An American Problem
As Native Americans face an alarming rate of diabetes, ADA, the Indian Health Service, and other partners are taking on the challenge
Alvin Windy Boy has type 2 diabetes—as do both of his parents and three of his 10 brothers and sisters. Their family, like so many others on the Chippewa Cree of the Rocky Boy's Reservation in Rocky Boy, Mont., has seen firsthand the toll diabetes has taken on tribal communities: According to the Indian Health Service (IHS), 16.3 percent of all American Indians and Alaska Natives have diabetes, compared with 7 percent of the country as a whole.
That alarming rate has prompted the American Diabetes Association, members of the United States Congress, and leaders in the Native American community to advocate for more federal health care dollars to be channeled toward fighting the epidemic. As a result of those efforts, Congress established the Special Diabetes Programs for Indians (SDPI) in 1997, providing grants to the IHS's programs for diabetes treatment and prevention.
In December, President George W. Bush signed the reauthorization of this legislation for one year. Now, the ADA, the Indian Health Board, and the Juvenile Diabetes Research Foundation are working together to urge Congress to extend this legislation—which currently provides $150 million per year for SDPI and $150 million for a Special Statutory Funding Program for Type 1 Diabetes Research—for 5 years at $200 million per year per program. "Even though we're living in 2008," says Windy Boy, a former elected chairman of his tribe, on his reservation "we are still at a 1930s, 1940s rate of health care delivery. At that rate, we have another 60 years to catch up on."
Senator Max Baucus (D-MT), whose Medicare legislation secured a one-year extension for SDPI reauthorization last year, said that with diabetes rates rising, treatment and prevention are more important than ever.
"Native Americans are three times more likely [than other Americans] to die as a result of type 2 diabetes, and rates are rising," Baucus says. "Investing in treatment and prevention programs is crucial…In Indian country, these programs have had a very significant impact—the number of amputations in Native American communities has decreased significantly in recent years."
One of the first cochairs of the Tribal Leaders Diabetes Committee (from 1998 to 2004), Windy Boy became an advocate for the health care of Native Americans across the country. "We gathered tribes nationwide, one from each of the 12 regions, and determined we needed to put together a tribal team," he says. "We advanced a plan that would map out not only the disease, but how we would address" it on the reservations. Over the past 10 to 12 years, he adds, health care availability and affordability have improved as a result of the committee's work and Congressional support for the Special Diabetes Programs.
Also a key player in the effort, ADA's Awakening the Spirit Team, established in 1996, has been working with IHS and spreading the message about diabetes among the Native American community. "The SDPI funding has resulted in almost 400 new diabetes treatment and prevention programs in Indian communities across the country," says Yvette Roubideaux, MD, MPH, chair of the Awakening the Spirit Team for ADA. "Evaluation of the program has shown increased access to services and reductions in intermediate outcomes of diabetes care, such as decreases in A1C levels in people with diabetes."
Despite progress, there remains a whole host of problems that continue to fuel diabetes on Native American reservations. The time and expense of travel, as well as the expense and availability of healthy food options, are both major obstacles. "Those who are on dialysis, for example, have to travel as far away as Billings, Mont., a 600-mile trip roundtrip, 3 days a week," Windy Boy says. "And you take a look at the convenience stores located in Rocky Boy, and 67 percent of all that food is not good for [people with diabetes] or young people—[soda] pop, sugars, that's what my people are relegated to." On reservations, where people have enough trouble feeding large families and experience a high rate of unemployment, healthy food can be cost-prohibitive, Windy Boy says.
One way to address these issues is through education. "We need more education about what people can do to prevent diabetes and to treat diabetes and prevent complications," Roubideaux says. "People need access to the best quality care and can only do that if they understand what quality care means and how they can get it."
Windy Boy has retired from his national role, but still spends plenty of time advocating diabetes awareness among his community and especially in his own home, where he and his wife are trying to instill healthy habits in their 11 children. "Statistics tell me that we're all susceptible," he says. "So we're advocating exercise, exercise—that's our check and balance.
"Our big family is just like every other big family on the reservation," Windy Boy continues. "We're just a small player in the larger scheme of getting diabetes awareness into the community."