Native American Heritage Month

By Vida Velasco-Popov, MS Student at PACE University

Each October, the sitting president of the United States declares November as Native American Heritage Month. The idea of recognizing Native Americans for their significant contributions began in 1912, when the director of the Museum of Arts and Science in Rochester, New York, Dr. Arthur C. Parker proposed American Indian Day As a member of the Seneca Tribe, Dr. Parker worked for three years with Boy Scouts of America, Congress, and the American Indian Association till the day was formally approved in 1915 The tradition expanded further in 1990, under the Bush administration after a joint resolution concluded to designate November as National American Indian Heritage Month This federally recognized month was created with the intention of honoring Native Americans and Alaska Natives for their contributions to the United States and the world. In honor of Native American Heritage Month, this blog aims to shed light on common health challenges facing these communities and how strategic community-based nutrition interventions led by RDs have the potential to address current health disparities.

According to the CDC, Native Americans and Alaska Natives show the highest prevalence of diabetes compared to any other race or ethnicity in the United States. When we look at the statistics, we find 16% of Native American adults diagnosed with diabetes compared to 8% of white peopleThe US Department of Health and Human Services reveals that Native Americans and Alaska Natives are 50% more likely to struggle with obesity compared to non-Hispanic whites Not only do these chronic conditions lead to further health complications, they also increase mortality and lower overall quality of life. Based on the outcomes of several different studies, it seems community-based approaches to nutritional interventions work most effectively for curbing current chronic disease trends in Native American and Alaska Native populations. Though, it may seem relatively simple to identify specific health challenges and patterns within these communities, understanding how some nutritionally based initiatives might result in better health outcomes than others present more of a challenge. In reviewing several different studies and looking at different aspects of care including cultural sensitivity, relation to traditional foods, and the inclusion of native world views, I hope to share some insight into this relevant topic.

Keeping culture and history in mind when working with these groups is especially important for creating deeper connections and establishing trust with patients. From 2008-2014, researchers conducted a study covering lasting effects of community-based nutrition and general health interventions through the Traditional Foods Project. Through this research, it was found that a combination of honoring traditional foods, encouraging physical activity and including social support led to positive change in 17 Native American and Alaska Native tribes By taking time to work with community partners to better understand traditional values and way of life, researchers were able to see how unconventional methods such as storytelling led to healthy lifestyle changes within the community. Linking traditional values with the need to improve personal health, led to increased use of community gardens and participation in activities such as traditional fishing, and hunting Encouraging change from a tribal perspective allows for deeper understanding of how factors such as poverty, historical trauma, and territorial displacement come into play when considering how to implement nutritional health interventions in culturally sensitive ways.

Movement away from traditional native foods to more processed diets heavy in packaged food is associated with increased rates of obesity, diabetes, and other chronic diseases in Native American and Alaska Native communities Traditional diets range from Navajo foods such as corn, squash, sheep, berries, and wild plants to Tohono O'odham nation foods which include saguaro fruit, cholla buds, and tepary beans which provide a rich variety of nutrients In a health study on the Inuit diet, it was found that traditional country foods such as caribou, birds, fish, raw fireweed leaves, and berries have rich nutrient profiles which contribute positively to overall health; compared to sweets and potato chips which were reported in over 90% of the 2,595 Inuit adult participants Convenience stores sell mostly packaged food, which negatively impacts food selection. Here, we find two conflicting decisions: does one purchase food for convenience or follow traditional ways of eating which require more time and effort. When considering how important the process of harvesting and consuming traditional foods is for preserving Inuit cultural identity, it makes sense to work within these communities to understand their traditions and relate these practices back to health. Though market food availability for Inuit people increased significantly after the 1950s, this shift has not necessarily improved diet quality The 24-hour dietary recall methods used, revealed how sugar sweetened beverages, added sugar and bread accounted for 20% of total diet energy in these communitiesThis is not to say that nutrient dense foods were not available in market settings, but rather these communities may not have consistent access to nutrition education which would help tremendously in guiding food purchasing decisions. By working collaboratively with native communities, RDs might offer knowledge and expertise to promote healthful food decisions while community members might contribute by sharing traditional recipes and worldview which would help ensure cultural relevance to support positive change.

Looking into Native American diets studied in six different Midwestern and Southwestern reservations in a cross-sectional analysis using a semi-quantitative Block Food Frequency Questionnaire (FFQ), provides some perspective on how these groups compare to the national average with regards to DGA recommendations It was found that less than 2% of participants met DGA fruit intake recommendations compared to the national average of 12%; for vegetable intake we find 42% met recommendations compared to just 9% nationally This finding seems particularly interesting because we might expect both fruit and vegetable intake to be lower compared to national averages due to limited access to grocery stores and high rates of poverty, but this is simply not the case. One potential explanation may relate to the high percentage of participants enrolled in food assistance programs. Over 70% of participants were enrolled in SNAP, WIC or FDPIR Food assistance programs such as SNAP and FDPIR offer nutrition education and programming for Native American communities which may contribute to the high vegetable intakes observed, however further studies are needed to understand why low fruit intakes were reported. Another interesting aspect of this study has to do with data collection methods. Fifteen percent of the 601 participants studied, were surveyed using native language and an additional fifteen percent of participants were interviewed using a mixture of native language and English Of the studies I’ve read on this topic, very few use native language to connect with participants. This linguistic strategy is particularly useful when working with members of a community who may not be fluent in English. Eliminating language barriers is beneficial for reducing reporting errors and establishing trust with participants.

Establishing cultural relevance within a proposed nutritional intervention greatly contributes to overall success. A systematic review of nutrition interventions in Native American and Alaska Native populations revealed that using more than three strategies for community engagement was associated with significant outcomes Of the 49 studies assessed in the review, 79% resulted in behavior, knowledge, or health changes. Furthermore, 31 programs reported significant changes and 28 of the studies involved community partnerships Strategies such as involving community partners, training peer educators, or involving local food systems are all useful strategies for building community relationships to ensure overall success of a program. From personal experience, as a community health volunteer, I’ve learned that people respond best when they feel they have autonomy. Instead of creating a narrative where you might think of yourself as an individual working to help other people, think of your role as building a partnership between you and the community. As you offer guidance and support, spend time learning from the people you’re working with and try to understand their way of life and what knowledge they may bring to the table. By considering the strengths of indigenous communities and involving these groups as decision makers or co-designers, this has the potential to expand the reach and depth for future RD supported nutrition interventions. 

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