Environmental and Epidemiological Data About American Indian Communities
Population Health and Evidence-Based Practice Sample
In 2015, chronic diseases such as heart disease, diabetes, and cancer were among the top seven causes of death in the United States (Centers for Disease Control and Prevention [CDC], 2017). Many health care organizations have focused their resources on controlling and preventing chronic diseases among community members through population health management (PHM) strategies (see Appendix, Terms and Definitions). In response to the prevalence of chronic diseases, the Gilbert-Hopes Family Health Center (GHFHC) in Southern Arizona has created a population health improvement plan based on PHM strategies to improve one pervasive health concern in its community—Type 2 Diabetes Mellitus (T2DM). Type 2 Diabetes Mellitus in American Indian (AI) communities is the focus of the plan. The initiatives implemented under the health improvement plan will use the best available evidence on Southern Arizona’s AI communities gained through the evaluation of demographic, epidemiological, and environmental data. Additionally, the plan will apply strategies for communicating health improvement goals with AI communities and health care professionals in an ethical, culturally sensitive, and inclusive way.
Environmental and Epidemiological Data About American Indian Communities
According to 2012 data, diabetes is a serious chronic disease affecting 29.1 million people in the United States. It can lead to conditions such as kidney failure, blindness, and heart disease. Diabetes also makes patients vulnerable to infections that require amputation (CDC, 2014). In Arizona, which has the third largest population of AIs in the country, almost 16% of AIs reported having diabetes, especially T2DM (Bass, Bailey, Gieszl, & Gouge 2015). In Southern Arizona, the CDC estimates that about 24.1% of adult AIs have diabetes. The state’s distribution of T2DM is caused by a combination of genetic and environmental factors.
Behavioral risk factors such as smoking, alcoholism, sedentary lifestyles, weight gain, and poor diets can be classified as environmental factors of T2DM and were observed among Navajo Nation and Pima Indians (Arizona Department of Health Services, Bureau of Tobacco and Chronic Disease [AZDHS], 2011; Murea, Ma, & Freedman, 2012). Exposure to pollutants is another environmental factor that can be associated with T2DM because pollutants affect insulin sensitivity and glucose metabolism (Eze et al., 2015). Genetic factors include a family history of obesity or diabetic vascular complications. Individuals with such a family history are at high risk of getting Type 2 diabetes (Murea, Ma, & Freedman, 2012).
The evaluation of epidemiological and environmental data about T2DM in AI communities has revealed several gaps in knowledge. To begin with, most epidemiological data about AIs by federal agencies such as the CDC do not have information on populations living in Indian reservations as reservations are independent governmental entities (AZDHS, 2011). Moreover, further evaluation is needed on the effects of exposure to environmental pollutants; most studies tend to focus on behavioral risk factors. These gaps in knowledge can cause health disparities among urban AIs and those living in reservations, thereby making it difficult to identify chronic disease patterns.
Furthermore, there is a need for further evaluation of sociocultural and linguistic factors that often prevent people from accessing health care. The concept of cultural competence (see Appendix, Terms and Definitions) is imperative if the GHFHC wishes to successfully implement a population health improvement plan that will address the various needs of AI communities.