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CHW Health Disparities Initiative

Heart Disease Prevention in American Indians and Alaska Natives

Heart disease is a serious problem for all Americans, and it has become the leading cause of death for American Indians and Alaska Natives. Studies among many individual tribes have shown that rates of heart disease have dramatically increased over the past two to three decades. In fact, heart disease rates in these groups are not only significantly higher than those found in the general population but also continuing to increase.1,2

Read on to find out how community health worker (CHW) heart health programs targeting American Indians and Alaska Natives were implemented:

Recognizing the need for heart disease prevention in these communities, the NHLBI and the Indian Health Service (IHS) have collaborated for several years to plan, develop, and implement effective approaches to improve the heart health of American Indians and Alaska Natives.

History of the Project

In 1998 and 2000, the NHLBI and IHS conducted an assessment of heart health needs of American Indian/Alaska Native communities and developed heart health education materials, including the video “Your Heart, Your Drum” and three easy-to-read educational booklets. A revised version of these booklets has since been created, entitled Your Choice for Change!, for the American Indian community.

Between 2000 and 2002, heart health strategies were implemented in three tribal communities: the Laguna Pueblo of New Mexico, the Ponca Tribe of Oklahoma, and the Bristol Bay Corporation of Alaska. A major outcome during this time was the creation of the Honoring the Gift of Heart Health (HGHH) manual, which was adapted from the NHLBI’s original Your Heart, Your Life manual and tailored for use in diverse American Indian/Alaska Native settings.

The NHLBI and IHS then cooperated in developing and implementing a heart health training effort for these three tribal communities. When this effort proved to be effective, the NHLBI and IHS embarked on a major effort between 2003 and 2006 to create a national strategy on heart health for IHS. The strategy included training, capacity building, and dissemination of HGHH materials through a national training workshop and six regional training workshops.

National Workshop: Strengthening the Heartbeat of American Indian and Alaska Native Communities

In 2003, the NHLBI and IHS sponsored a National Cardiovascular Health (CVH) workshop in Phoenix, AZ, for 64 tribal leaders, health directors, community health educators, dietitians, nutritionists, and community health representatives. Tribal participants from 22 states and all 12 IHS regions were represented. The workshop’s overall purpose was to develop core teams of national advocates for tribal heart health, training faculty, and community heart health educators, who would support the effort to provide heart health education and outreach to tribes around the country.

At the end of the workshop, the national teams

  • Embraced the HGHH training and manual.
  • Began to develop tailored strategies and activities to fit the needs and opportunities of their areas.
  • Built on their heart health knowledge and skills to implement activities.
  • Had learned strategies for motivating communities and partners to take actions that lead to healthy people and effective heart health programs.
  • Increased their knowledge of the importance of data collection and program evaluation.
  • Were empowered to implement heart health activities once they returned to their areas and communities.

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1 Rhoades, D. A. (2005). Racial misclassification and disparities in cardiovascular disease among Native Americans and Alaska Natives. Circulation, 111(10), 1250-1256.

2 Howard, B. V., Lee, E. T., Cowan, L. D., Devereux, R. B., Galloway, J. M. Go, O. T.,…Welty, T. K. (1999). Rising tide of cardiovascular disease in American Indians: The Strong Heart Study. Circulation, 99(18), 2389-2395.

Last Updated: June 2014

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