The Changing Face of Minnesota Providing Culturally Appropriate Care

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Diabetes in AmericanIndians in Minnesota
J. Michael Gonzalez-Campoy, MD, PhD,
FACE President, Minnesota Medical
Association Medical Director and CEO Minnesota
Center for Obesity, Metabolism and Endocrinology
(MNCOME) DrMike_at_MNCOME.com
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Culturally Appropriate Health Care

• Care tailored to meet the patients needs, taking
  into account the patients ethnic, racial,
  cultural, and socioeconomic status, results in
  better, less costly outcomes.

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Minnesota(a Native American Name)

• The Healthiest State in the Country
• A State with Health Care Disparities
• A State where we can do better

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Demographics
2000 U.S. Census
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American Indian History
Removal and Reservations
Assimilation and allotment
Reorganization
1880
1934
1954
Restoration and Recognition
Termination
1970
To-date
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American Indian History

• Susan La Flesche Picotte, MD
• Medical College of Pennsylvania
• March 14, 1889
• Carlos Montezuma, MD
• Chicago Medical College
• March 26, 1889

Speroff, Leon Carlos Montezuma, MD, A Yavapai
American Hero
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AAIP is dedicated to pursuing excellence in
Native American health care by promoting
education in the medical disciplines, honoring
traditional healing practices and restoring the
balance of mind, body, and spirit.
http//www.aaip.com/
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Racial and Ethnic Distributionof Selected Health
Professions
U.S. Census 2000
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Growth Trends Among Populations of Color
Minnesota, 1980-2000
U.S. Bureau of Census, Census 2000
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Change in Median Household Income Minnesota,
1989-1999
U.S. Bureau of Census, Census 2000
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Education AttainmentMinnesota, 2000
U.S. Bureau of Census, Census 2000
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Cultural Proficiency

• Working effectively with people from your own
  culture
• Working effectively with people from cultures
  other than your own

Becky Gonzalez-Campoy Executive Director, MNCOME
Foundation
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American IndianDiabetes

• Compared to Whites
• Diabetes rates are over three times higher
• In 1997, the Indian Health Services reported that
  the age-adjusted prevalence of diagnosed diabetes
  among American Indians age 20 and older among
  tribes in Michigan, Minnesota and Wisconsin was
  15.2 percent.
• A similar rate, 17.6 percent was found among
  American Indians living in Hennepin County, Minn.

http//www.health.state.mn.us/ommh/amindian.html
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American IndianDiabetes

• Type 2 diabetes has doubled from 1990-1998 among
  Bemidji Area American Indians ages 35 years and
  younger
• Compared to Whites
• Diabetes-related kidney failure is almost six
  times greater (1999)
• diabetes related mortality is over three times
  greater (1989-2000)

http//www.health.state.mn.us/ommh/amindian.html
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Causes of Mortality inPatients With Diabetes
Pneumonia/Influenza
Other
MalignantNeoplasms
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5
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55
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Diabetes
CerebrovascularDisease
Heart Disease
Geiss LS, et al. In Diabetes in America. 2nd
ed. NIH Publication No. 95-1468. 1995233-257.
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American IndianCardiovascular Disease

• Mortality rates resulting from CVD are generally
  lower in Minnesota than the nation as a whole
• American Indian death rates were 33 percent
  higher than the state population figures
• American Indian death rates were 44 percent
  higher than the total U.S. American Indian
  population.

http//www.health.state.mn.us/ommh/amindian.html
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American IndianPremature Death

• American Indians in the 15-24, 25-44 and 45-64
  year old age ranges had death rates that were up
  to 3.5 times higher than the death rate of Whites
  in those same age groups
• These disparities in rates are due to a number of
  factors, including
• unintentional injury 21.43
• homicides 11.66
• heart disease 9.04
• cirrhosis 7.21

http//www.health.state.mn.us/ommh/amindian.html
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Mortality Rates MinnesotaFive Year Average,
1997-2001
Minnesota Department of Health, Center for Health
Statistics
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Disparity Ratio - American Indian to White
Minnesota, 1997-2001
Minnesota Department of Health, Center for Health
Statistics
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Mortality Rates by Race/Ethnicity in Minnesota,
1997-2001
Minnesota Department of Health, Center for Health
Statistics
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Minnesota Entities to Eliminate Disparities in
Health Care

• Native American Communities
• Minnesota Department of Health
• Office of Minority and Multicultural Health
• Minnesota Medical Association
• Minority and Cross-Cultural Affairs Committee
• State Task Force to Eliminate Disparities in
  Health Care

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www.health.state.mn.us/diabetes/plancentral
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MN Diabetes Plan 2010

• Community Health Promotion
• Goal 3 Foster community-based collaboration and
  communication
• Goal 4 Create a healthier environment
• Health Care Delivery and Professional Issues
• Goal 2 Promote professional development and
  resolve workforce shortages
• Goal 3 Make diabetes services fully accessible
• Goal 4 Improve diabetes services
• Diabetes Education and Support Systems
• Goal 1 Make diabetes education accessible and
  culturally appropriate
• Goal 2 Inform consumers about financial
  resources for diabetes health services
• Goal 3 Develop support systems for people with
  diabetes
• Financial and Resource Issues
• Goal 3 Assure health care coverage for all
  people in Minnesota
• Goal 4 Address socioeconomic factors impacting
  diabetes
• Diabetes Data Assessment and Communication

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MNCOME FOUNDATIONOUTREACH PROGRAM
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MNCOME FOUNDATIONOUTREACH PROGRAM
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WOLF PROGRAM

• In 1997 a Minnesota State legislative bill was
  passed which created an American Indian Diabetes
  Prevention Advisory Task Force
• Representative of all eleven Minnesota tribes.
• The purpose of the Task Force is
• to advise the MN Diabetes Program's WOLF - Work
  Out Low Fat program
• aid in disseminating the program in American
  Indian schools.
• Now in its sixth year, the Advisory Task Force is
  facilitated by the MN Diabetes Program and
  continues to meet quarterly.

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WOLF PROGRAM

• Bois Forte Reservation
• Fond du Lac Reservation
• Grand Portage Reservation
• Leech Lake Reservation
• Lower Sioux Indian Community
• Mille Lacs Reservation
• Prairie Island Community
• Red Lake Reservation
• Shakopee-Mdewakanton Sioux (Dakota) Community
• Upper Sioux-Pejuhutazizi Kapi Community
• White Earth Reservation

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WOLF PROGRAM

• a school-based grade 1-4 curricula.
• Eight-week, 16 session curricula
• includes American Indian traditions related to
  health, physical activity and nutrition
• physical activity videos designed for American
  Indian children
• comics reinforcing curricula messages
• small group, skill building and goal setting
  activities
• low fat snack tastings and preparation
• at-home activities for parents/guardians.

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WOLF PROGRAM

• a school-based grade 1-4 curricula.
• Eight-week, 16 session curricula
• includes American Indian traditions related to
  health, physical activity and nutrition
• physical activity videos designed for American
  Indian children
• comics reinforcing curricula messages
• small group, skill building and goal setting
  activities
• low fat snack tastings and preparation
• at-home activities for parents/guardians.

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WOLF PROGRAM

• MN Diabetes Program
• provides technical support to the reservations in
  the area of primary prevention of type 2 diabetes
  among American Indian youth
• offers annual training to tribal schools
  implementing the WOLF curricula.

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WOLF PROGRAM

• Over 1,560 students in reservation schools have
  been taught the curricula during the first 5
  years (in 3 public, 6 tribal and 1 private
  schools).
• One reservation has used elements of the WOLF
  curricula in their after school program.
• Another incorporated elements of the WOLF
  curricula in their summer camp program.

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The Red Lake Diabetes Program
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The Red Lake Diabetes Program

• By using community educators and implementing the
  use of diabetes flow charts
• The average hemoglobin A1c was significantly
  decreased in the community.
• The access of patients to care was improved.
• The number of amputations at Red Lake was
  significantly decreased.

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Culturally Appropriate Health Care

• Care tailored to meet the patients needs, taking
  into account the patients ethnic, racial,
  cultural, and socioeconomic status, results in
  better, less costly outcomes.