Good Health and Wellness in Indian Country

American Indians (AI) and Alaska Natives (AN) have higher rates of disease, injury, and premature death than other racial and ethnic groups in the United States [1, 2]. AI and AN adults have a higher prevalence of obesity, are twice as likely to have diagnosed diabetes, and are more likely to be current smokers[3]. Rates of death due to stroke and heart disease are higher among AI and AN than among members of other racial and ethnic groups [4]. The prevalence of tooth decay among AI and AN children aged two to five years is nearly three times the US average [5]. Since 2014, NCCDPHP has funded three (3) cooperative agreements to reduce health disparities and increase health equity among American Indians and Alaska Natives. A Comprehensive Approach to Good Health and Wellness in Indian Country (DP14-1421, or GHWIC) has long-term goals of reducing rates of death and disability from tobacco use, diabetes, heart disease and stroke, and reducing the prevalence of obesity. GHWIC supports a coordinated, holistic approach to healthy living and chronic disease prevention using community-chosen, culturally adapted policies, systems, and environmental improvements to achieve these goals. GHWIC’s Component 1 recipient activities addressed all of NCCDPHP's four domains: epidemiology and surveillance, environmental approaches, health care system interventions, and community programs linked to clinical services[6]. Component 2 recipients had the option of providing subawards to Area Tribes and UIOs, which greatly increased the reach of GHWIC funding by providing resources to nearly 120 individual tribes via the subaward mechanism. The strengths of GHWIC provide the basis for this NOFO. Building Public Health Infrastructure in Tribal Communities to Accelerate Disease Prevention and Health Promotion in Indian Country (DP17-1704, or TECPHI) launched in October 2017 with the goal of contributing to reductions in chronic diseases and risk factors, reductions in disparities in health outcomes, and improvements in overall health by building public health capacity and infrastructure in Indian Country for disease surveillance; epidemiology; prevention and control of disease, injury, or disability; and program monitoring and evaluation[7]. In May of 2018, CDC launched Tribal Practices for Wellness in Indian Country (DP18-1812, or TPWIC). This 3-year funding opportunity supports tribal practices that build resiliency and connections to community, family, and culture, which over time, can reduce risk factors for chronic disease among AI and AN[8]. This NOFO will build on the successes and lessons of GHWIC, TECPHI, and TPWIC. The long term impact of this NOFO is to reduce rates of death and disability from commercial tobacco use, diabetes, heart disease and stroke; and to reduce the prevalence of obesity. This is a five-year funding opportunity (five-year period of performance, one-year budget period). This NOFO is the collaborative effort of six (6) divisions/office within CDC’s National Center for Chronic Disease Prevention and Health Promotion. Division of Diabetes Translation Division for Heart Disease and Stroke Prevention Division of Nutrition, Physical Activity, and Obesity Division of Oral Health Division of Population Health Office on Smoking and Health The strategies, activities, and outcomes of this NOFO will build upon the national efforts of these divisions/office to increase the health impact nationwide. The NOFO combines evidence-informed (1) policy, systems, and environmental changes (obesity, tobacco), and (2) clinical-community linkages (diabetes, heart disease and stroke prevention) strategies which may be culturally-adapted to meet the needs of the American Indian and Alaska Native communities. This NOFO has three (3) separate, competitive components with eligibility and scope of work requirements for each. Applicants must submit a separate application for each component for which they are applying. Component 1 (C1) recipients will implement evidence-informed and culturally-adapted strategies to improve the health of their community members and to prevent chronic diseases and their risk factors. Policy, system, and environmental change strategies are to prevent obesity or prevent and control commercial tobacco use and exposure. Community-clinical linkage strategies are to prevent type 2 diabetes and prevent heart disease and stroke. Component 2 (C2) recipients will allocate 50% of their annual award in subawards to at least four (4) American Indian Tribes, Alaska Native Villages or Urban Indian Organizations in their Area, and provide training, technical assistance, and evaluation support to all Tribes/Villages/UIOs in their Area with remaining award funds. Component 3 (C3) recipients will establish a Tribal Coordinating Center, develop a national communication plan, coordinate the development and implementation of a national evaluation plan in collaboration with CDC evaluators, and establish and support a Community of Practice (CoP) of representatives from each C1 and C2 recipient to support shared learning and peer support to advance the goals of GHWIC and support other chronic disease risk factors and conditions, (e.g., oral health, dementia, COPD). Arias, E., J. Xu, and M.A. Jim, Period life tables for the non-Hispanic American Indian and Alaska Native population, 2007-2009. Am J Public Health, 2014. 104 Suppl 3: p. S312-9. Espey, D.K., et al., Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives. Am J Public Health, 2014. Cobb, N., D. Espey, and J. King, Health Behaviors and Risk Factors Among American Indians and Alaska Natives, 2000-2010. Am J Public Health, 2014. Veazie, M., et al., Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009. Am J Public Health, 2014. 104 Suppl 3: p. S359-67. Braun, P.A., et al., A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children. J Dent Res, 2016. 95(11): p. 1237-44. Good Health and Wellness in Indian Country. 2015; Available from: https://www.cdc.gov/chronicdisease/tribal/factsheet.htm. Tribal Epidemiology Center Public Health Infrastructure. 2017; Available from: https://www.cdc.gov/chronicdisease/tribal/tecphi.htm. Tribal Practices for Wellness in Indian Country. 2017; Available from: https://www.cdc.gov/chronicdisease/tribal/tribalpractices.htm.