$3.9 Billion in Indian Country Grants:

Diabetes Prevention a Bust, NOW WHAT?

In preparing for a Native Health Summit talk, I dove into the realm of funding. Complete transparency, I had to google 26 x $150M – that large number tapped out my Canon calculator. The US Department of Health and Human Services, through IHS has invested roughly $150M a year in the form of a grant referred to as the SDPI (Special Diabetes Program for Indians) since 1997 as part of the Balanced Budget Act to address the growing epidemic of diabetes in American Indian and Alaska Native Communities.

The goal of the SDPI grant is to provide diabetes prevention and treatment services to American Indian and Alaska Native Communities. Health and Human Services (HHS), in a recent article dated 1/1/23 titled HHS Awards $139 million for Special Diabetes Program for Indians , stated “ The Special Diabetes Program for Indians has successfully implemented evidence-based and community-driven strategies to prevent and treat diabetes within American Indian and Alaska Native Communities.” It is very true that the level of care provided for the treatment of Diabetes has increased dramatically across Indian Country. It is false to claim that the program is finding success in the prevention of diabetes in any measure. In fact we have seen a dramatic rise since the inception of the program in 1997 only to see a few short years of decline from our highest point of 15.4% in 2013 to 14.6% in 2017, which is still higher than 2006 numbers. I would also wager to say that since COVID those numbers have exceeded 15.4%!

I understand the need for wins in this department as Diabetes is something we would not wish on anyone. We have to understand that what we have done over the past 26 years DOES NOT WORK! This challenge is not solved by simply increasing the amount of funding or continually spending for that matter! We all know the definition of Insanity.

According to the National Institute of Health “you are more likely to develop type 2 diabetes if you are not physically active and are overweight or have obesity.” They are not the only ones saying this – MAYO Clinic, Cleveland Clinic, Harvard, Stanford, UCLA to name a few. If being active and weighing less prevents diabetes from happening, this is where the prevention efforts need to FOCUS – just making sure we are clear on this single important point!

In all fairness the challenge of Diabetes prevention should not be put solely on the backs of HHS or IHS. We, as strong and proud people, need to own some of that responsibility. The debate of outdoor parks, walking paths, fitness facilities and other means to get our people moving needs to become prominent in our Tribal Council Agendas. Far too often I have seen the ball rolling on this topic with a Tribe only to have it completely stopped by the incoming Council who doesn’t prioritize health or fitness.

5 steps to take now for Diabetes Prevention.

1. Total buy In from Tribal Leadership

Sounds simple enough but is easier said than done. Each Council member brings their expertise, knowledge and own agendas they are pushing forward to the leadership table in the name of their people. If nothing else we have to realize that the healthier our people are as a whole, the better we do as a whole economically – which is part of our future “advancement engine”.

2. Diabetes Facility Standards

Currently each facility is operated by the expertise of the person who was hired to run the facility, most of which are pulling double duty. There is no guide book or degree on how to run a Native Fitness Center but at the very least there needs to be some accountability from leadership on actual metrics. Speaking to the facility standards, in every facility we have to make sure we are not only taking care of our youth but also our elders when choosing the equipment mix.

3. Open Lines of Communication within the Tribe itself – active participation amongst departments

Far too often the right hand doesn’t know what the left hand is doing in terms of fitness in many areas across Indian Country. There will be a diabetes facility funded by the SDPI grant and there will also be a Tribal Fitness Center. More often than not these two do not communicate with each other, and sometimes becomes competitive when they should actually be working together. I would go one step further and put a single person in charge of both programs with one nice facility vs. two smaller facilities.

4. Actual Metrics to determine traction & direction

In business we do a lot of things to determine ROI (return on investment). We also monitor direction or product release to determine if it’s viable. As we try different tactics and directions, the only way to know if we should keep going is to keep score. We have to set real metrics in order to know if our efforts are moving us closer to our goal. The most useful metric is usage, which should be tracked by every Native Fitness Facility as it provides an abundance of critical information.

5. Ability to Invest SDPI funds into the actual building of a Fitness Facility

Infrastructure across Indian Country is a huge challenge in most cases. We work out of abandoned schools & military structures along with portables, each of which presents its own challenges. As of right now the SDPI grant cannot be used for infrastructure, which puts unique challenges on diabetes directors in finding space to have a fitness facility. Many facilities get put in a corner of an old office, shed or other limited space areas. At the very least IHS should be providing a realistic budget for infrastructure. Spaces do not need to be elaborate to be functional. Depending on where you are in Indian Country Steel/Pole Building prices are extremely reasonable, especially when considering land is typically already owned by the tribe.

Despite the federal government’s substantial investment of $3.9 billion in SDPI grants, the lack of success in diabetes prevention is a matter of great concern for the future of our people. Moving forward, we need to realize that this is an Indian Country challenge and we need to stop exclusively relying on the Government to solve this plague that is affecting so many members of our family.

Post by OJ Fiander

Orien (OJ) is an enrolled member of the Grand Ronde Tribe in Oregon. He grew up most of his life on the Yakama Reservation with a few years on the Nez Perce Reservation. A successful entrepreneur, former division 1 athlete, husband of 24 years and counting, father of 6 and a weekend “anything outside” warrior!