Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) is a national Centers for Disease Control and Prevention (CDC) program aimed at eliminating racial and ethnic health disparities. It utilizes community-based approaches to reduce the burden of chronic illness in specific at-risk populations. Eighteen REACH Centers for Excellence in the Elimination of Disparities CEEDs serve as national expert centers implementing, coordinating, refining, and disseminating programmatic activities designed to eliminate health disparities. The University of Colorado Denver CEED addresses diabetes and cardiovascular disease (CVD) in urban American Indian and Alaska Native (AI/AN) populations.
Of all U.S. racial and ethnic groups, AI/ANs have the highest rates of type 2 diabetes mellitus. AI/ANs are more than twice as likely to have diabetes as non-Hispanic Whites. Diabetes mortality is also at least three times higher among AI/ANs than in the general U.S. population and the risk for developing cardiovascular disease in AI/ANs with diabetes is 3 – 4 times higher compared with AI/ANs without diabetes. Cardiovascular disease is now more common among AI/ANs than the U.S. all-race population and is increasing in prevalence and mortality. Major risk factors for diabetes and CVD, such as physical inactivity and obesity, also are highly prevalent among AI/ANs.
The majority of AI/ANs are now living in American cities, not on reservations. Yet Federal health care policy adressing AI/ANs continues to focus largely on the needs of those living on reservations in rural areas. Little is known about the health of urban Indians and few resources are directed towards their health care needs.
The goal of the University of Colorado Denver CEED is to reduce diabetes and CVD risk and promote wellness among urban AI/ANs. Our local efforts target the urban Indian populations of Albuquerque, New Mexico and Denver, Colorado. As the only national CEED for AI/ANs, we offer education and training on diabetes- and CVD-related topics relevant for organizations serving urban AI/ANs, as well as training on policy and systems changes to address health disparities and social injustice. Each year, we also offer 2 – 3 Legacy Awards or small grants to non-profit organizations serving urban Indians throughout the U.S. to fund implementation of Honoring the Gift of Heart Health—a AI/AN culturally tailored, community-based curriculum to empower AI/ANs to adopt healthier lifestyles—and social policy and environmental change to reduce diabetes and CVD risk in their local urban Indian communities. Our action items include:
Create and implement a comprehensive CVD and diabetes risk reduction program for urban Indian adults through collaboration with urban Indian organizations. This includes
A social media campaign on CVD and diabetes risk reduction specific for urban AI/ANs
In-service trainings for urban Indian clinic healthcare providers on diabetes and CVD risk factors and treatment, motivational interviewing techniques, and New Mexico Prescription Trails—a program designed to increase walking and wheelchair rolling, on suggested safe routes accessible by zip code with corresponding bus route information on the Rx trail website, through prescriptions for walking written by healthcare professionals
Encouraging organizations serving urban Indians to adopt the AHA’s Fit Friendly worksite wellness program focused on increasing physical activity and access to healthy foods
Coalition building to leverage resources and the will to increase access to healthy foods in urban food deserts and safe physical activity opportunities in urban areas, address institutionalized racism, and develop and implement other policies and environmental changes to achieve health equity for urban AI/ANs
Disseminate risk reduction interventions and tools and resources to address the social determinants of health to urban Indian clinics and organizations nationwide.