Leading with Tradition: Facing Cancer in Tribal Communities

Advancing Health Equity in American Indian Communities: An Approach to Culturally Appropriate Prevention

Authors:

Melanie Plucinski (Presenter)
American Indian Cancer Foundation

Amber Cardinal (Presenter) American Indian Cancer Foundation
Christopher Johnson, American Indian Cancer Foundation

Public Health Statement: Cancer disproportionately impacts AI populations. While every other population is experiencing a decrease in rates of cancer incidence and mortality, rates are increasing for AIs.

Purpose: The Tribal Health Equity project partners with tribes in the development of policy, systems and environmental change strategies to promote health equity, cancer prevention and healthy norms. Strategies employed: assessment of community readiness, community engagement, facilitated conversations to identify health priorities, action planning, technical assistance in drafting tribal policy, creation of culturally specific tools for implementation of change strategies and formal presentation of initiatives to leadership.

Methods/Approach: AICAF’s approach acknowledges cultural norms pertinent to each tribal community. Systems change outcomes related to partnerships have involved a restructuring. Through coalition building and strategic planning, AICAF supports enhanced communication flow and collaboration across tribal departments. Evaluation of the Tribal Health Equity project is conducted by Wilder Research and includes Ripple Effect Mapping to assess the strength of AICAF’s partnerships. Wilder made this conclusion, Partnerships are critical to advancing health equity and working to achieve policy, system, and environmental changes. The network map for the American Indian Cancer Foundation shows the organization has developed close collaborative relationships with all (100%) of its formal partners and are in weekly or monthly contact.

Results: Successes include: the development of a new tribal health advisory committee that implemented one major progressive healthy foods policy, which addresses the availability of healthy options in vending machines at the tribal Recreation and Government Center, an incentive policy to encourage powwow vendors to offer healthier options, and the establishment of healthy food and beverage guidelines for community meetings, forums and events. Among many, other impacts include the enactment of a comprehensive tribal tobacco policy, 4 community engagement sessions (100+ participants), 10 action plans and 6 culturally relevant resources.

Conclusions/Implications: Best practices generally do not produce the same results for AIs. Comprehensive strategies rooted in knowledge of cultural traditions are proving to be promising practices for elevating the health of AI people. This model can be applied to programs across the nation to reduce and eliminate the burden of chronic disease.

Health Disparities, Cancer, among the Haudenosaunee (People of the Longhouse)

Authors:

Dean Seneca (Presenter)
Office of State, Tribal and Territorial Support

Rodney Haring, Roswell Park Cancer Institute
Melissa Jim, Centers for Disease Control and Prevention

Public Health Statement: In order to eliminate health disparities for American Indian and Alaska Native (AI/AN) populations we must identify the health disparities.

Purpose: We present trends in all-cause mortality and leading causes of death among the Haudenosaunee Nations in New York State, compared to the Indian Health Service (IHS) East Region and the U.S.

Methods/Approach: Data from the linkage of IHS registration records with decedents from the National Death Index (1990–2009) were used to identify AI/AN deaths misclassified as non-AI/AN. We analyzed trends for 1990–2009 and compared non-Hispanic AI/AN and non-Hispanic white persons for the Haudenosaunee Nations in New York State, IHS East Region and the U.S.

Results: All-cause death rates over the past two decades for Haudenosaunee men declined at a greater percentage per year than for the East and US. Unfortunately, this decrease was not observed for Haudenosaunee women with all-cause death rates appearing to be stable over the past two decades. Haudenosaunee all-cause death rates were 14% greater than that for whites. The most prominent disparities between Haudenosaunee and non-Hispanic whites are concentrated in the 25–44 year age group (RR=1.85). Chronic liver disease, diabetes, unintentional injury, and kidney disease death rates differed considerably between Haudenosaunee and whites.

Conclusions/Implications: Haudenosaunee experienced higher rates for the majority of the leading causes of death than AI/AN in the East region. These results highlight the importance of Haudenosaunee-specific data to target prevention efforts that will address health disparities and inequalities in health.

Cancer Screening in Indian Country: An Overview of What Works in Tribal Communities

Author:

Breannon Babbel (Presenter)
The National Indian Health Board

Public Health Statement: American Indians and Alaskan Natives (AI/ANs) face significant health disparities and as a result are at increased risk for cancer. This is further compounded by the fact that AI/ANs also have less access to cancer screening compared with other populations. As a result, the National Indian Health Board aims to improve cancer screening rates—especially for colorectal, breast, and cervical cancers—in Indian Country.

Purpose: The purpose of the project was to develop and pilot test a screening toolkit for Tribal prevention and clinical programs seeking to improve their cancer screening efforts.

Methods/Approach: The NIHB undertook a formative research process to first paint an accurate picture of the Indian health care system actors’ existing cancer screening policies, clinical capacity, strengths, and areas for improvement. This data collection was targeted at Centers for Disease Control and Prevention Tribal awardees involved in the National Breast and Cervical Cancer Early Detection Program (NBCCDDP) and the Colorectal Cancer Control Program (CRCCP) and include qualitative key informative interviews. Based on this comprehensive review of existing cancer screening work in Tribal communities, the NIHB identified key evidence based interventions, resources, and strategies (practically comprising a toolkit) targeted at improving cancer screening rates with demonstrated success in Indian Country. Finally, the toolkit was rolled out to three pilot test sites interested in improving cancer screening rates.

Results: At time of abstract submission, results are pending.

Conclusions/Implications: While it is too early to assess overall conclusions, it is clear that culturally relevant methods are needed for cancer screening in Tribal communities to address the significant inequities American Indians and Alaskan Natives face in cancer mortality.

The Importance of Native Patient Navigators for Increasing Colorectal Cancer Screening Rates in American Indian Communities

Authors:

Tinka Duran (Presenter)
Great Plains Tribal Chairmen’s Health Board

Stella Zimmerman, ACET

Public Health Statement: American Indians (AI) living in counties served by the Indian Health Service are 21% more likely to receive a CRC diagnosis, and 39% more likely to die of CRC than non-Hispanic whites living in the same counties (Filippi et al., 2016), highlighting the urgency of implementing effective cancer prevention initiatives in tribal communities. Native Patient Navigators (NPN) play a significant role in decreasing health disparities in American Indian (AI) communities by offering instrumental cancer education and cancer screening support (Burhansstipanov, Harjo, Krebs, Marshall, and Lindstrom (2015).

Purpose: The purpose of this report is to understand culturally relevant strategies NPN employ in order to engage and motivate AI community members to be screened for CRC.

Methods/Approach: A recent project initiated by Great Plains Tribal Chairmen’s Health Board and funded by the Centers for Disease Control and Prevention, provided CRC education and screening support to AI community members in 19 tribal communities. Through this funding, two full-time NPNs were trained on CRC screening guidelines, provided CRC education by engaging in health and community events convened by tribes, and attended conferences and trainings important to implementing CRC prevention programs. All trainings were derived from evidence-based interventions and supporting strategies recommended by the U.S. Preventive Services Task Force and identified as effective within the community. The NPNs were later interviewed and asked to share their experiences working within tribal communities and strategies employed for increasing community interest in CRC.

Results: Results found that NPNs incorporated traditional values and beliefs into their work with AI community members to increase the impact of their work and maximize the effectiveness of their CRC prevention efforts using. The NPNs reported feeling very welcome, and community members appreciated their work and mission and connected with their culturally tailored communication style and respect for elders.

Conclusions/Implications: As members of the communities in which they serve, NPNs understand the unique challenges and culturally specific expectations of their AI peers, and use this knowledge to incorporate cultural norms and beliefs into patient education and cancer screening training. In this way, NPNs can significantly extend the reach and impact of cancer prevention interventions and improve the quality of life and cancer prevalence rates in AIs.