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DIABETES AMONG AMERICAN INDIANS: A CASE STUDY IN MOVING FROM
HEALTH DISPARITIES TO HEALTH EQUITY
Ronny A. Bell, PhD, MSProfessor, Department of Epidemiology and Prevention,
Division of Public Health SciencesCo-Director, Maya Angelou Center for Health Equity
18th National Health Equity Research WebcastUniversity of North Carolina Gillings School of Global Public Health
June 5, 2012www.minority.unc.edu/institute/2012/
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Health Disparities"Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States."
Source: National Institutes of Health
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Diabetes Disparities – American Indians
American Indians are at least 2.2 times more likely to develop diabetes in their lifetime compared to non-Hispanic Whites
The diabetes death rate is 3 times higher for American Indians compared to the US general population
American Indians with diabetes are 3.5 times more likely to develop kidney failure compared to the general population
Source: Indian Health Service
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Source: Bachar et al, Preventing Chronic Disease, 2006
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Prevalence of Diabetes in Youth Ages 10 - 19, by Race/Ethnicity and Clinical Diabetes Type
Type 1 Type 20
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SEARCH for Diabetes in Youth Study
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Diabetes Disparities Among American Indians Why?
The “Biomedical” Model
“Poor” DietPhysical Inactivity“Genes”Inadequate access to and utilization of health care resources
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Health Equity
• “Health equity is the attainment of the highest level of health for all people.
• Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.”
Source: US Department of Health and Human Services, National Partnership for Action to End Health Disparities
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Diabetes Disparities Among American Indians – Why?
The “Health Equity” ModelPovertyInappropriately applied local, state and federal policies
RacismHopelessness/FatalismHistorical Trauma
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Diabetes Disparities Among American Indians “Bad Sugar”
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Diabetes Prevention and Control In American Indian Communities
EducationCultural AdaptationEmpowermentAllocation of ResourcesHolistic Orientation
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Diabetes Prevention in American Indian Communities
Power to Prevent Campaign Move It! Campaign
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Cultural Approaches to Diabetes Prevention and Control
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Cultural Approaches to Diabetes Prevention and Control
Diabetes Talking Circles
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Changes in Indicators of Diabetes Control As a Result of the Special Diabetes Program for Indians (SDPI) and the Government
Performance and Results Act
Control Indicator Pre-SDPI (1995)
SDPI Era (2001)
A1c Control 8.9% 7.9%
Diastolic Blood Pressure
79 mm Hg 76 mm Hg
Total Cholesterol 208 mg/dl 193 mg/dl
Triglycerides 257 mg/dl 235 mg/dl
Source: Wilson et al, AJPH 2005
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Summary
Diabetes disparities clearly exist for American Indians
The causes of these disparities are multi-faceted The solutions to achieving health equity in
diabetes for American Indians are also multi-faceted, and require a concerted effort to address this tragedy
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