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Toward a Future of Good

Toward a Future of Good Health and Wellness: Inequities in American Indian and Alaska Native Health Jeffrey A. Henderson, MD, MPH President & CEO Black Hills Center for American Indian Health Rapid City, SD.

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Toward a Future of Good

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  1. Toward a Future of Good Health and Wellness: Inequities in American Indian and Alaska Native Health Jeffrey A. Henderson, MD, MPH President & CEO Black Hills Center for American Indian Health Rapid City, SD Presented at the 17th Annual Summer Public Health Research Videoconference on Minority Health, June 7, 2011, www.minority.unc.edu/institute/2011/

  2. Presentation Overview What are some prominent inequities in American Indian/Alaska Native health? Why do these inequities exist? What’s been done, or can be done about them?

  3. Acknowledgements Strong Heart Study Stop Atherosclerosis in Native Diabetics Study (SANDS) National Heart, Lung and Blood Institute Dr. Patricia Nez Henderson No Financial Conflicts

  4. Background Long history of AIAN disparities Multiple disease states and persistent across changing notions of disease causation Prominent social and political causes

  5. Prominent Observational Studies Strong Heart Study (1988-present) Navajo Health and Nutrition Survey (1991-92) Inter-Tribal Heart Project (1992-94) Education and Research Towards Health (EARTH) Study (2001-2007) BRFSS

  6. Leading Causes of Death, U.S. 38% 39% 23% AHA, 2005

  7. 156 Total All Areas 229.7 Aberdeen 151.6 Alaska 85.1 Albuquerque 287 Bemidji 206.4 Billings 129.3 California 190.4 Nashville 105.7 Navajo 163.6 Oklahoma 145.9 Phoenix 140.9 Portland 137.5 Tucson 0 50 100 150 200 250 300 American Indian Cardiac MortalityBy IHS Area, 1994 - 1996 per 100,000; age-adjusted; US All Races 138.3 Regional Differences in Indian Health - 1998-99

  8. Carotid Atherosclerosis in American Indians ARIC = Atherosclerotic Risk in Communities Study SHS = Strong Heart Study CHS = Cardiovascular Health Study Roman MJ, et al. Circulation 1998;98

  9. INCIDENCE OF CHDStrong Heart Study vs. ARIC CHD includes fatal and nonfatal events plus revascularization Fatal and Nonfatal Rates per 1000 person years. The Rising Tide of CVD in AI: The SHS, Circulation, 1999

  10. State and Contract Health Service Delivery Area (CHSDA) counties by IHS region

  11. Cancer incidence rates, both sexes combined, CHSDA and all counties

  12. Incidence rates for AIAN vs. NHW males by IHS region, 1999-2004

  13. Incidence rates for AIAN vs. NHW females by IHS region, 1999-2004

  14. AIAN Total Mortality NEJM 353;18 Nov 3 2005

  15. Why do these inequities exist?

  16. A multilevel model of disease causation Kaplan GA, Upstream approaches to reducing socioeconomic inequalities in health, Rev Bras Epidemiol 2002; 5(Supl 1):18-27.

  17. Percent of persons who self-report as AIAN within counties

  18. Percent of persons within counties living in poverty

  19. Buffalo Co., SD Shannon Co., SD Starr Co., TX Ziebach Co., SD Todd Co., SD Sioux Co., ND Corson Co., SD Wade Hampton, AK Maverick Co., TX Apache Co., AZ $5213 $6286 $7069 $7463 $7714 $7731 $8615 $8717 $8758 $8986 Top 10 poorest counties in America, 2000 US Census United States mean - $21,587

  20. Association between household income and risk of death

  21. AIAN Health Behaviors

  22. Healthcare ExpendituresAccess NEJM 353;18 Nov 3 2005

  23. What’s been/being done? Varied BHCAIH Efforts

  24. Black Hills Center for American Indian Health • Community-based 501 (c)(3) organization • Founded in 1998 • To conduct activities that will lead to the enhanced wellness of American Indian peoples, communities, and tribes • Research, Service, Education, and Philanthropy

  25. Black Hills Center for American Indian HealthResearch Portfolio • Currently home to 6 peer-reviewed health research grants and contracts totaling $9 million (historical: 32 and over $20 million) • Collaborative to Improve Native Cancer Outcomes (CINCO) CPHHD P50 – NIH/NCI • Native People for Cancer Control Community Networks Program – NIH/NCI • Native American Research Centers for Health: Lakota Center for Health Research – NIH/NIGMS/IHS

  26. Black Hills Center for American Indian HealthResearch Portfolio • Southwest Navajo Tobacco Education and Prevention Project (SNTEPP)– CDC/RWJ/ARNF/AZ • Lakota Oyate Wicozani Pi Kte RCT – NIH/NHLBI • The experience of chest pain among the Lakota pilot project – NIH/NCMHD

  27. Black Hills Center for American Indian HealthResearch Portfolio - Results • BHCAIH has consented more than 8,000 American Indians into its various studies in the past 8 years • Injected more than $5 million directly into impoverished Native communities • Directly or indirectly hired more than 40 tribal members to work on our varied projects • 36 scientific publications and 4 book chapters

  28. What’s been/being done? Varied BHCAIH Efforts SHS CVD Risk Prediction Model Stop Atherosclerosis in Native Diabetics Study (SANDS) Special Diabetes Program for Indians Competitive Grant Program

  29. What’s been/being done? Community-based interventions to lower CVD risk among AIANs (NHLBI) Economic Development Casino gaming Increasing # of interventions Fitful advances in tribal sovereignty

  30. CONCLUSIONS American Indians and Alaska Natives experience a number of health inequities These inequities often have long-established histories Social inequities have a profound impact on health status It is likely that improvements in social condition, more than anything else, will begin to alleviate inequities in health

  31. CONCLUSIONS Tribal/community, clinical, and national leadership and governmental financial support are essential Further research is needed to determine effective preventive interventions Successful interventions need to be replicated and/or scaled up Ongoing surveillance of behaviors and conditions is essential to gauge progress

  32. CONTACT INFORMATION Jeff Henderson President and CEO Black Hills Center for American Indian Health 701 St. Joseph St., Suite 204 Rapid City, SD 57701 (605) 348-6100 (605) 348-6990 fax E-mail: jhenderson@bhcaih.org

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