Coquille Indian Tribe Healthy Communities Project M7572

Healthy Places, Healthy People: A Framework for Oregon* Together heart disease, stroke, diabetes and chronic respiratory disease account for three of five deaths in Oregon. 61% of adults have one of the following: arthritis, asthma, diabetes, heart disease, high blood pressure, high cholesterol and stroke. 89% have one of the risk factors for these conditions: current smoker, overweight or obese, physical inactivity or consumption of too few fruits and vegetables. *Healthy Places Healthy People: A Framework for Oregon; OR DHS, Public Health Division, Health Promotion Chronic Disease Prevention. December 2008

Healthy Places, Healthy People: A Framework for Oregon Oregon Health Promotion Chronic Disease Prevention Program Vision 2020: All People in Oregon live, work, play and learn in communities that support health and optimal quality of life. Mission: To advance policies, environments and systems that promote health, and prevent and manage chronic disease. Work together to reduce exposure to tobacco products and secondhand smoke, make it easier to access healthy foods and be physically active, and assure people can easily manage their chronic diseases.

Coquille Indian Tribe Healthy Communities Project The Healthy Communities Project: Gathering partners and stakeholders to access the environmental and policy factors that affect the health of the community and the chronic disease environment. Identify community health strengths and needs of the Coquille Indian Tribe. Develop a multi-year plan focused on improvements to help community members be as healthy as possible. Purpose Reduce the incidence of chronic disease most closely linked to tobacco use, physical inactivity, and poor nutrition. Improvements to policy and environmental factors, policies, social norm and best practices to improve healthy behaviors.

Coquille Indian Tribe Healthy Communities Project Examples Tobacco Free Worksite Policy Examples of Health Policy that are now expectation: New York City Tenements Sanitation Indian Health Service Water and Sanitation Tobacco Use Surgeon General’s Report 1964 Seat Belts and Car Seats

Coquille Indian Tribe Healthy Communities Project OR Health Authority Health Promotion Chronic Disease Prevention (H.P.C.D.P.) Tobacco Prevention Education Program (T.P.E.P.) “Healthy Communities” Funding Conduct Community Health Assessment based on CDC CHANGE (Community Health Assessment and Group Evaluation) Tool Modified to meet the needs of the Coquille Indian Tribal Community

T.P.E.P. Stakeholders Health and Human Services Administrator Assistant Health and Human Services Administrator Tribal Council Representative Elders Program Coordinator Community Health Representative Coquille Indian Tribe Police Representative Coquille Indian Tribe Housing Authority Human Resources Director Prevention Coordinator Health Advisory Board Representative

Coquille Indian Tribe Healthy Communities Project Environmental Changes: physical, social, economic factors that influence practices Examples Walking path around the Kilkich Community Nasomah Healthy Traditions Incentive Policy Changes: laws, regulations, rules, protocols that guide behavior Examples Policies that require healthy food choices be offered at meetings Policies Smoke Free Tribal Events

Framework

C.H.A.N.G.E. Sample Questions Community-At-Large Sector Physical Activity To what extent does the Tribe encourage walking by developing, maintaining, and/or promoting walking routes to, from and around tribal properties? To what extent does the tribe offer, promote, or provide access to traditional cultural physical activities like dancing? Leadership Does the Tribe have a health promotion budget? Nutrition To what extent does the Tribe use locally grown and traditional foods at Tribal restaurants and events? Tobacco To what extent does the Tribe prohibit commercial tobacco use for outdoor public places? Chronic Disease Management To what extent does the Tribe educate Tribal members about obesity prevention?

C.H.A.N.G.E. Sample Questions Health Care Sector Physical Activity To what extent do health care providers assess patients’ physical activity during routine office visits? Nutrition To what extent do the health care facilities provide free or low cost weight management or nutrition programs? Tobacco To what extent do health care providers provide regular counseling about the harm of commercial tobacco use and exposure during routine office visits? Chronic Disease Management To what extent do the health care facilities have a systematic approach to diabetes care? Leadership To what extent do the health care facilities provide access to medical services outside of regular working hours ?

C.H.A.N.G.E Questions in each sector Major Community Events, Health Care, Education, Tribal Government, Work Site Score Policy 1 - Not identified as a problem 3 – Policy formulation and adoption 5 – Policy evaluation and enforcement Environment 1 – Elements not in place 3 – Some elements in place 5 – All elements in place

C.H.A.N.G.E. Findings Chronic Disease Management Received high scores except Major Community Events had scores less than 3 Reason: No onsite preventative medical screenings and chronic disease management education and prevention Education (Afterschool/Summer Programs/ Head Start and Tutoring) Lower score due to inconsistent engaging of parents in chronic disease prevention for Tribal youth Tribal Community low scores for use of traditional wellness to address chronic disease

CHANGE Findings Nutrition Low policy scores but high environmental. Many evaluated a 2 for policy and a 3 for environmental support. Indicating support from some but not consistent enough for policy. Examples: nutrition labeling of foods at Tribal events, healthy options at all Tribal events, healthy vending machines, access to refrigeration for staff, weight loss programs, promotion and education regarding traditional foods, programming to support community gardens, etc.

C.H.A.N.G.E. Findings Physical Activity Most differences between sectors For Example: Education and Tribal Community had only one score below 3 but worksite had many 1 and 2 scores. The environmental score for traditional cultural physical activities was 4 however, the policy score was 1. Midwinter gathering and Restoration Celebration had both scored low for policy but high in environmental.

C.H.A.N.G.E. Findings - Physical Activity

CHANGE Findings - Physical Activity

CHANGE Findings Commercial Tobacco Use Overall the Tribe’s policies and environmental support for commercial tobacco cessation received high scores. Access to commercial tobacco cessation products and services was indentified as particularity strong. Three questions scored low: Education sector scored a 2 for referring participants for tobacco cessation. Tribal Community received a 1 for environmental elements in place to prohibit commercial tobacco promotions, and prizes.

CHANGE Findings – Commercial Tobacco

Healthy Communities Discussion Draft: Community Health Action Plan Goal: To support Tribal members and Tribal employees making healthy choices, improving their health and well-being. Strategies: Develop policies and programs that make it easier for Tribal members and employees to: Choose to eat healthy foods Engage in physical activity Self-manage chronic disease Reduce, quit, or never start using commercial tobacco products

Coquille Indian Tribe Sample Strategies Policy Actions: Healthy Foods Develop a “Healthy Food” policy for all Tribe- hosted events and meetings with food that requires: Healthy food choice alternatives at all events and meetings with food. Traditional food options, with labeling that describes the food and its nutritional value, be available at all Tribe-hosted events and meetings with food. Smaller or half portions and “tasting options” with serving size labeling to be offered at all Tribe-hosted events and meetings with food.

Coquille Indian Tribe Sample Strategies Program Activities Physical Activity Develop informational materials about walking trails on Kilkich community land. Create maps or brochures of walking trails, include mileage information, elevation gain, and level of difficulty.  Funding Opportunity

Next Steps Currently in the Process of Completing the Healthy Communities Action Plan. Goal to complete Gain support and approval through the appropriate Coquille Tribal Channels. RFP “Oregon Healthy Communities Implementation Program”.

Healthy Tribal Communities Contact: Kelle Little, RD, CDE Health and Human Services Administrator Coquille Indian Tribe Community Health Center , ext: 20217