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DIABETES AMONG AMERICAN INDIANS, ALASKA NATIVES, AND NATIVE HAWAIIANS (AI/AN/NH)
Policy Date: 1/1/1998
Policy Number: 9812
The American Public Health Association,
Recognizing that diabetes mellitus is a common health condition accounting for 10 percent of internist visits and $100 billion in direct and indirect costs annually or 17 percent of all health care costs1 and that almost 16 million Americans have diabetes, a third of them undiagnosed;2 and
Realizing that diabetes is the seventh leading cause of death in the United States, and more than 187,000 men, women, infants and children died from the disease and its complications in 1995;3 and
Acknowledging that diabetes and its complications are major contributors to morbidity and mortality in all Native American populations, except for isolated Arctic groups;4 and
Observing that the diabetes mortality rates are reported to be 2.7 times higher in the American Indian and Alaska Native population than the population at large5 and when these mortality rates are adjusted for Native American heritage underreporting, the mortality rate is 4.3 times that of the white population;6 and
Finding that Native Hawaiians have a diabetes prevalence rate of 5.6 percent compared to 2.7 for Caucasians in the state of Hawaii and that this prevalence rate is an understatement of the actual rate due to socio-economic factors;7 and
Concerned that American Indians and Alaska Natives have a higher relative risk of diabetes than other groups of Americans (40 as compared to 2.5 for Blacks and Hispanic populations8) and that they are more likely to suffer from blindness, renal disease, other health problems associated with microvascular disease; and
Knowing that prevention, early detection, improved delivery of care, and diabetes self-management education can help prevent gestational diabetes or delay the onset of the progression of eye, kidney and nerve damage, gangrene, lower extremity ulcerations, amputations, and other complications;9 and
Noting that the United States Congress has taken action to address the disparity in diabetes rates for American Indians/Alaska Natives through the Balanced Budget Act of 1997 with an appropriation of $30 million per year for five years for expanded and more intensive diabetes prevention and treatment services in partnership with Tribes and Urban Indian Health programs; and
Acknowledging that the Balanced Budget Act of 1997 appropriation will begin to address the disparate need, but is not sufficient to resolve the disparity; therefore
1. Commends the Congress and the Administration for its decision to appropriate funding specifically to address diabetes among American Indians and Alaska Native men, women, infants, and children;
2. Encourages additional diabetes-related funding support directed to AI/AN/NH until the disparity in mortality and morbidity is eliminated;
3. Supports the development of health services and programs for prevention, early intervention, improved care delivery, and diabetes self-management education to serve the AI/AN/NH community;
4. Encourages partnerships among American Indian, Alaska Native, Native Hawaiian providers, the Indian Health Service, the Centers for Disease Control and Prevention (CDC), state and local health agencies, and service, civic, academic, and research institutions both public and private to prevent, manage and treat diabetes through information sharing, communications, technical assistance which shall include native researchers and culturally appropriate considerations;
5. Supports research activity dissemination to all AI/AN/NH health programs and providers via Indian Health Service and CDC cooperative agreements to ensure access to and availability of primary, secondary, and tertiary prevention research; and
6. Supports data collection, evaluation design and implementation activities of the AI/AN/NH health programs to demonstrate their impact and determine the merits of interventions in preventing and managing diabetes and its sequelae, while ascertaining unique measures developed and applied in AI/AN/NH communities and their applicability to other populations.
References
- Bureau of Primary Health Care. Consensus Conference of Health Status Gaps of Low Income and Minority Populations: A Synopsis, Health Resources & Services Administration, US Department of Health and Human Services, December 7-8, 1995.
- HHS Press Office. HHS Targets Efforts on Diabetes. Fact Sheet, US Department of Health and Human Services, October 30,1997.
- Ibid.
- Gohdes D. Diabetes in North American Indians and Alaska Natives. Diabetes in America, 2d ed. National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1997.
- Indian Health Service. Trends in Indian Health 1996. Public Health Service. Washington, DC: US Department of Health and Human Services.
- Newman JM, DeStefano F, Valway SE, et al. Diabetes-associated mortality in Native Americans. Diabetes Care. 1993;16 (Suppl. 1): 297-299.
- Wen M, Gao G. Prevalence of Diabetes in Hawai'i. Department of Health, State of Hawaii, November 1997.
- Op cit.
- Centers for Disease Control and Prevention: Diabetes: A Serious Public Health Problem, AT-A-GLANCE. Public Health Service. Washington, DC: US Department of Health and Human Services, 1996.
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