A Conversation with the Honorable Dr. Charles Grim

TC:  Do you think there are more culturally sensitive ways that these issues can be addressed in Indian country to get the message out there about what people can do to protect their health?

CG:  I think again that the short answer is yes, and I'll expand on that. I think really with all population groups, that you need to sort of tailor the message. I think with the Hispanic population and the African-American population, and the American Indian population, I think if you tailor it specifically to the culture of a population group, you're gonna be more effective. So I think a lot of the things we get, either from the popular press, or the Centers for Disease Control and Prevention are working on things with states; some of that stuff has already been modified for some of the larger ethnic groups in the country, but not for ours. And so we take it, and we do modify it.

We've done a lot, I think, around diabetes. You heard me mention on the budget question that our population has about a 420 percent higher mortality rate on diabetes. But in the past six years, we've gotten -- the last six was $100 million, and then they've added $50 million to it, so this year we're getting $150 million. And what we've learned in both science, and what we've been doing is that in the diabetes program prevention trials, we learned that Type II diabetes, which is the biggest problem in our country and in the nation really, it's preventable. So we got, for the first time, during sort of the middle of that demonstration money that we had, we had a scientific road map that we didn't have available before. So as we've used our monies, we've focused on screening more out there in the communities to find out, are we actually aware of how many people are diabetic. So we have seen an increase in our prevalent statistics. And a lot of that is because we had more money to go out and do primary screening. And we're placing a huge amount of emphasis on the grant programs we have out there on preventative measures on both adults and children.

And also, because of that, we've seen sort of the clinical indicators. And I won't go through what they are, but things like blood sugar control, blood lipids, protein and urine and things like that, that would indicate whether an individual has their diabetes under control or not. We've seen many of those clinical indicators trending now - we track all of them yearly across our population - we've seen those trending in the right direction. And I don't know if you have copies, but we put out every year books called Trends in Indian Health and Regional Differences, so it looks at over 5-10 year periods, or sometimes longer for certain statistics both at the national level in the one book, and then region by region in the other, as to how we're doing. So we've seen improvements over time in many, many of the disease states, and I can mention infant mortality, tuberculosis, deaths due to accidents, and huge improvements in diabetic care, even though we've identified more diabetics. And it is an epidemic, we consider, in our population.