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Health Promotion Among Diverse Populations

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Health Promotion in American Indians/Alaska Natives
Mona Reed
Grand Canyon University: NRS-429V
August 02, 2015

Health Promotion in American Indians/Alaska Natives
American Indians/Alaska Natives (AI/AN) are people who maintain a tribal or community attachment and are descendants from any of the original inhabitants of North, South and Central America. The U.S. Census Bureau, in 2013, reported that there are greater than 5.2 million AI/AN in the United States, and that number is expected to increase to 11.2 million by 2060 (CDC, 2015a).
AI/ANs have experienced a lower health status when compared to the national average of the non-Hispanic white population. The Indian Health Service (IHS), who provides health care services to those who reside on reservations, reports that this is due to inadequate education, discrimination in delivery of health services, disproportionate poverty and cultural differences. Also noted is that less than half of “AI/ANs permanently reside on a reservation and therefore have limited or no access to IHS services” (Indian Health Service, 2015a). In addition, the CDC reported in 2013 that 26.9% of AI/ANs lacked health insurance coverage. This writer will compare and contrast the health status of the AI/AN population with the non-Hispanic White population.
Health disparities in the AI/AN population are well documented in research. The Office of Minority Health (OMH) Health Disparities Overview notes that this population suffers from low education and high poverty, as well as living in mostly rural areas with poor access to healthcare. In general, those with the highest poverty level and least education suffer the worst health status (OMH, 2015a).
Based on information retrieved from the OMH website, average household income in 2012 for the AI/ANs was $37,353, compared to $56,565 for non-Hispanic Whites. This income correlated to living at a poverty level of 26% for AI/AN, as compared to 11% of non-Hispanic Whites (OMH, 2015a).
Eighty-two percent of AI/ANs had at least a high school education in 2012, as compared to non-Hispanic whites with 92%. In addition, 17% had obtained a bachelor’s degree and 6% had obtained advanced graduate degrees, in comparison to 33% and 12% for the non-Hispanic white population (OMH, 2015b).
Based on the National Health Interview Survey in 2012, 14.3% of AI/AN persons of all ages are in fair or poor health, while this decreases to 9.6% for the white, non-Hispanic population. In the AI/AN population, the three leading causes of death were cancer, heart disease and unintentional injuries. Heart disease, cancer and chronic lower respiratory diseases ranked as the top three in the non-Hispanic white population (Adams, Kirzinger, & Martinez, 2013).
Of the top three leading causes of death in the AI/AN population, The Office of Minority Health website (2015b) reports that AI/AN men and women generally have lower cancer rates than Caucasians. However, during the 2005-2009 reporting period, AI/AN men were twice as likely as Caucasians to have liver and inflammatory bowel disease. Stomach cancer was noted to be 1.6 times higher, and the rate of death twice as likely. AI/AN women were 2.8 times more likely to have, and twice as likely to die from liver and IBD cancer as Caucasian women, and 40% more likely to have kidney/renal pelvis cancer.
On average, AI/ANs have more heart disease than Caucasians due to having higher risk factors such as obesity, high blood pressure and current cigarette smoking. An article in the journal, Circulation (The American Heart Association [AHA], 2014), noted that the obesity rate (based on self-reports) for AI/AN was 46.5% versus 27.9% in Caucasians. In the 2005 CDC report on Heart Disease and Stroke Among American Indians and Alaska Natives, (Casper et al., 2005) stated that the national prevalence for high blood pressure among the AI/AN population was 26% for women and 29% for men. Additional information obtained from Circulation (2014) noted that the rates for current cigarette smoking were 25.7% in AI/AN men and 16.7% women, compared to 21.7% for Caucasian men and 18.7% women.
Murphy et al., (2014) reported that during 1990-2009, the rate of unintentional injury deaths in the AI/AN population was 2.4 times higher than the Caucasian population. Unintentional death injuries were those occurring from motor vehicle crashes (MVC), poisonings and falls. MVCs were the cause of the largest number, likely due to low restraint use (55% compared to 75% overall in the United States), and alcohol impairment. The AI/AN population have the highest death rate in motor vehicle crashes compared to all minority/ethnic populations.
Cultural values that affect behavior, attitude and beliefs must be considered in the efforts to improve the health of the AI/AN. In a presentation on health care beliefs and practices, the Director of Public Health for the National Indian Health Board presented some of the cultural beliefs on illness held by the AI/AN population. Among these was that
“Each person is put on the earth for a short time for a purpose, and when that purpose is

accomplished, the person is ready to leave this world. Death and illness are not caused by others

and prolonged grieving prevents the spirit from crossing over to the next world where there is no

pain, but peacefulness” (Haverkate, 2010). The author of this paper is of Seminole Indian

Heritage, and has suffered the loss of her only child, however, this is noted to be the most

beautiful theory on dying that she has ever seen).

The most effective primary approach to improving health is education that aims to prevent disease or injury before it occurs. Documented ways to improve health, and reduce the risk of cancer and heart disease, include eating a healthy diet, getting plenty of exercise, maintaining a healthy weight, not smoking, and consuming little to moderate amounts of alcohol. Primary methods of decreasing motor vehicle related injuries/death include increasing the use of restraints and decreasing impaired driving. The CDC began a Tribal Motor Vehicle Injury Prevention Program to reduce motor vehicle-related injuries and deaths. This primary prevention program increased seat belt and child safety seat use and decreased alcohol-impaired driving (Murphy et al., 2014b). Reducing the impact of illness or injury, known as secondary prevention, is accomplished by detecting and treating conditions as early as possible to halt or slow progress. Mammography and colon cancer screening are two screening tests that will detect these diseases soon enough to treat them in their earliest stages. The IHS has begun working with AI/AN communities by providing mobile mammography units and telemedicine in efforts to ease the challenge of accessing healthcare resources (IHS, 2015b). Helping manage long-term, chronic disease, or softening the impact of chronic disease, is known as tertiary prevention. This is accomplished by helping manage long-term, chronic diseases. Examples would be disease management programs for diabetes and heart disease. In 1997, The Special Diabetes Program for Indians began to target diabetes care and prevention. As reported in the journal, Health Affairs (2011), success has been shown by promoting diets based on traditional foods, conducting culturally appropriate teaching, or using traditional methods such as storytelling, to increase awareness and knowledge of diabetes (Sequist, Cullen, & Acton, 2011). While health disparities continue to exist in the AI/AN population versus the non-Hispanic White population, the Indian Health Service and the CDC are making strong efforts to overcome these issues by increasing efforts of prevention, early detection, diagnosis and treatment by providing greater access to healthcare.

References
Adams, P. F., Kirzinger, W. K., & Martinez, M. E. (2013, December). Summary health statistics for the U.S. population: national health interview survey, 2012. National Center for Health Statistics. Vital Health Statistics, 10(259). http://dx.doi.org/http://www.cdc.gov/nchs/fastats/american-indian-health.htm
American Indian and Alaska Native populations. (2015a). Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html
American Indian and Alaska Native populations. (2015b). Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html#
American Indians and Alaska Natives: health disparities overview. (2015). Retrieved from http://itepsrv1.itep.nau.edu/itep_course_downloads/AQ-Alaska_Resources/HealthEffects/AIAN_Disparities_Overview.pdf
Casper, M. L., Denny, C. H., Coolidge, J. N., Williams, Jr., G. I., Crowell, A., Galloway, J. M., & Cobb, N. (2005). Risk Factors for heart disease and stroke among American Indians and Alaska Natives, by state. Atlas of Heart Disease and Stroke Among American Indians and Alaska Natives. Retrieved from http://www.cdc.gov/dhdsp/atlas/aian_atlas/
Haverkate, R. (2010). Health care beliefs and practices among Native American patients [PowerPoint slides]. Retrieved from National Indian Health Board: http://nnphi.org/CMSuploads/NPHPSP.User.Call-10.10-23206.pdf
Indian Health Service. (2015a). http://www.ihs.gov/newsroom/factsheets/disparities/
Indian Health Service. (2015b). http://www.ihs.gov/communityhealth/hpdp/
Murphy, T., Pokhrel, P., Worthington, A., Billie, H., Sewell, M., & Bill, N. (2014a, June). Unintentional injury mortality among American Indians and Alaska Natives in the United States, 1990–2009. American Journal Public Health, 104. http://dx.doi.org/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035871/
Murphy, T., Pokhrel, P., Worthington, A., Billie, H., Sewell, M., & Bill, N. (2014b, June). Unintentional injury mortality among American Indians and Alaska Natives in the United States, 1990–2009. American Journal of Public Health, 104(Suppl 3), S470-S480. http://dx.doi.org/10.2105/AJPH.2013.301854
Profile: American Indian/Alaska Native. (2015a). Retrieved August 2, 2015, from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62
Profile: American Indian/Alaska Native. (2015b). Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62
Sequist, T. D., Cullen, T., & Acton, K. J. (2011, October). Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People. Health Affairs, 30(10), 1965-1973. http://dx.doi.org/10.1377/hlthaff.2011.0630
The American Heart Association. (2014, December). Heart disease and stroke statistics—2015 update. Circulation, 131, e29-e322. http://dx.doi.org/10.1161/CIR.0000000000000152

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