Community Change Project Kent 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.
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One role of the public health nurse is to address underserved and at-risk populations to remedy health disparities.This PowerPointwill address the health disparity of obesity within the American Indian(AI) community of Kent County, Michigan.
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.
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)
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)
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)
“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)
AI native land →
European colonization →
loss of cultural identity =
lack of education
lack of trust
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.
Community Mental Health
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.
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).
AI or culturally competent…
Assessment of Community
Identify underserved “hidden” AI population
Commission report or supplement to next Kent County Health Assessment focusing on AI health disparities
Provide training for cultural competency of Kent County public health workers
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
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
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 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.
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
Evaluation of the one-, five-, and ten-year goals for completion.
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.
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.
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.
“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.
References underserved and at-risk
References underserved and at-risk