American Indian

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By Michele Felber, Joshua Hulbert, Brittany Klug, Victoria Mbah, Cameron Verkaik

● The health issues of the American Indian are similar to other cultures, this is affirmed in the Needs theory that states “...all people have common needs that must be met and that are essential to maintaining optimum health” (Maville, J. & Huerta, C., 2013, p.30).

● The understanding is that although the factors are generally similar they are particular in individuals, groups, communities, states, or nations. (Maville & Huerta, 2013)

Introduction

Introduction Continued

● The health issues of this culture are different because the American Indian community has different values and beliefs.

● The cultural foundation of specific groups may be traced back to factors such as; biological, environmental, sociological, spiritual, political, intellectual, sexual, and technological.

● These factors in combination with lack of cultural competency play crucial roles in the prevalence and growing incidence of cardiovascular disease.

Demographic Data Describing American Indian Population

A majority of American Indians live in the city This major demographic shift was a result of the US government’s relocation program in the 1950s which was an effort to bring American Indians to several cities in which jobs were plentiful.The relocation of these americans led to a demographic shift

● Over 60% of American Indians are now living in major metropolitan areas - the lowest metropolitan percentage of any racial group

● The largest american indian population is located in New York City● Other cities with large American Indian populations, in order of populations, are

Los Angeles, Phoenix, Oklahoma, Anchorage, Tulsa, Albuquerque, Chicago, Houston, San Antonio, Tucson, Philadelphia, and San Diego.

● The percentage of American Indians and Alaska Natives that live on reservations or other trust lands is 22 %

● 1.5 million American Indian and Alaska Natives are under the age of 18 - which comprises 30 percent of this racial group.

Demographics The 2010 Census reveals that 78 percent of the AI/AN live outside of tribal statistical areas (Lawson & Russell 2013)

● There are 566 federally recognized (AI/AN) tribes, 100 state recognized tribes as well as tribes that are not state or federally recognized.

● Federally recognized tribes are provided health and educational assistance through a government agency called Indian Health Service (IHS)

● The IHS Operates a comprehensive health service delivery system for

approximately 2 million American Indians and Alaska Natives. Typically, the urban clientele has less accessibility to hospitals;

health clinics or contract health services implanted by the IHS and tribal health programs.

Demographic Data Describing Chosen Vulnerable Population

Cultural Descriptors That Impact HealthThe U.S. Department of Health and Human Services (IHS) operates a comprehensive health service delivery system that impacts all American Indian (AI) and Alaska Native (AN).

● There are approximately 2 million AI and AN. ● The clientele is mostly urban that has less accessibility to hospitals; health

clinics or contract health services implanted by the IHS and tribal health programs

● The median household income for AI and AN is $37,353, as compared to $56,565 for non-Hispanic Whites

● 26 percent of this racial group live at the poverty level, as compared to 11 percent of non-Hispanic Whites, in 2012

● In 2012, 47.5 percent of AI and AN had private health insurance coverage. 38.1 percent of AI/ANs relied on Medicaid coverage, and 22.6 percent of AI/ANs had no health insurance coverage.

Studies on the urban American Indian and Alaska Native population have documented a frequency of poor health and limited health care options for this group (OMH, 2014)

Cultural Descriptors that Impact HealthIt is significant to note that American Indians/Alaska Natives frequently contend with issues that prevent them from receiving quality medical care. ● cultural barriers● geographic isolation● low income● Unsanitary waste and sewage disposal● limited health care options

(CDC, 2013)

Health risk factors in your populationRisk Factors:

There are several risk factors related to Heart Disease. Some of these risk factors are:

Low leisure time physical activity (Buggey, T., 2007)

Obesity and Overweight

Hypertension

High Cholesterol

Cigarette Smoking

(Lawson & Russell 2013)

Retrieved from http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=6&ID=3025

Environmental or Community Risk Factors

Environmental Issues- “American Indians and Alaska Natives (AI/AN) face a number of environmental hazards that affect their health status, such as living in remote and isolated locations that expose residents to severe climatic conditions, hazardous geography, and disease-carrying insects and rodents. Other factors include limited availability of housing and extensive use of substandard housing; unsanitary methods of sewage and waste disposal; and unsafe water supplies,” (IHS, 2014)

Access to Care (IHS, 2014)- Lack of fiscal resources- Lack of transportation- Living in remote locations

Retrieved from http://www.ihs.gov/communityhealth/hpdp/Retrieved from http://www.ihs.gov/newsroom/factsheets/environmentalhealthservices/

Environmental or Community Risk Factors

Underfunding of health care- “The US spends less per capita on health care for Native Americans than it does on Medicaid recipients, prisoners, veterans, or military personnel,” (Goodkind, pg. 387)- Funding for AN/AI is 60% less on average - Government funding meets only 55% of the AN/AI needs- This is particularly true of NA children

Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J., Ross, L., Freeland, L., & ... Lee, C. (2010). Promoting healing and restoring trust: Policy recommendations for improving behavioral health care for American Indian/Alaska Native adolescents. American Journal of Community Psychology, 46(3/4), 386-394. Retrieved from: DOI:10.1007/s10464-010-9347-4

Environmental or Community Risk Factors

Communication- Modern medicine takes the presented symptoms and associates them with a medical diagnosis

- Native American culture describes problems as an association to their own bodies and lives

- Native American culture uses storytelling and metaphor to relay information (Kalbfleisch, pg 161)

- Many different dialects

Kalbfleisch, P. (2009). Effective health communication in Native populations in North America. Journal of Language and Social Psychology, (2), 158-173. Retrieved from: DOI:10.1177/0261927X08330607

Statistics Related to Population and Health Risk Factors

American Indian/Alaska Native adults are 50 percent more likely as White adults to be current cigarette smokers. (OMH, 2014)

American Indian/Alaska Native adults are 1.3 times as likely as White adults to have high blood pressure

(OMH, 2014)

Virginia Henderson’s Needs Theory

● Biological, psychological, spiritual, social being

● Views individuals as a whole with various fundamental needs

● 14 Basic Human Needs

● Needs Versus Wants

● Health promotion is person centered

● Assist in achieving health and promoting independence as quickly as possible

Components of Basic Human Needs● Breath normally● Eat and drink adequately● Eliminate body wastes● Move and maintain desirable postures● Sleep and rest● Select suitable clothes● Maintain body temperature within a normal range by adjusting clothing and modifying the

environment ● Keep the body clean and well groomed and protect the integument● Avoid dangers in the environment and avoid injuring others● Communicate with others in expressing emotions, needs, fears, or opinions● Worship according to one's faith● Work in such a way that there is a sense of accomplishment● Play or participate in various forms of recreation ● Learn, discover, or satisfy the curiosity that leads to normal development and health, and use

the available health facilities

Waller-Wise 2013

Relationship to Health Promotion

● Health promotion is person centered

● Responsible for own health promotion

● If individuals are unable to perform the duties that promote health, a nurse will assist the patient where he/she is lacking until patients can care for themselves once again

● If death is imminent the nurse will aid in reducing discomfort

Henderson’s Needs Theory Relates to the Native American population as they have high rates of diabetes and heart diseaseThe Native American population has a higher population with coronary heart disease than Non-Hispanic White’sWith the high rates of diabetes and heart disease they need to have an increase access to healthcare

Age-adjusted percentages of coronary heart disease among persons 18 years of age and over, 2011

American Indian/Alaskan Native Non-Hispanic White American Indian/AlaskaNative/Non-Hispanic White Ratio

7.2 6.3 1.1

Espey, 2011

Plan of Action to Address Health Issue and Implementation of Action Idea

Team-Based CareWho is part of the team?

● The patient● Patients primary care provider● Other health care professionals

What does the team do?The team members provide support and SHARE responsibilities of care to help aid the primary care provider.responsibilities include:

● medication management● self-management● adherence to plan● patient follow-up visits

Retreived from: http://www.thecommunityguide.org/cvd/teambasedcare.html

Plan of Action continued

Why choose Team-Based care?● Evidence supports that team based care for blood pressure control has been proven cost effective

o Intervention cost- $284 per patient per yearo Health care cost- (23 estimates show) $65 higher per patient per year, (10 est) show TBC was lower in

patient cost per year.

● Results from 52 studies concluded that team based care is applicable to various groups and settings such as:o adults and older adultso Women and Meno Health care and community based settings

● In addition to improvements in blood pressure outcomes the use of team-based care was also effective in improving other cardiovascular risk factors such as diabetes and cholesterol.

Retrieved from:http://www.thecommunityguide.org/cvd/RRteambasedcare.thml

Implementation of Team-Based care● Main goal is to allow the individual to keep their primary care physician.

● We will work on pairing their main care physician with a group of healthcare professionals educated in team-based care.

● Individuals will meet with their primary care physicians in an agreed upon location either health care facility or at a community center.

● If the individual does not have a primary care provider, we will arrange a designated care provider for every location the team-based care is being provided (community center’s).

Describe Setting for Health Promotion Activity

We discussed possible locations for our activity including - the reservation, an educational setting such as a high school, a work environment, or a community center.The majority of the American Indian populations are located in cities and not on reservations therefore the community center seem the most productive site.Our activity would be promoted in the local high school, reservations, and media outlets to encourage many attendees.We would provide a method of transportation to people who would like to attend but could not get there by their own means.

Relate Presentation to Goals of Healthy People 2020

Healthy People 2020 goal: “Improve cardiovascular health and quality of life through prevention, detection and treatment of risk factors for heart disease and stroke.”

Healthy people 2020 objectives:Heart Disease and stroke:

● HDS-4 “Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high.”

● HDS-5 “Reduce the proportion of persons in the population with hypertension.”

Retrieved from:http://www.healthypeople.gov/2020/TopicsObjectives2020/topicsObjectivesSearchResults.aspxRetrieved from:http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21

References

Buggey, T. (2007). A picture is worth. Journal of Positive Behavior Interventions, 9(3), (pp.151-158). Retrieved from Academic

Search Premier database

Center for Disease Control. (2013). National vital statistic report. 61(4). Table 17 and Table 16. Retrieved from:

http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf [PDF | 3MB]

Environmental Health Services. (2014). Indian health service: The federal health program for American Indians and Alaska Natives.

Retrieved from: <http://www.ihs.gov/newsroom/factsheets/environmentalhealthservices//>.

Espey, D. K. (2011). Leading causes of death and all-Cause mortality in american indians and alaska natives. American

Journal of Public Health, 2-5. Retrieved from DOI:10.2105/AJPH.2013.301798

Guide to Community Preventive Services. Cardiovascular disease prevention and control: Team-based care to improve blood

pressure control. Retrieved from: www.thecommunityguide.org/cvd/teambasedcare.html

Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J., Ross, L., Freeland, L., & ... Lee, C. (2010). Promoting healing and restoring

trust: Policy recommendations for improving behavioral health care for American Indian/Alaska Native adolescents. American Journal of

Community Psychology, 46(3/4), 386-394. Retrieved from: DOI:10.1007/s10464-010-9347-4

References continuedHealthy People 2020, (2014). Heart disease and stroke. Retrieved from:

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21

Health Promotion. (2014). Indian Health Service: The Federal Health Program for American Indians and Alaska Natives.

Retrieved from: <http://www.ihs.gov/communityhealth/hpdp/>.

Jernigan, V., Duran, B., & Ahn, F. (2010). Changing patterns in health behaviors and risk factors related to cardiovascular disease among american indians and

alaska natives. American journal of public health, 100(4), 677-683.

Kalbfleisch, P. (2009). Effective health communication in Native populations in North America. Journal of Language and Social

Psychology, (2), 158-173. Retrieved from: DOI:10.1177/0261927X08330607

Lawson, R. (2013). Encyclopedia of American Indian issues today. (pp. 897). Westport, CT, USA: ABC-CLIO.

Maville, J. A., & Huerta, C. G. (2013). Health promotion in nursing. (3rd ed.) (pp. 30-32). Clifton Park, NY: Delmar.

Office of Minority Health. (2014). U.S health and human services the office of minority health. Retrieved from:

http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=6&ID=3025#sthash.0Hq

Waller-Wise, R. (2013). Utilizing Henderson's nursing theory in childbirth education. International Journal of Childbirth Education, 28(2), 30.

Retrieved July 27, 2014, from Academic OneFIle.