Improving the health of alaska native people through use of a policy change model and capacity building

Abstract

Public health training often includes program and education development but not policy, systems, and environmental (PSE) strategies. The Alaska Native Tribal Health Consortium's Good Health and Wellness in Indian Country program works to build tribal PSE change capacity. Trainings included community health assessment, facilitation and leadership engagement, policy and systems, and digital storytelling. From 2014 to 2017, 30 PSE changes were made: 3 tobacco-free healthcare organization policies; 2 tobacco- free tribal resolutions; 1 tobacco-free school district policy; 3 healthy food policies and environmental changes; 4 improvements in patient-provider communication; 13 prediabetes, obesity, and/or tobacco screening and referral policies; 3 improvements to health care facility signage; and 1 Baby-friendly Hospital application, protecting the health of 46,000 tribal community members. Targeted training and technical assistance moved tribal staff from a focus on direct services to population-based improvements. This increased self-efficacy may increase the sustainability of chronic disease public health efforts and improve tribal health. Background Alaska Native people have significantly higher rates of chronic disease than non-Hispanic white people in the United States, and multiple health disparities exist between these 2 populations (1). Modifiable chronic disease risk factors, including unhealthy diet, physical inactivity, and tobacco use, are also common (1). Access to affordable groceries, fresh fruits and vegetables, and medical, dental, and behavioral health care services are limited in most rural or remote Alaska Native communities. Despite these challenges, Alaska Native people are strong and resilient, with traditions and values that facilitate a culture of health (2). Changing the policy, systems, and environmental (PSE) factors that affect where people live, work, and play is increasingly being used nationally to support healthy behaviors and increase program sustainability after grant funding ends (3-5). Despite the benefits of improving PSE factors, public health program staff are generally not trained in PSE-change skills such as assessing community needs, developing policy, engaging stakeholders, countering resistance, navigating the policy landscape, working with nontraditional partners, or advocating for changes. These skills are important for ensuring that policy makers adopt, implement, and maintain PSE changes (6,7). In this article, we describe activities that increased tribal staff members' ability to effect PSE change, outcomes of those efforts, and recommendations for others doing similar work.