Connie Davis, MSN Executive Director Cherokee Nation Health Services

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1 Overview of the Cherokee Nation Health System & Efforts to Eradicate Diabetes and Obesity through Culturally Appropriate Treatment, Education, & Prevention Connie Davis, MSN Executive Director Cherokee Nation Health Services

2 Policy Statement Tribal and rural communities must find innovative solutions to their problems, solutions which are deeply rooted in their unique culture, and traditional ecological knowledge.

3 The Cherokee Nation existed before the United States and the State of Oklahoma. GROUP OF CHEROKEES WHO VISITED LONDON IN 1762

4 Cherokee Nation Sovereign Nation within a Nation Tripartite government 2 nd largest Indian Nation (322,855 Registered citizens) CN has a land base totaling 4,336,200 acres 14 county area (over 9,200 sq mi.) Largest employer in northeastern Oklahoma (10,000+) Capitol located in Tahlequah, Oklahoma

5 Jobs keep our people home in communities; which allows us to keep our language alive; which preserves our culture. All of which improves our quality of life.

6 Overview of The CN Health Services

7 Cherokee Nation Health Services The 14-county service area of Cherokee Nation includes a network of eight health centers and one hospital. The facilities serve more than 130,000 eligible patients throughout the 14-county service area. 1,067,904 Ambulatory patient care visits during FY-2013 Between , nearly million patient visits have occurred at Cherokee Nation health centers 7

8 Cherokee Nation Health Services Scope of Services Chronic/Acute care Inpatient Care Behavioral Health Contract Health Nutrition Dental Physical Therapy Community Health Nursing Health Promotion/Disease Prevention Nursing Radiology Optometry WIC Laboratory Podiatry

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11 Diabetes an Overview and our approach to care and Prevention

13 Diabetes Prevalence Among American Indians/ Alaskan Natives The most recent published Diabetes Surveillance Report by CDC shows that American Indians have a significantly higher prevalence rate (17.5%) than whites, blacks or Hispanics The age-adjusted diabetes death rates were over 100% higher among American Indians than Non- Hispanic white(36.4/100,000 vs. 18.2)

14 Diabetes Prevalence in Cherokee Nation Of the 130,000 patients within the Cherokee Nation, 11,317 have been diagnosed with diabetes, giving a prevalence rate of 88.9 per 1,000 In patients over 40 years old, prevalence was closer to 250/1,000

16 Cherokee Nation Principal Chief Bill John Baker declared November as Diabetes Awareness Month in the Cherokee Nation. Chief Baker, surrounded by the tribe s top health leaders, signed a proclamation Monday to raise awareness about a leading epidemic affecting Native Americans.

17 Cherokee Nation Approach to Diabetes Prevention & Care Special Diabetes Program for Indians (SDPI) Diabetes Prevention Program(DPP) which promotes weight loss and healthy cooking and food intake among patients with pre-diabetes Diabetes Prevention Curriculum Being taught in 15 schools within CN-TJSA

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19 Obesity an Overview and our approach to care and Prevention

20 Obesity and American Indians/Alaska Natives American Indian/Alaska Native women are 30% more likely than non-hispanic White women to be obese. American Indian or Alaska Native adults are 60% more likely to be obese than non-hispanic Whites.

21 Obesity Prevalence in Cherokee population Over all 34% of the patients who received healthcare at CN health facilities were Obese Overweight For age group 0-12 years, 36.85% patients were Obese or Overweight For age group years, 45.62% were Obese or Overweight

22 Obesity Epidemic and Our response Obesity has been linked to diabetes, heart disease, various cancers, osteoarthritis and a number other ailments. The Cherokee nation has been aggressively pursuing all available options to curb obesity epidemic in our population. I would like share some of the ideas we have tried in our population

23 Cherokee Nation s approach to deal with Obesity Epidemic Healthy Living Program- Supports School and Community Health Leadership Grant Awards. Community and School Gardens, Traditional Cherokee Foods Gathering Trips, Healthy Cooking classes Traditional Cherokee Games Wings Fitness- community lead running/walking groups, Summer Youth Fitness Camps

24 Additional programs which promote Active and Healthy Living Safe Routes to School Implemented in 5 schools in TJSA Childhood Obesity Prevention and Treatment Toolkit Implemented in all CN clinics and the hospital Farm to School Implementation working with 15 schools to develop implementation plans Active engagement in Tahlequah s Foundation for a Fit Future to lead a community-based effort to provide education and opportunities for healthy living

25 Just Right Program With this project we are exploring best practice model to prevent excessive weight gain in expectant Cherokee moms. We enroll expectant moms at a very early stage of pregnancy and promote healthy behaviors which include healthy diets, exercise, and healthy cooking classes with an emphasis on traditional Cherokee foods and Cooking methods.

26 Other ideas.. Cherokee Nation Health services has recommended covering Bariatric surgery under our health plan A Study on the Economic Impact of Bariatric Surgery Cleveland Clinic Cost of surgery $19,000 vs cost of obese diabetic average $2500/year

27 Cherokee Nation Businesses CNB contributes over 35% of casino profits back into our health system for Contract Health Services (Endrocrinology, Cardiology etc ) $100 million health expansion

29 My story I was diagnosed with diabetes at the age of seven Lack of access to health care due to rural location Registered Nurse for 26 years The patients I serve

30 My babies

31 My sister.

33 WADO! (Thank You)

Native Strong Visiting & Learning Grantee Conference

Native Strong Visiting & Learning Grantee Conference Susan V. Karol, M.D. Chief Medical Officer Indian Health Service May 13, 2014 1 A Quick Look at the Indian Health Service Provides a comprehensive health