Prevention Fund Helps Makah Tribe Awaken Sleeping “Ways of Wellness”
By Rob Waters
The Makah tribe of Washington is one of more than 60 cities, counties, states, tribes and nonprofit groups that received Community Transformation Grants totaling $107 million last year from the Centers for Disease Control and Prevention. The money for these grants came from the Prevention and Public Health Fund, a funding arm of the Affordable Care Act established to combat disease and lower healthcare costs by promoting wellness and prevention. This year, another $70 million has been awarded to towns and cities with fewer than 500,000 people to expand community prevention efforts.
The Prevention Fund is helping these communities work to prevent diabetes and cancer and improve the health and fitness of residents. But it’s also under threat as some Congressional leaders press for budget cuts in advance of the so-called fiscal cliff. This week and next, I’m examining how health officials and residents in places like Nashville, Tuolumne County, California and Neah Bay, Washington, are putting money from the Prevention Fund to use.
Verna Bowechop-Bunn lives as far west as it is possible to go in the continental United States, and nearly as far north, in the tiny town of Neah Bay, Washington, on the Makah Indian reservation. The reservation sits at the northern tip of the Olympic Peninsula, pointing like a finger into the Strait of Juan de Fuca, which separates the U.S. from Canada’s Vancouver Island.
For the Makah, living by the sea has always meant living from the sea—and the bounty of fish and shellfish found in the strait. For centuries, until the 1920s, the Makah were known as expert whalers who stalked their prey from large canoes, advancing to throw their harpoons from close range, then paddling furiously to avoid a gray whale’s thrashing tail.
Bowechop-Bunn has lived on the reservation all her life. Now 83, she grew up in the 1930s, when “we had that Depression and there was no employment,” she remembers. “It was hard times so our people lived more or less from the ocean.”
As traditional hunters and gatherers, the Makah people were active, says Elizabeth Buckingham, the tribe’s health director. “Fisherman stay healthy and lean, however in the modern age, most of us make a living doing sedentary work,” she says. “It’s no longer necessary to have a strong, healthy back to get your food and the things you need to live.”
That’s been the case in Bowechop-Bunn’s family. Over the years, she worked as a dispatcher for the tribal police and coordinated the local Head Start program. Her husband was a contractor who cleared land and did road work. Their jobs kept both of them fairly active—until her husband died 10 years ago and she became more of a homebody and started getting less exercise.
“The way I was living and eating wasn’t good for my body,” she says.
These kinds of experiences affected the whole tribe. About half of tribal members have weight levels that put them at risk for chronic conditions like diabetes and heart disease. Nearly a third of patients at the clinic use tobacco. And, according to estimates derived from the 2000 census, life expectancy at birth for Native people in Clallam County, where the Makah reservation is located, is 69, nine years lower than that of white residents.
So when the Centers for Disease Control invited cities, states, and tribes, to apply for Community Transformation Grants with funding from the Public Health and Prevention Fund, the Makah leadership jumped at the opportunity. The tribe was in the process of starting a wellness center and was focused on the need to return to “our traditional active life, our Makah ways of wellness,” says Buckingham.
“In our culture, if there’s a past practice and you haven’t been doing it any more, you says it’s sleeping,” she says. “I would say we are just waking up these practices that are good for us.”
This focus on wellness and the work the tribe was already doing through its Sophie Trettevick Indian Health Center helped the Makah earn a $219,000-a-year grant for five years to increase its ability to promote health and prevent disease among its members. Tribal health leaders sprang into action, organizing a leadership team and a community coalition and setting up a series of community meetings and dinners that drew as many as 200 people.
At the meetings, and in surveys, tribal members were queried about their practices and needs. What do they eat? Where do they buy fresh fruits and vegetables and how often do they eat them? Would they eat more if fresh produce were sold at the local market instead of driving two hours to shop at Big Box supermarkets? How often do they walk or ride a bicycle? What would help them walk or ride more often?
From these surveys, Makah leaders learned a lot, says Mel Melmed, the tribe’s public health director. Two-thirds of people said they would eat more fruits and veggies if they were easier to get locally. Thirty-two percent said they’d walk more if there were fewer loose dogs; 23 percent if there were more sidewalks and streetlights.
The tribe used this information to get another small grant from the EPA focused on walking and biking. They brought in experts from Forterra, a Seattle-based environmental group, to assess the obstacles that keep people from walking and riding more and to explore ways to overcome those barriers. Volunteers from The Bikery, also based in Seattle, taught tribal members how to perform bicycle repairs. Cascade Bicyle Club donated free biking helmets to those who needed them.
One year into the grant, new initiatives are beginning to emerge. A walking program begun three weeks ago gives community elders like Verna Bowechop-Bunn the opportunity to walk with partners, including high school students, and to use the indoor gym at the high school as a safe walking space. Plans are being developed to start a farmer’s market. Managers of the mini-mart in Neah Bay will receive training in how to better manage and promote fresh foods and are slated to begin selling them later this winter.
“Our community is slowly noticing the importance of taking care of ourselves by walking, exercising and eating healthy,” says Bowechop-Bunn. “It’s the most beneficial thing that’s happened to me in a long time.” She and her people are waking up their old, healthy habits.
A video on the Makah’s effort to return to their “ways of wellness” can be seen here: http://www.youtube.com/watch?v=ziFfTLDBmyA.
This week and next, I’m using this space to talk about the impact the Prevention Fund is having in communities across the country. If you think prevention is important, you can do your part by telling your representatives in the House and Senate to support the Affordable Care Act—and especially the Prevention and Public Health Fund. If you have a community prevention story you’d like to share, comment here or email me at email@example.com.