlson

Mallory Gilbert

Cherie McKay-Horst

Julie Saladin

Ferris State UniversityFigure 3. Feather drum (Costume Craze, n.d.)

Figure 2. Buffalo drum (Tribal Hut, n.d.)

Figure 1. Native American eagle (Tatoospedia, n.d.).

Native American Health Promotion for Heart Disease

The purpose of this presentation is to provide an understanding of the Native American culture as it pertains to health care beliefs. We will be discussing a health promotion plan in anticipation that it will decrease the incidence of heart disease among this population. The Transtheoretical Model (TTM) and stages of change will be used in creating a plan to promote health and well-being within multiple communities while meeting the transcultural needs of the Native American population.

Demographic Data

In the United States (U.S.) the Native American population makes up the smallest racial-ethnic group with about two million people (National Heart, Lung and Blood Institute [NHLBI], 1998)

There are approximately 3.4 million Native Americans in the nation with 566 tribes recognized by the federal government (Indian Health Service [IHS], 2014).

They are typically less educated and poorer than other populations in the U.S. (NHLBI, 1998).

“Native American’s tend to procure jobs dealing with agriculture,

craft, and repair service” (NHLBI, 1998, p.9).

Demographic Data Continued…

American Natives have poorer health and lower life expectancies than Americans (IHS, 2014).

Health disparities of the American Natives include lack of education, increased poverty, lack of health care services, and cultural discrimination as compared to Americans (IHS, 2014).

Native Americans are plagued with many environmental issues because of living in rural areas where they are subjected to inclement weather, diseased insects and/or rodents, contaminated water supplies, poor waste disposal, and lack of housing (IHS, 2014).

Demographic Data Continued…

The leading causes of death between 2006 and 2008 in the Native American population were heart disease, cancer, accidental injuries, and chronic respiratory conditions (IHS, 2014).

Behavioral issues such as alcohol and substance abuse, mental health diagnosis, and suicide affect the health of Native Americans (IHS, 2014).

The IHS provides health services to approximately 2.2 million of the 3.4 million estimated Native Americans in the nation (IHS, 2014).

Cultural Factors

Tobacco plays an important role in traditional beliefs and ceremonies which makes control of tobacco use difficult (Espey et al., 2014)

Native Americans view medicine as “more about healing the person than curing a disease” (American Cancer Society, 2008, para. 3).

Traditional healers are used in conjunction with conventional medicine which Native Americans often refer to as “white man’s illness” (American Cancer Society, 2008, para. 7).

Native Americans believe that Traditional healers restore balance, well-being, harmonious relationships, and spirituality (American Cancer Society, 2008).

Cultural Factors Continued… Traditional healers use “herbal remedies, purifying rituals, shamanism,

and symbolic healing rituals to treat illnesses of both the body and spirit” (American Cancer Society, 2008, para. 6).

Moghaddam, Momper and Fong (2013) states “Traditional healing is

regarded as the use of spirituality and culturally salient ceremonies, including smudging, talking in circles, and sweat ceremonies” (p. 1115). Native Americans believe these rituals provide a cleansing of the body and spirit.

Traditional healing is proven to be important to the Native Americans’ cultural beliefs and in affecting health behaviors that directly correlate with the public health of their communities (Moghaddam et al, 2013).

“Participation in traditional spirituality was shown to have significantly positive effects on alcohol cessation” (Moghaddam et al, 2013, p. 1116).

Health-Risk Factors High blood pressure High blood cholesterol Cigarette smoking Physical inactivity Obesity Diabetes

Health Care Discrimination• Research has shown that Native American’s who feel they are

being discriminated against are less likely to participate in preventative healthcare services (Moghaddam et al, 2013).

(NHLBI, 2008)

Statistics for Health Risk Factors Hypertension

• 25.8% of Native Americans/Alaska Natives have high blood pressure (American Heart Association, 2013)

High Cholesterol• 31.2% of Native Americans/Alaska Natives were told by a health-

care provider that they had high cholesterol in 2003 (United States Department of Health and Human Services, 2014b)

Cigarette Smoking• Percent of Native American or Alaska Native men 18 years and

over who currently smoke cigarettes: 24.6% (Centers for Disease Control and Prevention [CDC], 2014)

• Percent of Native American or Alaska Native women 18 years and over who currently smoke cigarettes: 23.8% (CDC, 2014)

Statistics for Health Risk Factors Continued…

Obesity• Data from 2011 show that Native American/Alaska Native youth

have an obesity rate of 17.7% (American Heart Association, 2013).

Diabetes• In 2009, 786 Native Americans/Alaska Natives died from diabetes

mellitus (American Heart Association, 2013).

Physical Inactivity• In 2011, only 17% of Native American/Alaska Native adults age

18 or older met the 2008 Federal Physical Activity Guidelines (American Heart Association, 2013).

Statistics for Heart Disease Heart disease is the leading cause of death among Native Americans

and Alaska Natives (CDC, 2013). Among Native American men ages 45-74, the incidence of

cardiovascular disease ranges from 15 to 28 per 1,000. Among women it ranges from 9 to 15 per 1,000 (American Heart Association, 2013).

In 2009, coronary heart disease resulted in 1,813 deaths among Native Americans or Alaska Natives (American Heart Association, 2013).

Among Native Americans or Alaska Natives, 12.7% have heart disease, 7.2% have coronary heart disease, and 25.8% have hypertension , and 4.6% have had a stroke (American Heart Association, 2013).

Native Americans and Alaska Natives die from heart disease at younger ages than any other racial or ethnic groups in the United States. Approximately 36% die before the age of 65 from heart disease (CDC, 2013).

Environmental/Community Risk Factors Cardiovascular disease is a relatively new phenomenon for

Native Americans, who once were thought to have a genetic resistance to this disease. Much of the increase can be attributed to changes in diet and lifestyle (National Conference of State Legislature, [NCLS], 2006).

Some environmental/community changes include:• Moving from a traditional diet to a typical American diet and

lifestyle• The typical American lifestyle that includes low rates of physical

activity and frequent consumption of high-calorie, high-fat prepackaged foods are significant contributing factors

• Cultural approaches to health and health education that differ from the general population, including perceptions of health and wellness and the use of traditional healers

• Lack of access to health care resources• High poverty rates• Underfunded Tribal Health Care System

(NCSL, 2006)

Health Promotion Theory The health promotion model we will be incorporating into the project

will be TTM. This theory can be applied to a variety of behaviors, populations, and settings (Velicer, Prochaska, Fava, Norman, & Redding, 1998)

The TTM and the Stages of Change Model has led to development of a community-level HIV intervention that has shown to reduce behaviors that put people at greater risk for HIV (Cabral, Cotton, Salaam, & Gielson, 2004). Based on this research we plan to implement the Stages of Change Model to decrease risk behaviors including lack of exercise, poor nutrition, smoking, and alcohol intake to reduce the chance of Native Americans in the community developing heart disease.

This model will focus on the decision making of the individual in the community (Pender, Murdaugh, & Parsons, 2011). Positive self-efficacy, pro-decisional balance, ability to identify situations, and the process of change will help individuals in the community succeed in decreasing the risk of heart disease (Velicer et al., 1998).

Health Promotion Theory Continued…

The role of culturally appropriate interventions and acculturation status, must be taken into thought when developing interventions (Pender, Murdaugh, & Parsons, 2011).

Behavioral changes of the individual will occur as a progression through a series of changes that include precontemplation, contemplation, preparation, action, and maintenance (Velicer et al., 1998).

Once the individuals favor the attempt to change over the cons of not changing, the action plan can be implemented (Velicer et al., 1998).

Goals

The development of strategies that support/reinforce healthy behavior and incorporate the use of Native American traditional healing.

The establishment and promotion of environments that support the prevention of heart disease through healthy eating, physical activity, and tobacco and alcohol-free lifestyles for all Native Americans, with an emphasis on access to resources (Texas Department of State Health Services 2013).

Community linkages: Promote partnerships between community and tribal groups to provide enhanced and coordinated services.

Health systems interventions: To promote capacity and infrastructure changes within the health delivery system to effectively prevent, treat, and manage heart disease and stroke for all Native Americans (Administration for Native Americans, 2014).

Goals Continued…

Surveillance and Evaluation: Collect comprehensive heart disease data and evaluative the plan of action.

To ensure the highest possible health status for Native Americans and to provide all resources necessary to raise the health status of the population to at least the levels set forth within the Healthy People 2020 initiative (IHS, n.d.).

The long-term goal is to reduce mortality and morbidity in Native American communities.

Identify and develop individual and family interventions to sustain health-promoting behaviors.

Plan of Action Heart disease is a serious health problem for Native Americans. High

blood pressure, high blood cholesterol, obesity, smoking, physical inactivity, and diabetes can increase the risk for heart disease (NHLBI, 2008).

The program will focus on a plan of action that addresses:• Native American population well-being both socially and

environmentally through awareness, education, and change• Strategic partnership development and community linkages• Policy promotion that support healthy living for individuals,

families, and communities• Health equity of Native Americans• Evidence-based research to help serve the Native Americans• Surveillance and evaluation• Workforce development of a skilled, diverse, and dynamic health

care team to promote health and help prevent heart disease

(NHLBI, 2008)

Plan of Action Continued… The services will include:

• Outreach and information programs• Access assistance to resources• Support groups in the community• Physical activities including obesity prevention• Tobacco prevention and cessation• Nutritional education and resources• Reduction in alcohol consumption• Self-management with wellness visits• Diabetes control and prevention

These programs will offer a variety of services that meet the Native Americans needs to combat heart disease.

(CDC, 2005)

Plan of Action Continued…

The plan with allocate funding from Federal and State grants to implement the needed programs (IHS, n.d.).

Native Americans can become a healthier population with community-based public health efforts developed to embrace prevention as a priority (IHS, n.d.).

The success of this plan requires partners in all sectors at all levels to work collaboratively.

Help revive, create, and preserve healthy traditional ways shared in homes, schools, and communities (IHS, n.d.).

Plan of Action Continued…

There are many things a Native American family can do to lower the risk for heart disease:• Take steps to lose weight, if you are overweight • Get 30 to 60 minutes of moderate physical activity daily• Eat less saturated fat and sodium• Eat more fruits, vegetables, and whole grains• Cook with lean meats, wild game, chicken, and fish • Tobacco cessation• Have regular checkups• Limit or avoid alcohol• Take your medications as prescribed

• There are programs to help with the prescription cost if you are unable to afford them.

(NHLBI, 2008)

Health Promotion Setting

Our setting in which we will carry out the health promotion plan will be through local community health centers in partnership with tribal organizations.

These health centers will provide services both on the Indian reservations and to the surrounding communities.

The coalition in development of services will include the IHS, Federal, State, city and county governments, and tribal organizations.

The programs are developed to help to attract children, young and older adults, and seniors through innovative fitness programs, health technology, and healthy aging programs in the community centers (IHS, n.d.).

Evaluation Evaluation of change to the community will be conducted by onsite

staff through personal interviews and calculating the data on community wide improvement.

A survey will be mailed out to all residents of the community who participate in the health center to evaluate the services offered and assess personal feedback.

A personal phone survey will be also utilized within the community to see what resources the community enjoys and what they would like to see changed or added.

All data will be analyzed and any goals for the community will be altered based on those results. If objectives are not met from the results of interviews, surveys, and individual test results then modifications will be made to improve outcomes in the community.

Healthy People 2020

By following the proposed plan of action, Native American people will be able to achieve the various goals set in the Healthy People 2020 initiative.

The vision statement of Healthy People 2020 is “A society in which all people live long, healthy lives” (United States Department of Health and Human Services, 2014a, para.3).

Healthy People 2020 and our plan of action encourages communities and different sectors to collaborate together to achieve goals.

The proposed plan of action and Healthy People 2020 works to empower individuals, helping them to make educated health decisions (United States Department of Health and Human Services, 2014a).

Healthy People 2020 Continued…

Both the proposed plan of action and Healthy People 2020 recommend goals that aim to improve cardiovascular health through prevention and treatment of risk factors that include hypertension, smoking, diabetes, poor diets, and obesity.

The proposed health promotion plan and the Healthy People 2020 initiative both work toward achieving health equity for Native American people, to eliminate health disparities, and strive to improve the health of the people.

Health disparities based on gender, age, area of the country lived, and socioeconomic status are acknowledged through Healthy People 2020 and will be addressed in the proposed health promotion plan of action (United States Department of Health and Human Services, 2014a).

Conclusion

By following the proposed plan of action, the Native American population can reach the goals set forth in the Healthy People 2020 initiative. The cooperation between multiple organizations will increase efforts to bring higher health status enjoyed by most Americans to the Native American Population. Our proposed plan of action utilizing the TTM health model will aid to increase health promotion and decrease disparities encountered by the Native American population in the United States. The plan of action incorporates Native American transcultural needs in health promotion and will facilitate the efforts in decreasing the rate of heart disease in the population and increasing their chance at a healthier and longer life.

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