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S. HRG. 115–48 

NATIVE YOUTH: PROMOTING DIABETES 

PREVENTION THROUGH HEALTHY LIVING 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MARCH 29, 2017 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

JOHN HOEVEN, North Dakota, Chairman 

TOM UDALL, New Mexico, Vice Chairman 

JOHN BARRASSO, Wyoming 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JAMES LANKFORD, Oklahoma 

STEVE DAINES, Montana 

MIKE CRAPO, Idaho 

JERRY MORAN, Kansas 

MARIA CANTWELL, Washington 

JON TESTER, Montana, 

AL FRANKEN, Minnesota 

BRIAN SCHATZ, Hawaii 

HEIDI HEITKAMP, North Dakota 

CATHERINE CORTEZ MASTO, Nevada 

T. MICHAEL ANDREWS, Majority Staff Director and Chief Counsel 

JENNIFER ROMERO, Minority Staff Director and Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on March 29, 2017 ............................................................................ 1 

Statement of Senator Cortez Masto ....................................................................... 4 

Statement of Senator Daines .................................................................................. 3 

Statement of Senator Franken ............................................................................... 4 

Statement of Senator Heitkamp ............................................................................. 28 

Statement of Senator Hoeven ................................................................................. 1 

Statement of Senator Murkowski ........................................................................... 4 

Statement of Senator Udall .................................................................................... 2 

WITNESSES

Buchanan, Rear Admiral Chris, Acting Director, Indian Health Service, U.S. 

Department of Health and Human Services ...................................................... 6 

Prepared statement .......................................................................................... 7 

Eagle, Jared, Director, Fort Berthold Diabetes Program, Three Affiliated 

Tribes .................................................................................................................... 14 

Prepared statement .......................................................................................... 15 

Hawley, Hon. Vinton, Chairperson, National Indian Health Board (NIHB) ...... 9 

Prepared statement .......................................................................................... 11 

Sensmeier, Martin, Actor and Ambassador, Boys & Girls Clubs of America ..... 16 

Prepared statement .......................................................................................... 18 

Villegas, Alton, Tribal Youth, Salt River Pima-Maricopa Indian Community; 

Accompanied by Rachel Seepie, Senior Fitness Specialist, Diabetes Service 

Program—Health Service .................................................................................... 20 

Prepared statement .......................................................................................... 21 

APPENDIX

Allen, Hon. W. Ron, Tribal Chairman, Jamestown S’Klallam Tribe; Board 

Chairman, Self-Governance Communication & 

Education Tribal Consortium, prepared statement ........................................... 39 

Barlow, Allison, Ph.D, MA, MPH, Director, Center for American Indian 

Health, Johns Hopkins Bloomberg School of Public Health, prepared statement ...................................................................................................................... 41 

Crabbe, Kamana’opono M., Ph.D. (Ka Pouhana)/CEO, Office of Hawaiian 

Affairs (OHA), prepared statement .................................................................... 45 

Rock, Patrick M. MD,, CEO, Indian Health Board of Minneapolis, Inc., prepared statement ................................................................................................... 46 

Tuomi, Ashley, President, National Council of Urban Indian Health, prepared 

statement .............................................................................................................. 47 

United South and Eastern Tribes Sovereignty Protection Fund (USET SPF), 

prepared statement .............................................................................................. 41 

(1) 

NATIVE YOUTH: PROMOTING DIABETES 

PREVENTION THROUGH HEALTHY LIVING 

WEDNESDAY, MARCH 29, 2017 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:45 p.m. in room 

628, Dirksen Senate Office Building, Hon. John Hoeven, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JOHN HOEVEN, 

U.S. SENATOR FROM NORTH DAKOTA 

The CHAIRMAN. Good afternoon. We will call this hearing to 

order. 

Up front, I want to thank all our panelists for being here. 

Today the Committee will hold an oversight hearing on Native 

Youth: Promoting Diabetes Prevention through Healthy Living. 

In 1997, Congress authorized the Special Diabetes Program for 

Indians to address the extraordinary prevalence of diabetes among 

Indians. It is now in its twentieth year and up for reauthorization 

this year. 

This program has demonstrated significant inroads in reducing 

diabetes and its complications, such as limb amputations, heart 

disease and kidney failure. However, there is still more work to be 

done. 

Indian people have a greater chance of being diagnosed with diabetes than any other racial or ethnic group in the Country. It is 

the fifth leading cause of death for Native people. This disease is 

now afflicting the youth. 

Native youth are reportedly nine times higher than non-Hispanic 

whites to be diagnosed with Type 2 diabetes and the related complications of heart disease, kidney failure, and other diseases. 

I look forward to hearing from our witnesses regarding why, according to Indian Health Service information, and during the existence of this special program, the rates of diabetes among the youth 

have increased and obesity rates have pretty much stayed the 

same. 

As we know, obesity is one indicator for the future risk of becoming diabetic. If it is not decreasing, then before we reauthorize this 

program and talk about a funding authorization level, we need to 

examine how well this special program is serving the Native American youth. 

2 

We know, on the bright side, Type 2 diabetes is both preventable 

and manageable, particularly through healthy living. Healthier lifestyles can help improve blood glucose levels, decrease obesity rates, 

lower blood pressure, and decrease bad cholesterol levels for our 

youth. 

Today we look forward to hearing from our witnesses on how 

they are making a difference in the lives of Native youth and any 

improvements needed for this special program. We must work together to prevent further diabetes prevalence in Indian Country 

and continue the good work that is currently being done. 

With that, I want to start with a special welcome to one of our 

witnesses today. Again, I welcome all of you but a special welcome 

to a witness from my home State of North Dakota, Mr. Jared 

Eagle. Thank you for being here from the Three Affiliated Tribes 

in New Town, North Dakota. 

I want to thank all of you for being here and welcome you. 

I also want to turn to Vice Chairman Udall for any opening 

statement he would like to make. 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you very much, Chairman Hoeven, for 

calling this oversight hearing on Native Youth and Diabetes Prevention. 

Too often in this Committee, we hear about the challenges facing 

Indian Country but I hope today’s hearing will give us an opportunity to focus on the success stories. Throughout my time in public service, I have been fortunate to get to know some truly inspiring Native youth. Whether it is meeting with students from the 

Santa Fe Indian School on a trip to D.C. or joining kids from Santa 

Clara Pueblo’s Youth Running Club for a run back in New Mexico, 

the one thing I always hear when I talk with Native youth is how 

important community, culture and mentorship are to their success. 

As a committee, we should look for more ways to support the efforts of tribes and Native communities to engage Native youth in 

healthy lifestyles. I am glad we are here to learn more about the 

positive impact that culturally informed community health promotion programs can have in Indian Country. 

One of the main ways Congress has supported tribally-driven diabetes prevention initiatives over the last 20 years has been 

through authorizing the Special Diabetes Program for Indians, otherwise known by the acronym SDPI. SDPI funds diabetes prevention and treatment programs in more than 300 Native communities 

across the Country, resulting in a 61 percent increase in culturallybased diabetes education programs. 

The SDPI impact can be measured by more than statistics and 

health care cost savings. This program has helped to improve the 

quality of life for thousands of diabetic and pre-diabetic American 

Indians and Alaska Natives. I am sure many of the witnesses here 

today can attest to the positive impacts SDPI has had on their 

communities. 

Despite the outstanding impact this program has had over the 

last two decades, it has suffered under the strain of one to two year 

3 

reauthorizations. These short-term extensions have made it difficult for tribal diabetes programs to plan for the long term. 

That is why I introduced a bill to reauthorize SDPI for another 

seven years. This long-term extension will provide Native grantees 

with peace of mind during the annual appropriations process and 

it makes a commonsense investment in preventive health care programs that will curb ever increasing medical costs. 

I will conclude by inviting other members of this Committee in 

support of reauthorization of SDPI. I look forward to hearing from 

our witnesses about the innovative work SDPI has helped fund in 

their communities. 

Thank you again, Mr. Chairman, for focusing on diabetes and 

prevention in this Committee. 

The CHAIRMAN. Thank you, Senator Udall. 

Are there other members who would like to make an opening 

statement? 

STATEMENT OF HON. STEVE DAINES, 

U.S. SENATOR FROM MONTANA 

Senator DAINES. Thank you, Chairman Hoeven and Vice Chairman Udall. 

Let me tell you a story. It is the story of Dustin Mitchell. 

Dustin is 14 years old. He is a member of the Confederated Salish and Kootenai Tribes of the Flathead Reservation in Northwest 

Montana. He is a regular, fun loving kid. He plays football, goes 

to school, and drives race car competition in the summer. 

In 2012, he was diagnosed with diabetes. The diagnosis came as 

a shock to him and his family. The Mitchells did not have other 

family members who had struggled with diabetes before and needed to learn how to cope with Dustin’s new challenge. 

Soon thereafter, Dustin attended the American Diabetes Association’s Camp Montana in Fishtail, Montana. There is a name for 

you, Fishtail, Montana, a beautiful place in our State. That is 

where he went to camp. He learned about healthy eating, exercise 

and how to manage his diabetes. 

Now, Dustin still plays football in the summer and he is still racing racecars but this year, his Bandolero race car will feature a 

large sticker that will read ‘‘Hope,’’ along with the signature diabetes awareness blood drop that calls attention of others to this epidemic. 

Native children ages 10 to 19 years old are nine times more likely than their young Caucasian counterparts to be diagnosed with 

Type 2 diabetes. Through lifestyle adaptations like the ones Dustin 

made and by supporting the Special Diabetes for Indians Program, 

which every Montana tribe benefits from, we can prevent more Indian children and adults alike from becoming diabetic. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Daines. 

Senator Franken. 

4 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Thank you, Chairman Hoeven and Vice Chairman Udall, for calling this oversight hearing. 

Thank you to all of our witnesses for your testimony today. I look 

forward to hearing your testimony. I will keep my remarks very 

brief. 

Many of us in this room have spent years working on this issue. 

For me, diabetes was the topic of the second Floor speech I gave 

when I became a U.S. Senator. It has been an issue I have worked 

on ever since. We are all aware of the toll of diabetes on families 

across the Nation, specifically of course in Indian Country which is 

why this hearing is an important opportunity for this Committee 

to take up this important issue, one that is so prevalent among our 

Indian youth. 

Thank you again, Mr. Chairman and Ranking Member, and all 

of our witnesses. I look forward to your testimony. 

The CHAIRMAN. Senator Cortez Masto. 

STATEMENT OF HON. CATHERINE CORTEZ MASTO, 

U.S. SENATOR FROM NEVADA 

Senator CORTEZ MASTO. Chairman Hoeven, thank you so much 

and Ranking Member Udall. 

This is a fantastic panel. I just wanted the opportunity, however, 

to introduce all of you to one of the panelists from the great State 

of Nevada. That is Chairman Vinton Hawley from the Lake Paiute 

Tribe located in Nevada. I am so pleased you were able to join us 

today. 

Chairman Hawley is here today in his capacity as the Chair of 

the National Indian Health Board which represents tribal governments that both operate their own health care systems and those 

that rely on care provided through the Indian Health Service. 

He also serves as President of the Nevada Intertribal Council, a 

network of 27 tribes and community organizations serving Indian 

people living in Nevada and the Great Basin region. He is a proud 

member of both the Pyramid Lake Paiute Tribe and the HopiTewa. I am so happy he is here to join us today. Welcome to all 

of you and thank you. 

The CHAIRMAN. Senator Murkowski. 

STATEMENT OF HON. LISA MURKOWSKI, 

U.S. SENATOR FROM ALASKA 

Senator MURKOWSKI. Thank you, Mr. Chairman. 

I too will be brief but I thank you for having this very important 

hearing today. I think we have recognized here in Congress that 

we are dealing with something that is epidemic in proportion and 

to know that we have dedicated funding through the SDPI program 

in hopes of obtaining better data, lowering the rates and making 

a real impact in the lives of not only children but all of Native 

Americans. 

We have seen some encouraging signs in Alaska through the 

SDPI program as we deal with the diabetes epidemic today. We 

have 19 Native organizations or tribes participating in programs 

across the State. 

5 

We still have a pretty big problem. According to CDC, in 2014, 

approximately 41,181 in Alaska, 7.6 percent of the population had 

been diagnosed with diabetes. We understand what this leads to in 

terms of other serious conditions. 

It is not only the individual that has diabetes, it is the toll on 

the families as well as they care for their loved ones, but also the 

fact that it is passed down through generations, sometimes through 

factors such as poor eating habits, and a lack of a healthy lifestyle. 

Those too are passed down. 

In Alaska, we have some additional challenges. In remote areas, 

when you have an inability to get good, healthy foods in a grocery 

store, your fruits and vegetables, they just do not exist or if they 

do, they are too expensive, so many of our Alaska Natives rely on 

good subsistence food whether it is moose, caribou or fish. 

Sometimes these foods are not available, so you have to rely on 

less healthy alternatives which are costly and contribute to further 

challenges. Also, you have long winters that make healthy outside 

activities somewhat limited. 

We are making some good progress. I think that is important, 

particularly the progress with our young people. 

I would like to recognize one of our panelists this afternoon and 

thank him for joining us today. Martin Sensmeier was raised in 

Yakutat, Alaska, a small community, less than 1,000 people, a 

beautiful community. Martin is Tlingit and Koyukon-Athabascan. 

I want to thank you for traveling here today, Martin. It is a long 

haul. We know that. The last time I saw you in D.C., you had once 

again traveled all the way across the Country to spend just one 

day, just one day, with Native youth. That truly was your personal 

statement and commitment to the mission and the cause that you 

lead so ably and competently. You are a role model for so many. 

I thank you for that and I thank you for being here and providing us with your comments today. 

With that, Mr. Chairman, I thank you. 

The CHAIRMAN. Thank you, Senator Murkowski. 

We are very pleased to have our witnesses today. They are: Rear 

Admiral Chris Buchanan, Acting Director, Indian Health Service, 

U.S. Department of Health and Human Services, Rockville, Maryland; The Honorable Vinton Hawley, Chair, National Indian Health 

Board, Washington, D.C.; Mr. Jared Eagle, Program Director, Fort 

Berthold Diabetes Program—Three Affiliated Tribes, New Town, 

North Dakota; Mr. Martin Sensmeier, Actor and Ambassador, Boys 

& Girls Clubs of America, Atlanta, Georgia, most recently in the 

movie The Magnificent Seven. We will get a few more details on 

his acting as well as diabetes. I know I am not the only one interested to hear a little bit more about that. 

Mr. Alton Villegas is also here. He represents Tribal Youth from 

the Salt River Pima-Maricopa Indian Community, Scottsdale, Arizona. I understand they tried to take you out for a hamburger last 

night and you ordered a salad. Way to go. You are setting a good 

example right there. Ms. Rachel Seepie, Senior Fitness Specialist, 

Diabetes Service Program - Health Service, Salt River Pima-Maricopa Indian Community, Scottsdale, Arizona, is with him also. 

6 

Thanks again to all of you. If you will hold your comments to five 

minutes if you could, your full written statement will be made a 

part of the permanent record. 

Admiral Buchanan. 

STATEMENT OF REAR ADMIRAL CHRIS BUCHANAN, ACTING 

DIRECTOR, INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. BUCHANAN. Good afternoon everyone. Good afternoon, Chairman Hoeven, Vice Chairman Udall, and members of the Committee. 

My name is Chris Buchanan. I am an enrolled tribal member of 

the Seminole Nation of Oklahoma. I am a Commissioned Corps officer with the Public Health Service and the Acting IHS Director. 

I have been with the Indian Health Service for about 24 years and 

have held various levels of assignments within the Indian Health 

Service. 

I am truly honored to be here to testify before the Senate Committee on Indian Affairs concerning Native youth and promoting diabetes prevention and healthy living. 

Mr. Chairman, I want to thank you and Vice Chairman Udall for 

your leadership on the Committee and for elevating the importance 

of delivering quality health through the Indian Health Service. 

Diabetes is a chronic disease, is complex and costly and requires 

tremendous long-term efforts to prevent and treat. American Indians and Alaska Native people are affected more by diabetes. Diabetes rates in these populations are more than twice that of non-Hispanic Whites in the United States. 

I am happy to report after several decades of intensive efforts by 

the Indian Health programs and partners we are seeing clear evidence that this epidemic has leveled off. Within our communities, 

the years of increasing rates of diabetes stopped in 2011 and it has 

not risen since that time. 

As shown by the graph to the left, new cases of kidney failure 

due to diabetes declined by 54 percent among American Indians 

and Alaska Native adults from 1996 to 2013. This is a much larger 

decline than in any other racial group in the United States. 

As the future of Indian Country depends on the health of its 

youth, recent data shows there is good news here as well. The rate 

of Type 2 diabetes in American Indian youth ages 10 to 19 did not 

increase from 2001 to 2009. 

Although the rate is still higher than other ethnic and racial 

groups, the rate of obesity in American Indian and Alaska Native 

youth has also leveled off. The obesity rate in American Indian and 

Alaska Native children ages 2 to 19 years remained nearly constant from 2006 to 2015. However, it is still higher than U.S. youth 

overall. 

Several key factors contributed to this significant and ongoing 

progress including the Special Diabetes Program for Indians, also 

known as SDPI. Twenty years ago, in 1997, Congress created the 

SDPI in response to the diabetes epidemic that was escalating at 

an alarming rate in the Native population. 

The SDPI Program provides grants to tribal IHS urban Indian 

Health organizations for diabetes prevention and treatment servVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 S:\DOCS\26197.TXT JACK
7 

ices. Grantees collectively serve over 782,000 American Indians and 

Alaska Native people per year. Two-thirds of the grantees use at 

least some of their SDPI funds to work with children and youth. 

Examples of the services that grantees implement to reduce risk 

factors of obesity and diabetes in youth include school and community-based physical activity, nutrition and education, community 

gardens, American Indian and Alaska Native traditional sports and 

dancing and obesity management clinics. 

In addition to the SDPI, the IHS has established partnerships to 

advance the health of Native youth and families. The Indian 

Health Service provides $1 million per year to support obesity prevention at Boys and Girls Clubs in Indian Country. 

We do this through a cooperative agreement with the National 

Congress of American Indians. The NCAI awards funds to these 

clubs so that they can implement the program known as TRAIL. 

Over 14,000 Native youth have participated in the TRAIL program 

since 2003. 

Although it takes many years to turn around an epidemic like diabetes, American Indians and Alaska Native communities are making a significant improvement in childhood obesity, diabetes prevalence and diabetes and kidney-related failure. 

Thank you for your commitment to Native youth as well as your 

vision and leadership for diabetes prevention and treatment among 

American Indians and Alaska Native people. 

I would be happy to answer any questions the Committee may 

have. Thank you. 

[The prepared statement of Mr. Buchanan follows:] 

PREPARED STATEMENT OF REAR ADMIRAL CHRIS BUCHANAN, ACTING DIRECTOR, 

INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Chairman and Members of the Committee: 

Good afternoon, Chairman Hoeven, Vice-Chairman Udall, and Members of the 

Committee. I am Chris Buchanan, an enrolled member of the Seminole Nation of 

Oklahoma and currently the Acting Director of the Indian Health Service (IHS). 

Prior to that I was the IHS Deputy Director, leading and overseeing IHS operations 

to ensure delivery of quality comprehensive health services. I am pleased to have 

the opportunity to testify before the Senate Committee on Indian Affairs on our accomplishments in preventing diabetes for Native youth through our work in partnership with American Indian and Alaska Native (AI/AN) communities. I would like 

to thank you and Vice-Chairman Udall for your leadership on the Committee and 

for elevating the importance of delivering quality care through the Indian Health 

Service. 

The IHS plays a unique role in the Department of Health and Human Services 

(HHS) because it is a health care system that was established to meet Federal trust 

responsibilities to American Indians and Alaska Natives. The mission of the IHS, 

in partnership with American Indian and Alaska Native people, is to raise the physical, mental, social, and spiritual health of AI/ANs to the highest level. The IHS provides comprehensive health service delivery to approximately 2.2 million AI/ANs 

through 26 hospitals, 59 health centers, 32 health stations, and nine school health 

centers. Tribes also provide healthcare access through an additional 19 hospitals, 

284 health centers, 163 Alaska Village Clinics, 79 health stations, and eight school 

health centers. 

Diabetes is a complex and costly chronic disease that requires tremendous longterm efforts to prevent and treat. Although diabetes is a nationwide public health 

problem, AI/AN people have been and remain disproportionately affected, with diabetes prevalence more than twice that for non-Hispanic whites in the United States. 

However, after several decades of intensive efforts by the IHS, Tribes, Urban Indian 

health organizations, and other partners, we are seeing clear evidence that this epidemic has leveled off. 

8 

1 IHS National Data Warehouse. 2016. 

2 Bullock A, Burrows NR, Narva AS, et al. Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives—United States, 1996– 

2013. MMWR Morb Mortal Wkly Rep 2017;66:26–32. DOI: http://dx.doi.org/10.15585/ 

mmwr.mm6601e1. 3 Id. 

4Dabelea D, Mayer-Davis EJ, Saydah S, et al. Prevalence of Type 1 and Type 2 Diabetes 

Among Children and Adolescents From 2001 to 2009. JAMA 2014 May 7;311(17): 1778–1786. 5Ogden CL, Carroll MD, Lawman HG, et al. Trends in Obesity Prevalence Among Children 

and Adolescents in the United States, 1988–1994 Through 2013–2014. JAMA 2016:315 

(21):2292–2299; IHS National Data Warehouse. 2016. 

In AI/AN people, the years of increasing diabetes prevalence stopped in 2011 and 

it has not risen since that time. 1 In addition, data show that focusing on quality, 

team-based clinical care has reduced devastating complications from diabetes. According to the January 2017 Centers for Disease Control and Prevention (CDC) 

Vital Signs report, new cases of diabetes-related kidney failure decreased dramatically (54 percent) among AI/AN adults from 1996 to 2013, a much larger decline 

than in any other racial group in the United States. 2 This decrease is especially important given that Medicare spent over $82,000 per person for beneficiaries of all 

races with diabetes-related, end-stage kidney disease in 2013. 3

As the future of Indian Country depends on the health of its youth, recent data 

show that there is good news here as well. Although the prevalence of type 2 diabetes in American Indian (AI) youth ages 10–19 is higher than in other racial/ethnic 

groups, the prevalence for AI youth in this age group did not increase from 2001– 

2009. However, during that same period, it increased significantly for white, black, 

and Hispanic youth. 4 Even better, as it predicts future diabetes risk, the prevalence 

of obesity in AI/AN youth has also leveled off. Although higher than in US youth 

overall, obesity prevalence in AI/AN children and youth ages 2–19 years remained 

nearly constant from 2006–2015. 5 Several key factors contributed to this significant 

and ongoing progress, including the Special Diabetes Program for Indians (SDPI). 

The SDPI was established by Congress in 1997 in response to the diabetes epidemic that was escalating at an alarming rate in AI/AN people. The SDPI provides 

grants to Tribal, IHS, and Urban Indian health organizations for diabetes prevention and treatment services. The IHS administers the SDPI grant program to promote evidence-based best practices as well as to ensure accountability for the funds 

and compliance with grants regulations. The SDPI 2014 Report to Congress documented the continued improvements in key clinical outcome measures since the inception of the SDPI. The SDPI is currently authorized at $150 million per year 

through the end of FY 2017. 

Since the inception of SDPI, grantees have successfully implemented evidencebased and community-driven strategies to prevent and treat diabetes. There are currently 301 SDPI grant programs in 35 States, 252 Tribal, 20 IHS, and 29 Urban. 

Grantees collectively served over 782,000 AI/AN people per year, with two-thirds of 

grantees using at least some of their SDPI funding to work with children and youth. 

Examples of services that grantees implement to reduce risk factors for obesity and 

diabetes in youth include school and community-based physical activity and nutrition education, community gardens, AI/AN traditional sports and dancing, cooking 

classes, sports leagues, and obesity-management clinics. The innovative programs 

they have developed honor and incorporate their unique and diverse tribal cultures. 

In addition to the SDPI, the IHS has established many partnerships to advance 

the health of Native youth and families. The IHS provides $1 million per year to 

support obesity prevention at Boys & Girls Clubs (Clubs) in Indian Country through 

a cooperative agreement with the National Congress of American Indians (NCAI). 

NCAI conducts an annual grant process to awards funds to Native Clubs so they 

can implement the Together Raising Awareness for Indian Life (TRAIL) program. 

TRAIL uses a comprehensive curriculum that includes educational, nutritional, and 

physical activities to promote healthy lifestyles, obesity prevention, and self-esteem 

for AI/AN youth. Over 14,000 AI/AN youth, ages seven through 11 years, have participated in the TRAIL program since 2003. 

As important as it is to work with school-aged children, recent science has shown 

that risk factors for obesity and diabetes start in the earliest days and years of life. 

IHS has a Memorandum of Understanding with Johns Hopkins University’s Center 

for American Indian Health to promote implementation of their evidence-based 

Family Spirit home visiting intervention. Working with pregnant women and young 

families, Family Spirit has been proven to reduce risk factors in American Indian 

9 

6 Barlow A, Mullany B, Neault N, et al. Paraprofessional-delivered, home-visiting intervention 

for American Indian teen mothers and children: 3-year outcomes from a randomized controlled 

trial. Am J Psychiatry 2015;172:154–162 

children that are associated with later development of obesity and substance 

abuse. 6

Although it takes many years to turn around an epidemic like diabetes, this is 

happening in AI/AN communities, with significant improvements in childhood obesity, diabetes prevalence, and diabetes-related kidney failure. Thank you for your 

commitment to Native youth as well as your vision and leadership for diabetes prevention and treatment among AI/AN people. I look forward to continuing to work 

with you, our communities, and other partners to ensure the health of our Native 

youth and families. I will be happy to answer any questions the Committee may 

have. 

The CHAIRMAN. Thank you, Admiral. 

Mr. Hawley. 

STATEMENT OF HON. VINTON HAWLEY, CHAIRPERSON, 

NATIONAL INDIAN HEALTH BOARD 

Mr. HAWLEY. Chairman Hoeven, Vice Chairman Udall and members of the Committee, thank you for holding this important hearing on improving the lives and health of American Indian and Alaska Native youth through preventing diabetes. 

My name is Vinton Hawley, Chairman of the Pyramid Lake Paiute Tribe, President of the Intertribal Council of Nevada and 

Chairperson of the National Indian Health Board. I appreciate the 

opportunity to provide this testimony today on behalf of the National Indian Health Board and the 567 Native Nations we serve. 

One of the most prominent health disparities in tribal communities is the high rate of Type 2 diabetes. Our people of all ages 

are impacted by Type 2 diabetes and its many chronic complications whether through our own individual diagnosis or the diagnosis of a loved one. 

Because of stories like this and the many tribal families who endure suffering because of Type 2 diabetes, tribal communities must 

have the resources and support they need to access fresh and nutritious foods, safe places for physical activity and quality diabetes 

treatment and intervention programs. Because traditional subsistence lifestyles have been replaced with Federal programs such as 

the Food Distribution Program on Indian reservations, many tribal 

communities have a new reliance on store-bought foods, poor access 

to fresh produce, and have increased consumption of fast foods. 

These compounding issues have resulted in our children suffering 

from higher rates of obesity and related complications, such as 

Type 2 diabetes. Our Native youth ages 10–19 are nine times more 

likely to have Type 2 diabetes compared to non-Natives. This is unacceptable. 

People with diabetes diagnosed before they turn 20 years old 

have a life expectancy that is up to 27 years shorter than people 

without diabetes. 

One program in particular, the Special Diabetes Program for Indians, has been a major success for diabetes treatment and prevention programs throughout Indian Country. SDPI, as stated, was enacted by Congress in 1997. Along with its sister program for Type 

1 diabetes research, it has become the Nation’s most strategic, comVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 S:\DOCS\26197.TXT JACK
10 

prehensive and effective effort to combat diabetes and its complications. 

This success is largely because communities design and implement their own diabetes interventions that are culturally appropriate. SDPI currently provides grants for over 300 programs in 35 

States. 

The success is shown in national data. Because of SDPI, our communities are reducing individual cholesterol levels, A1C levels and 

losing weight. Since SDPI started, end stage renal disease due to 

diabetes in our people has gone down by 54 percent. 

Treatment for this is the biggest driver of Medicare costs, about 

$87,000 per patient per year just by reducing ESRD–D, we are saving the Federal Government millions of dollars a year and more 

importantly, saving the lives of our people. 

SDPI is also improving entire tribal communities. For example, 

the Pyramid Lake Paiute Tribe focuses on diabetes education. Over 

the years, my tribe’s diabetes education has evolved to be conveyed 

to our tribal youth that diabetes does not have to be a death sentence as it is often perceived. 

Youth are also now more engaged with their aunts, uncles, 

grandmas and grandpas. They can help those family members 

know diabetes is manageable. We are living longer lives and SDPI 

is uniting communities, preserving cultures and filling generational 

gaps. 

SDPI authorization is set to expire this September. We urge Congress to act swiftly to reauthorize SDPI and ensure continuity and 

the successful prevention and intervention efforts being conducted 

all across Indian Country. In addition to SDPI reauthorization, the 

National Indian Health Board has developed other recommendations for tribes and policymakers to pursue and strengthen diabetes 

prevention efforts for Native youth. In the interest of time, I would 

direct you to our written testimony for further detailed recommendations. 

While tribes have made important gains in recent years in terms 

of Type 2 diabetes funding, improved health outcomes and the leveling off of diabetes incidence rates through initiatives like SDPI, 

there is still a long way to go before Native youth, children and 

families will no longer be devastated by the impacts of diabetes and 

its complications. 

Thank you again for the opportunity to offer this statement. We 

appreciate being able to work together with you on this important 

issue. We look forward to working together on issues such as confirming an IHS director. 

The National Indian Health Board and the 567 federally-recognized tribes we serve endorsed Dr. Charles Green as IHS director 

and will work with the Committee to achieve his confirmation. 

Thank you. If you have any questions, I am more than happy to 

answer those. 

[The prepared statement of Mr. Hawley follows:] 

11 

1Story, M. et al. (2003). Obesity in American-Indian Children: Prevalence, Consequences, and 

Prevention. Preventative Medicine, 37(1), S3–S12, S5. 2 (Dabelea, et al., 2014) (2) 

3SEARCH for Diabetes in Youth Study http://www.ncbi.nlm.nih.gov/pubmed/17015542 

PREPARED STATEMENT OF VINTON HAWLEY, CHAIRPERSON, NATIONAL INDIAN HEALTH

BOARD (NIHB) 

Introduction 

Chairman Hoeven, Vice Chairman Udall and Members of the Committee, thank 

you for holding this important hearing on improving the lives and health of American Indian and Alaska Native youth through preventing diabetes. Thank you for 

the opportunity to provide this testimony on behalf of the National Indian Health 

Board (NIHB). 

The federal promise to provide for the health of Indian people was made long ago. 

Since the earliest days of the Republic, all branches of the federal government have 

acknowledged the nation’s obligations to the Tribes and the special trust relationship between the United States and Tribes. The United States assumed this responsibility through a series of treaties with Tribes, exchanging compensation and benefits for Tribal land and peace. The Snyder Act of 1921 (25 USC 13) legislatively affirmed this trust responsibility. To facilitate upholding its responsibility, the federal 

government created the Indian Health Service (IHS) and tasked the agency with 

providing health services to AI/ANs. Since its creation in 1955, IHS has worked to 

fulfill the federal promise to provide health care to Native people. 

To provide context for this discussion, I would first like to provide you with some 

health statistics for American Indians and Alaska Natives (AI/ANs). The AI/AN life 

expectancy is 4.5 years less than the rate for the U.S. all races population. AI/ANs 

suffer disproportionally from a variety of diseases. According to IHS data from 

2005–2007, AI/AN people die at higher rates than other Americans from alcoholism 

(552 percent higher), unintentional injuries (138 percent higher), homicide (83 percent higher) and suicide (74 percent higher). Indian Country also suffers disproportionately from diabetes at a rate 182 percent higher than the general U.S. population. 

Chronic poverty, historical trauma, remote locations, and a devastatingly underfunded Indian health delivery system all contribute to these statistics. The United 

States is too great a nation to stand idly by while AI/ANs, the first Americans, live 

with these realities. 

Diabetes in Indian Country 

American Indian and Alaska Native (AI/AN) youth, children, and families face 

many disparate adverse experiences and health outcomes compared to the general 

U.S. population. One of the most prominent health disparities in Tribal communities 

is the high rate of type 2 diabetes. AI/ANs of all ages are disproportionately impacted by type 2 diabetes and its many chronic complications- whether through 

their own individual diagnosis or the diagnosis of a loved one. The Gila River Indian 

Community has reported a 4 year old presenting with type 2 diabetes—and they are 

not alone. As such, Tribal communities must have the resources and support they 

need to access fresh and nutritious foods, safe places for physical activity, and quality diabetes treatment and intervention programs. 

Because AI/AN traditional subsistence lifestyles have been replaced with federal 

programs such as the Food Distribution Program on Indian Reservations, the Food 

Stamp Program, and the Commodity Supplemental Food Program, many Tribal 

communities have a new reliance on store-bought foods, poor access to fresh 

produce, and have increased consumption of fast foods. These compounding issues 

have resulted in American Indian and Alaska Native children suffering from higher 

rates of obesity and related complications, such as type 2 diabetes. 1

Even in the general U.S. population, type 2 diabetes is increasingly diagnosed in 

youth and now accounts for 20–50 percent of new-onset diabetes case patients. However, type 2 diabetes disproportionately affects minority race and ethnic groups— 

with the highest rates being among American Indian and Alaska Native youth. 

While few longitudinal studies have been conducted, it has been suggested that the 

increase in type 2 diabetes in youth is a result of an increase in obesity in the overall population. 2 The majority of studies that have been done have been conducted 

on American and Canadian Indigenous populations because of the high rates of diabetes experienced in Tribal communities. Therefore, we know American Indian and 

Alaska Native youth age 10–19 are nine times more likely to have diagnosed type 

2 diabetes compared to young non-Hispanic whites in the same age group. 3 FurtherVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 S:\DOCS\26197.TXT JACK
12 

4 IHS Division of Diabetes Statistics https://www.ihs.gov/sdpi/includes/themes/ 

newihstheme/displaylobjects/documents/factsheets/FactlsheetlAIANl508c.pdf 5 (Mayer-Davis, et al., 2009) 

6 (Bullock, et al., 2017) 

7 U.S. Renal Data System: https://www.usrds.org/2013/view/v2l11.aspx, Accessed on 

March 27, 2017. 8 Bachar JJ, Lefler LJ, Reed L, McCoy T, Bailey R, Bell R. Cherokee Choices: a diabetes prevention program for American Indians. Prev Chronic Dis [serial online] 2006 Jul [date cited]. 

Available from: URL: http://www.cdc.gov/pcd/issues/2006/jul/05l0221.htm 

more, from 1990–2009 AI/AN youth age 15–19 experienced an increase in diagnosed 

diabetes of 110 percent. 4 While these statistics are staggering, there are personal 

stories and real life implications behind each of the Native youth and families that 

have been diagnosed with type 2 diabetes. People with diabetes diagnosed before the 

age of 20 years have a life expectancy that is 15–27 years shorter than people without diabetes. 5 Given this, it is more important than ever that Tribal communities 

work to prevent diabetes and its complications in young American Indians and Alaska Natives. One program in particular, the Special Diabetes Program for Indians 

(SDPI), has been especially successful in establishing and sustaining effective diabetes treatment and prevention programs in Indian Country. 

Special Diabetes Program for Indians 

Because of the rising rates of type 2 diabetes in American Indian and Alaska Native youth and the U.S. population in general, Congress established the Special Diabetes Program for Indians in 1997. The SDPI was first funded through the Balanced 

Budget Act in conjunction with the Special Diabetes Program for Type 1 Diabetes 

(SDP)—a program that addresses the opportunities in type 1 diabetes research. Together, these two programs have become the nation’s most strategic, comprehensive 

and effective effort to combat diabetes and its complications. 

The SDPI is changing the troubling statistics for American Indians and Alaska 

Natives of all ages with marked and measurable improvements in average blood 

sugar levels, reductions in the incidence of cardiovascular disease, prevention and 

weight management programs for our youth, and a significant increase in the promotion of healthy lifestyle behaviors. This success is due to the nature of this grant 

program that allows communities to design and implement diabetes interventions 

that address specific cultural approaches identified community priorities. The SDPI 

currently provides grants for over 300 programs in 35 states. 

As a result of intensive data collection and analysis over the past two decades of 

the SDPI, we are able to demonstrate remarkable outcomes from SDPI programs, 

including a reduction in A1C levels, reduced cholesterol levels, and weight loss of 

program participants around Indian Country. Recently, the Centers for Disease 

Control and Prevention (CDC) published data in its Morbidity and Mortality Weekly 

Report about the remarkable decline in End-Stage Renal Disease (ESRD) due to diabetes seen in American Indians and Alaska Natives in 1996–2013. During this time 

period, similar to that of the SDPI, AI/ANs have experienced a 54 percent decline 

in incidence rates of ESRD due to diabetes—the steepest decline of any other ethnic 

group. The CDC report also states, ‘‘because of SDPI, the partnership of IHS and 

I/T/U programs is stronger, and together they provide a comprehensive public 

health-oriented national program that has demonstrated success in addressing the 

diabetes epidemic and reducing complications such as ESRD–D.’’ 6 ESRD treatment 

costs Medicare roughly $87,000 per patient, per year, so SDPI is also resulting in 

significant cost savings for federal health programs. 7

As the data shows, the diabetes treatment and prevention programs funded by 

SDPI are clearly improving, as well as saving lives, in Tribal communities and 

transforming the way diabetes is addressed. For example, the Alaska Native Tribal 

Health Consortium’s (ANTHC) ‘‘Store Outside Your Door’’ program highlights traditional foods of the Native peoples living within the region and teaches families how 

to harvest and prepare nutritious traditional foods that do not include many of the 

preservatives and sugars of the processed foods often available at local grocery 

stores. This model makes nutritious foods accessible to the community and infuses 

the local Indigenous culture back into mealtime. Another example of the effective, 

innovative community health programming being conducted in Tribal communities 

around Indian Country is the ‘‘Cherokee Choices’’ program at the Eastern Band of 

Cherokee Indians (EBCI). Like many Tribal communities, the EBCI has higher 

rates of obesity and type 2 diabetes than the U.S. general population. To combat 

these high rates, the Cherokee Choices program includes three main components: 

elementary school mentoring, worksite wellness for adults, and church-based health 

promotion. 8 As a holistic approach to preventing diabetes and obesity in the local 

AI/AN population, Cherokee Choices also seeks to address racism, historic grief and 

13 

9 Native Children’s Policy Agenda: Putting First Kids 1st http://nihb.org/docs/10122015/ 

Augl2015lNativelChildrenslPolicylAgenda.pdf 

trauma, mental health, and creates a supportive environment for developing positive policy changes. 

These are just two examples of the over 300 Tribal programs nationwide taking 

an innovative, holistic and community- and evidenced-based approach to preventing 

diabetes in Native youth, children and families. As one young American Indian from 

the Klamath Diabetes Program stated after participating in the diabetes prevention 

program at the Cow Creek Consortium in Oregon, ‘‘I truly believe [SDPI] can dramatically improve the health of the Klamath Tribes and bring us mo ben dic 

hosintambiek (‘‘good health’’ in Klamath). I would have never had the courage or 

been in the shape necessary to accomplish my goals had it not been for the Diabetes 

Prevention Program. It is imperative that these types of programs are firmly in 

place to lead us to the next level of good health’’. 

Most recently in the long history of the SDPI, in April 14, 2015, the U.S. Senate 

passed a two year reauthorization of the Special Diabetes Program for Indians 

(SDPI) as part of The Medicare Access and Children’s Health Insurance Program 

(CHIP) Reauthorization Act of 2015 (P.L. 114–10). The measure passed the Senate 

by a bipartisan vote of 92–8. This followed action by the U.S. House of Representatives on March 26, 2015, which also passed the legislation by a bipartisan vote. 

SDPI is one of many programs in this legislation. However, the reauthorization is 

set to expire on September 30, 2017. Meaning, over 300 diabetes treatment and prevention programs around the country would no longer be available to the most vulnerable population for this devastating disease. Congress must act swiftly to reauthorize the SDPI and ensure continuity in the successful prevention and intervention efforts being conducted all across Indian Country. 

NIHB and Tribes are encouraged by the strong support enjoyed by SDPI in Congress. In September 2016, a letter addressed to Congressional leadership in support 

of SDPI and SDP garnered signatures from 356 House Members and 75 Senators. 

We hope that Congressional leaders make the renewal of these programs a legislative priority in the coming months. Failure to enact SDPI swiftly will result in the 

loss of staff for many SDPI programs living in rural areas and will cause disruptions to patient care. 

Putting First Kids 1st 

The National Indian Health Board, in partnership with the National Congress of 

American Indians, the National Indian Education Association, and the National Indian Child Welfare Association have created a joint policy agenda for American Indian and Alaska Native children. This agenda, updated in 2015, is intended to be 

a tool to develop integrated policy approaches and specific recommendations for 

Tribal governments, policymakers, and local leaders to use when creating and implementing a vision for thriving, vibrant Native communities. The agenda includes 

a ‘‘Healthy Lifestyles’’ component that outlines policy recommendations that would 

specifically help policymakers and Tribal communities prevent diabetes in Native 

youth, children, and families through increasing physical activity, improving access 

to nutritious foods, and increasing access to health care and public health services. 9

In addition to the swift reauthorization of the Special Diabetes Program for Indians 

outlined earlier, the NIHB puts forth the following recommendations for Tribes and 

policymakers to pursue to strengthen diabetes prevention efforts and to make 

healthy lifestyles more accessible to Native youth and families: 

• Ensure that community food programs, especially youth breakfast and lunch 

programs, incorporate healthy food choices and locally produced or traditional 

food options. 

• Co-locate food assistance programs to serve meals to elders along with Head 

Start, child care, or school programs to reduce administrative costs and resources. 

• Work to improve the Food Distribution Program on Indian Reservations by incorporating more traditional, locally-produced foods as healthier options. 

• Provide direct funding to Tribes who want to administer the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program). 

• Work to create similar options for the Women, Infants and Children (WIC) program and increase Tribal flexibility in administering this program. 

• Advocate for Tribal provisions within the National School Lunch Program and 

the School Breakfast Program for Tribal schools. 

14 

• Work with school nutrition programs to replace junk foods with healthier options in vending machines and school cafeterias. These programs should permit 

Tribal administration and should ensure that state-administered programs are 

sufficiently responsive to the needs of Native youth. 

• Promote the expansion of retail grocery markets in Native communities. 

• Support federal programs that encourage at-home food production, such as 

backyard gardens and training on planting and maintenance. 

• Work to ensure that Bureau of Indian Education (BIE) schools receive funding 

to build and upgrade sports-related facilities, such as gymnasiums, fields, and 

tracks to increase safe places for Native children and youth to be physically active. 

• Incorporate wellness programs in health clinics and facilities. While health 

care addresses disease prevention and treatment, wellness encompasses daily 

lifestyle choices, environment, emotional and spiritual well-being, and health 

education. Through wellness promotion, the incidence of health problems can be 

reduced, along with long term health care costs. 

• Improve outreach services and health education. For example, a Tribal diabetes 

patient education program, which focuses on teaching people how to manage 

their disease on a daily basis, is an important tool for reducing diabetes-related 

complications. These programs can also be directed to helping children manage 

their diabetes from an early age. Similarly, community outreach services can 

help educate people about the availability of health benefits and teach children 

to make healthy choices early in life. 

• Develop school-based health clinics. Students perform better in class when they 

are healthy and ready to learn. School-based health centers bring the doctor’s 

office to the school so students avoid health-related absences and get support 

to succeed in the classroom. 

Conclusion 

Thank you again for the opportunity to offer this written statement. While Tribes 

have made important gains in recent years in terms of type 2 diabetes funding, improved health outcomes, and the leveling off of diabetes incidence rates, there is still 

a long way to go before Native youth, children, and families will no longer be devastated by the impacts of diabetes and its complications. 

The CHAIRMAN. Thank you, Mr. Hawley. 

Mr. Eagle. 

STATEMENT OF JARED EAGLE, DIRECTOR, FORT BERTHOLD 

DIABETES PROGRAM, THREE AFFILIATED TRIBES 

Mr. EAGLE. Good afternoon, Committee, and Chairman Hoeven. 

Thank you for the opportunity to speak. 

My name is Jared Eagle. I am a member of the Three Affiliated 

Tribes, the Mandan, Hidatsa, and Arikara Nation. 

We serve the people of the Three Affiliated Tribes. We have benefitted SDPI funding for the last 18 years, 15 of those mainly in 

the clinical format with the last three being in the preventative aspects of it, specifically on youth. 

I cannot express enough the importance of the SDPI initiative 

and the resources that it provides to our community. Through 

SDPI funding, we have been able to provide essential treatment 

and prevention initiatives to our over 750 diagnosed patients and 

provide prevention services to over 1,200 youth based through five 

schools and about 250 square miles. 

The focus of our program is to provide access to effective nutrition and physical activity opportunities that are not accessible to 

the people on our reservation in most aspects. These initiatives include group fitness classes, cooking classes, grocery store tours, 

one-on-one dietitian consultation, and prevention resources through 

screening and education. 

15 

We live in a food desert. Of the six communities, we only have 

two grocery stores in those two communities so access to fresh 

produce and healthy foods is very minimal sometimes. The overweight and obesity rates on Fort Berthold are 55 percent among 

youth grades K–12. The adult population is about 86 percent overweight and obese. 

The direct link between overweight, obesity and diabetes prevalence, specifically in Native Americans, and the importance of SDPI 

programming could not be more evident for us. 

One major aspect that we incorporate to combat this epidemic 

which affects about 15 percent the MHA Nation is our Healthy Futures Program. Through Healthy Futures, we screen 1,200 youth in 

grades K–12 to identify if they are in an overweight or obese status. We identify what their Body Mass Index is. We screen them; 

for diabetes, and if they show signs of being pre-diabetic, they are 

referred to a more intense follow-up service with a pediatrician and 

our clinical staff. 

Through this process ,we are able to connect directly with the 

parents to make the necessary changes to develop and instill 

healthy behaviors and to avoid a lifestyle of chronic disease. 

The work we do at the Fort Berthold Diabetes Program allows 

us to connect with the communities, and provides us the opportunity to reach a broad demographic of people that our IHS clinic 

or another hospital simply cannot reach outside of a traditional 

medical practice. 

Culturally, we are able to create deep and lasting connections as 

well as providing services such as traditional food education, gardening, language and educating at powwows. Other community 

gatherings reach into and across the communities and make a 

much stronger individual connection to help save lives. Through 

SDPI funding we are able to provide these types of services to reduce the incidence of diabetes, preserve the health of our people 

and reduce the long-term health care costs that they could face. 

Thank you for allowing me to witness in front of you today. I will 

answer any questions or provide any additional information you 

might need. 

[The prepared statement of Mr. Eagle follows:] 

PREPARED STATEMENT OF JARED EAGLE, DIRECTOR, FORT BERTHOLD DIABETES

PROGRAM, THREE AFFILIATED TRIBES

Good afternoon Committee, my name is Jared Eagle, I am the Director of the Fort 

Berthold Diabetes Program in New Town, ND. We serve the people of the Three Affiliated Tribes, the Mandan, Hidatsa, and Arikara Nation. Our program has benefitted from 18 years of SDPI funding providing essential diabetes related services 

to our people ranging from clinical care and prevention for the first 15 years and 

specifically targeted towards prevention initiatives the past three years. 

I cannot express enough the importance of the SDPI initiative and the resources 

that it provides to our community. Through SDPI funding we are able to provide 

essential treatment and prevention initiatives to our 750 diagnosed patients and 

over 1,200 youth spread out among our six communities and five schools in a 250 

mile radius. 

The focus of our program is to provide access to effective nutrition and physical 

activity opportunities not accessible to the people on our reservation. These initiatives include group fitness classes, cooking classes, grocery store tours, one-on-one 

dietitian consultation and prevention resources through screening and education. 

We live in a food desert, and of the six communities on Fort Berthold only two 

have grocery stores and access to fresh produce and healthy food options. The overVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 S:\DOCS\26197.TXT JACK
16 

weight and obesity rates on Fort Berthold are 55 percent among youth grades K– 

12 and 86 percent among the adult population. The direct link between overweight/ 

obesity and diabetes prevalence, specifically in Native Americans, the importance of 

SDPI programming could not be more evident. 

One major aspect that we incorporate to combat this epidemic which effects about 

15 percent of the MHA Nation is our Healthy Futures Program. We screen 1,200 

youth in grades K–12 to identify if they are overweight or obese. Those with a high 

Body Mass Index (BMI), are then screened for diabetes, and if they show signs of 

being pre-diabetic they are referred for more intense follow-up services with a pediatrician and our clinical team. Through this process we are able to connect directly 

with the parents to start making the necessary changes to develop and instill 

healthy behaviors to avoid a lifestyle of chronic disease. 

The work we do at the Fort Berthold Diabetes Program allows us to connect with 

the communities, and provides us the opportunity to reach a broad demographic of 

people that our IHS clinic or another hospital simply cannot reach outside of a traditional medical practice. Culturally, we are able to create deep and lasting connections as well in providing services such as traditional food education, gardening, language and educating at powwows and other community gatherings that reach into 

and across the communities and make a much stronger individual connection and 

save lives. 

Through SDPI funding we are able to provide these types of services to reduce 

the incidence of diabetes, preserving the health of our people and reducing the longterm health care costs that they could face. Thank you for allowing me to testify 

and I would be happy to answer any questions or provide any additional information. 

The CHAIRMAN. Thank you, Mr. Eagle. We appreciate it. 

Mr. Sensmeier, I understand you are in the Magnificent Seven, 

is that correct, and you have a new movie coming out entitled Wind 

River. 

Mr. SENSMEIER. That is right. 

The CHAIRMAN. Give us a quick once-over about your character 

in the last movie and what you are going to do in the next movie. 

Mr. SENSMEIER. In the Magnificent Seven, I played one of the 

Seven starring alongside our national spokesperson and club alumni, Mr. Denzel Washington. In Wind River, I star alongside Jeremy 

Renner, Elizabeth Olsen and Graham Greene. It takes place on the 

Wind River, Wyoming Reservation. It is a murder mystery. I am 

not going to tell you too much about that. I will let you go see it. 

STATEMENT OF MARTIN SENSMEIER, ACTOR AND 

AMBASSADOR, BOYS & GIRLS CLUBS OF AMERICA 

Mr. SENSMEIER. Chairman Hoeven, Ranking Member Udall, and 

distinguished members of the Committee, I want to thank you for 

the opportunity to testify at today’s hearing. 

[Greeting in Native Language.] 

My original name is [phrase in Native Language]. I am from the 

Eagle Bear Clan of the Tlingit Tribe of Alaska. 

As a Native American actor and Native ambassador of Boys & 

Girls Clubs of America, it is an honor to be here today to advocate 

for wellness among Native people of all Nations, focusing largely on 

our youth. 

Growing up, I attended the Boys & Girls Club of Alaska and 

learned early the benefits of a healthy and active lifestyle. Health 

is not just about physical and medical, it also impacts how young 

people cope with emotional and mental health. 

I am privileged to be an Ambassador for the Boys & Girls Clubs 

of America and I am a member of the Native Wellness Institute as 

well as an Ambassador for the Nike N7 Fund. These platforms 

17 

have provided an opportunity to reach out to more youth and play 

a role as a mentor and advocate promoting healthy life styles for 

our Native youth. 

As a former Club kid, I can testify to how Boys & Girls Clubs 

on Native Lands are working to decrease the high rates of diabetes 

and obesity in Indian communities though physical activities, nutrition, and education. 

For 25 years, Boys & Girls Clubs of America has established an 

enduring presence on Native lands. Currently, there are nearly 200 

Boys & Girls Clubs serving over 86,000 Native youth, from over 

100 different American Indian, Alaska Native and Hawaiian communities in 27 States. 

As the Nation’s largest service provider to Native youth, Boys & 

Girls Clubs in Indian Country are committed to addressing unique 

to Native lands through increasing culturally relevant and meaningful opportunities. 

Healthy eating and being active has always been a major part of 

my life. I have been so excited to see the partnership between the 

Boys & Girls Clubs of America, the National Congress of American 

Indians and the Indian Health Service on programs such as TRAIL 

to diabetes prevention that is making healthy living an essential 

part of the club members’ experience. 

Even more exciting, however, is the IHS funded program that 

looks to include traditional food in activities so that youth are connecting with their culture as well as keeping their bodies healthy. 

I have heard directly that some of the clubs’ kids are getting introduced to dried moose meat. It is personally one of my favorites. 

The TRAIL Program has reached over 14,000 Native youth in 

communities across our Country, including my home State of Alaska. I would personally like to thank IHS, NCAI, BGCA and Congress for their continued support of this impactful program that encourages healthy habits and resiliency in Native youth. 

It has made a profound difference in Indian Country. I have no 

doubt it will continue to do so as this Committee lends its direct 

support. Additionally, through BGCA’s Healthy Habits program 

that serves K–12, youth learn to adopt healthy eating habits. The 

lessons cover dietary guidelines, understanding food labels, strategies to increase food and vegetable consumption and interactive 

healthy cooking demonstrations. 

Roughly 91 percent of participants reported maintaining or improving their nutrition and healthy habits. Successes were 

achieved through increasing knowledge about healthy nutritional 

choices, teaching how to identify healthy options in the grocery 

store and demonstrating healthy meal preparation. This also includes sharing lessons learned with families and community elders. 

Additionally, Triple Play, BGCA’s comprehensive health and 

wellness program, strives to improve the health of Club members 

ages 6 to 18 by increasing their daily physical activity and teaching 

them good nutrition. This program utilizes three components: 

mind, body and soul. 

The mind component teaches youth to eat smart through the 

power of choice, calories, vitamins and minerals, the food pyramid 

and appropriate portion size. The body component boosts Clubs’ 

traditional physical activities to a higher level by providing sports 

18 

and fitness activities for all youth. The Soul component helps build 

positive relationships and cooperation among youth and young people. 

In addition, Clubs provide programming that incorporates tribalfocused, non-traditional sports, such as cultural dance, canoeing 

and archery; while nutrition programs incorporate local, cultural 

foods and culinary customs to ensure kids are moving and eating 

a balanced, healthy diet. Generations of children currently benefit 

from investments in programs at Clubs which help them grow into 

healthy, responsible adults. 

I would like to say that the Boys & Girls Clubs of America has 

been a very integral part of my success. I am directly affected by 

diabetes. My dad has diabetes. I am proud to use my platform to 

be a part of this movement to stop diabetes in Indian Country. 

Again, I thank the Committee. We appreciate your interest in 

this critical issue. I am happy to respond to any questions you may 

have regarding the movies or the movement. 

[The prepared statement of Mr. Sensmeier follows:] 

PREPARED STATEMENT OF MARTIN SENSMEIER, ACTOR AND AMBASSADOR, BOYS & 

GIRLS CLUBS OF AMERICA

Chairman Hoeven, Ranking Member Udall, and distinguished members of the 

Committee, thank you for the opportunity to testify at today’s hearing. My name 

is Martin Sensmeier of Tlingit, Koyukon-Athabascan, and Irish descent. I was 

raised in a Tlingit Coastal Community in Southeast Alaska and grew up learning 

and participating in the traditions of my Tribe. As a Native American actor and Native ambassador of Boys & Girls Clubs of America, it is honor to be here today to 

advocate for wellness among Native people of all Nations, focusing largely on youth. 

Growing up, I attended the Boys & Girls Club of Alaska and learned early the 

benefits of a healthy and active lifestyle. Health is not just about physical and medical, it also impacts how young people cope with emotional and mental health. 

Throughout my life and career as an actor it has been important to maintain these 

habits. I am privileged to be an Ambassador for the Boys & Girls Clubs of America 

and I am a member of the Native Wellness Institute. These platforms have provided 

an opportunity to reach out to more youth and play a role as a mentor and advocate 

promoting healthy life styles for our Native youth. 

As a former Club kid, I can testify to how Boys & Girls Clubs on Native Lands 

are working to decrease the high rates of diabetes and obesity in Indian communities though physical activities, nutrition, and education. For 25 years, Boys & 

Girls Clubs of America has established an enduring presence on Native lands and 

has committed to improving the capacity of Boys & Girls Clubs to serve these youth. 

Currently, there are nearly 200 Boys & Girls Clubs serving over 86,000 Native 

youth, from over 100 different American Indian, Alaska Native and Hawaiian communities in 27 states. 

Boys & Girls Clubs of America continues its pledge to assist communities and expand youth development in Indian Country. Such efforts have been demonstrated 

by the establishment of the Boys & Girls Clubs of America’s Native Services in 

2013, and growth in national staff, many who are Native themselves, that work 

across the country to support our Club professionals. As the Nation’s largest service 

provider to Native youth, Boys & Girls Clubs in Indian Country are committed to 

addressing the challenges and issues unique to Native lands through an increase 

in opportunities that are culturally relevant and meaningful. 

While many Native youth thrive and succeed in life, as a whole they are one of 

our country’s most vulnerable populations. Persistent issues of unemployment, poverty, physical and sexual abuse and a host of other risk factors existing in Indian 

Country, have created a climate where suicide, alcoholism and drug abuse amongst 

tribal youth is perpetuated. There are many statistics that paint an alarming portrait of the well-being of Native youth in America today. Because time is limited, 

I will offer just two that we are here today to discuss. 

1. Native American youth have disproportionally high rates of obesity and diabetes relative to the American populations. 

19 

2. The rate of type-2 diabetes among AI/AN youth is nearly 3 times the national 

average. 

Research found that 12–19 year-old AI/AN youth participating in a survey consumed fruits, vegetables and dairy products less than once per day, which is below 

the recommended dietary allowance. 

There are multiple factors that have led to the decline in physical activity and 

poor nutrition habits across our Native lands. On many Native lands, families are 

likely to purchase foods that are locally accessible, familiar and convenient to prepare, but may be lacking in nutritional value. Youth many not learn the skills and 

tools to prepare healthy, balanced meals at home. This contributes to obesity, malnutrition related diseases, and a pattern of poor eating habits. 

Because of the relationship between diet and obesity, Clubs are promoting healthy 

eating behaviors that can help decrease the prevalence of obesity. Boys & Girls 

Clubs on Native Lands provide the greatest opportunity for impact. Boys & Girls 

Clubs of America’s vision is to turn these Clubs into models of wellness, improving 

the nutrition and health of youth and families in some of our nation’s most impoverished communities. 

Through programs like the Boys & Girls Clubs of America’s Healthy Habits program that serves K–12, our Clubs empower Native youth with the knowledge and 

resources to adopt healthy eating habits. Healthy Habits provides outcome-driven 

nutrition education opportunities for Club members, which is critical to improving 

their health and wellness. 

In 2016, 16 Boys & Girls Clubs in Indian Country from across the country representing various tribal communities provided healthy meals and nutrition education utilizing BGCA’s Healthy Habits program in a culturally sensitive and age 

appropriate way. Lessons covered dietary guidelines, understanding food labels, 

identifying food groups, strategies to increase fruit and vegetable consumption, and 

interactive healthy meal and snack cooking demonstrations. Clubs reported that, 

with consistent participation in the program, youth have begun to share new information and healthy eating strategies with their families. 

Native Clubs that implemented the Healthy Habits program reported progress 

made to promote health and wellness among youth and the greater community. 

Roughly 91 percent of participants reported maintaining or improving their nutrition and healthy habits, specifically 74 percent improved and 17 percent maintained. Successes were achieved through increasing knowledge about healthy nutritional choices, teaching how to identify healthy options in the grocery store and 

demonstrating healthy meal preparation. This also includes sharing lessons learned 

with families and community elders. 

Other programs like, Triple Play, BGCA’s comprehensive health and wellness program, developed in collaboration with the U.S. Department of Health and Human 

Services, strives to improve the overall health of Club members ages 6–18 by increasing their daily physical activity, teaching them good nutrition and helping 

them develop healthy relationships. This program utilizes three components, Mind, 

Body and Soul. The Mind component encourages young people to eat smart through 

the Healthy Habits program, which covers the power of choice, calories, vitamins 

and minerals, the food pyramid and appropriate portion size. The Body component 

boosts Clubs’ traditional physical activities to a higher level by providing sports and 

fitness activities for all youth. Body programs include six daily fitness challenges; 

teen Sports Clubs focused on leadership development, service and careers in athletics; and Triple Play Games Tournaments, inter-Club sectional tournaments that 

involve multiple team sports. The Soul component helps build positive relationships 

and cooperation among young people. 

In addition, Clubs provide programming that incorporates tribal-focused, non-traditional sports, such as cultural dance, canoeing and archery; while nutrition programs incorporate local, cultural foods and culinary customs to ensure kids are moving and eating a balanced, healthy diet. 

According to the 2013 United States Census, American Indians/Alaska Natives 

had a higher rate of poverty than any other racial group, which was 29 percent as 

compared to the national poverty rate of 15 percent. Due to high poverty rates, access to healthy food options may be limited. As such, meals and snacks provided 

during Club hours may be the only or last meal a child eats during the day. 

20 

1Finkelstein, E.A., Graham, W.C.K. and Molhotra, R. (2014). ‘‘Lifetime Direct Medical Costs 

of Childhood Obesity,’’ Pediatrics, Vol. 133, No. 5, 854–862, http://pediatrics.aapublications.org/ 

content/133/5/854.short. 

Over a lifetime, the medical costs associated with childhood obesity are about $19,000 more per child than those for a child of normal weight. 1

• Every 100 youth Boys & Girls Clubs help develop habits that enable them to 

maintain a healthy weight, could save as much as $1.9 million in lifetime medical costs. 

• According to the Centers for Disease Control and Prevention, 31 percent of Native Youth are obese, a rate 177 percent higher than that of the general population. Whereas only 30 percent of all U.S. youth get physical exercise every 

day, Boys & Girls Clubs’ outcome data reports 60 percent of Native Club youth 

exercise 5 or more days per week. 

For 25 years, Boys & Girls Clubs in Indian Country have proven to be a gamechanger for Native youth, by helping them overcome the many societal issues and 

personal obstacles they face in their communities and home environments. We 

would not have been nearly as successful without partners like the Indian Health 

Services and the National Council of American Indians. 

Boys & Girls Clubs will continue to play a critical role in breaking a perpetual 

cycle of extreme poverty, low academic performance, and significant health problems. We envision Native youth on their path to great futures, succeeding in school, 

becoming community leaders, assuming roles as contributing members of the workforce, and engaging in regular physical activity and good nutrition. 

Boys & Girls Clubs in Indian Country have an unprecedented opportunity to help 

more Native youth to lead sustainable change, while embracing their culture and 

traditions. We believe generations of children to come will benefit from investments 

in programs and services, such as Boys & Girls Clubs, that help them grow into 

responsible adults—and that America stands to gain from the increased productivity 

and contributions of these future citizens and Native leaders. 

Again, thank you to the Committee, we appreciate your interest in this critical 

issue. We are happy to respond to any questions. 

The CHAIRMAN. Thank you, Mr. Sensmeier. 

Mr. SENSMEIER. Thank you. 

Mr. Villegas and Ms. Seepie. 

STATEMENT OF ALTON VILLEGAS, TRIBAL YOUTH, SALT 

RIVER PIMA–MARICOPA INDIAN COMMUNITY; 

ACCOMPANIED BY RACHEL SEEPIE, SENIOR FITNESS 

SPECIALIST, DIABETES SERVICE PROGRAM—HEALTH 

SERVICE 

Mr. VILLEGAS. Good day, everybody. My name is Alton Villegas. 

I am 11 years old and going to be turning 12 in December. I am 

the oldest brother in my family. I have two really good friends 

Lorenzo Klein Romero and James Upshaw. 

I am a member of the Salt River Pima-Maricopa Indian Community. I am a member of the fifth grade at Salt River Elementary 

School. I like my school very much and my favorite subject is reading. I also like sports like cross country and wrestling. 

When I am home, I like to go jumping on my trampoline with 

my siblings. Soon, because it is almost summer, I get to go swimming. 

Last summer I went to a diabetes prevention camp which is 

funded by the SDPI grant. My mom and my grandma have diabetes. A lot of people in Salt River have diabetes, sadly. I think a lot 

of people have diabetes because they do not eat healthy and they 

do not exercise. 

I want to be healthy so I went to camp. I wanted to be able to 

help my mom and my grandma be healthier. I also wanted to show 

21 

my brothers and sisters how they could be healthier. When I was 

there, I lost nearly 16 pounds. I am not done. 

Camp also helped me make better choices in what I eat and they 

taught me that playing outside was fun and not boring. When I 

came home from camp, my family thought I would like to have a 

hamburger, fries or a pizza but I did not want that or the salt. At 

the time, I did not eat the salt, I did not eat all of it. 

Like Mr. Hoeven said, that is my idea, order a salad. Chicken 

Caesar is really good. You should go there. 

They were very surprised. I remembered eating junk was not 

okay, but if I did that, the program taught me eating good and exercising, I would lower my sugar and feel better and I did. I cannot 

wait to go back to camp again this year. I know I will learn more 

and will have a lot of fun. 

I think more kids would learn from the diabetes camp and they 

can help other people in Salt River to be healthier so they will not 

be sick. 

I would like to invite you to come to Arizona in the summer. We 

go to camp where it is not so hot. I want you to see our camp. 

Thanks for helping me and helping my mom and my grandma. 

[The prepared statement of Mr. Villegas follows:] 

PREPARED STATEMENT OF ALTON VILLEGAS, TRIBAL YOUTH, SALT RIVER PIMAMARICOPA INDIAN COMMUNITY; ACCOMPANIED BY RACHEL SEEPIE, SENIOR FITNESS

SPECIALIST, DIABETES SERVICE PROGRAM—HEALTH SERVICE

Background 

The Salt River Pima-Maricopa Indian Community appreciates the opportunity to 

provide oral and written testimony to the Senate Select Committee on Indian Affairs on the Special Diabetes Prevention Initiative, particularly relating to prevention of diabetes among Native Youth through Healthy Living. 

The Salt River Pima-Maricopa Indian Community (Community) is a federally recognized tribe created by federal Executive Order on June 14, 1879 and is the homeland of two distinct tribes; the Pima—‘‘Onk Akimel O’odham’’ (River People), and 

the Maricopa—‘‘Xalychidom Piipaash’’ (People who live toward the Water). The 

Community is comprised of 52,600 acres, with 19,000 held as a natural preserve, 

which are divided into Community-owned land and individual allotments. SRPMIC 

consists of two geographical areas; the Salt River and Lehi Communities that are 

separated by the Salt River, with the Lehi Community located south of the river. 

The Community lands are adjacent to the Phoenix metropolitan area in central Arizona and located within Maricopa County. SRPMIC shares a common boundary 

with the cities of Mesa, Tempe, and Scottsdale, town of Fountain Hills and Ft. 

McDowell Yavapai Nation. Current total enrolled membership is 10,378 of which approximately 6,000 members reside within the Community’s boundaries. 

Unlike many remotely located Indian reservations, SRPMIC lies within a county 

determined to be one of the most rapidly growing metropolitan populations, which 

has brought two major commuter freeways to the Community. However, the Community still lags far behind the United States and nearby adjacent cities in both 

social and economic development and experiences social and health problems similar 

to those found on more remotely located reservations. 

Medical services are provided by a combination of Indian Health Service (Phoenix 

Indian Medical Center and the Salt River Health Clinic), regional healthcare corporations (Scottsdale Osborn Hospital and Mayo Clinic), and private practice providers located throughout the metropolitan area. 

In addition, the Community supports a Department of Health and Human Services (HHS) which provides clinical staff working in coordination with federal providers at the Salt River Health Clinic. Within HHS, there are Public Health workers, Behavioral Health therapists, Prevention and Intervention services, psychiatrists, WIC and other administrative staff. These programs are supported not only 

with tribal funds but other grant funding. 

The Community has over 10,000 enrolled members and approximately 6000 of our 

members live in Salt River. 39 percent of our members are under age 18. 53 percent 

22 

of our members are female and 47 percent are male. The five year rolling average 

age of death for 2016 and the four preceding years is 48.19 years of age for males 

and 58.09 years of age for females. The highest number of deaths occur in the age 

group 20–45. Many of the deaths are related to diabetes and its’ complications. 

Special Diabetes Prevention Initiative in SRPMIC 

The Community Council has identified reducing the prevalence of diabetes in the 

Community as a needed priority. The Council views the prevalence of diabetes and 

resulting complications as one of the related causes to the early death rates in the 

Community. The consequence of these early deaths are devastating for the children, 

families and the Community. 

Health issues in the Community have been identified by the elected Community 

Council, Diabetes Advisory Team (DAT), and obesity screening by the elementary 

and high school nurses. 

Since many of our tribal members and their families receive health care through 

the Indian Health Service, we are able to pull the following data from the electronic 

health record system for the time period January 1, 2016—December 31, 2016. 

There are 1062 patients from the Salt River Community who are in the Diabetes 

Registry. We know from the data that there are more females than males who are 

diabetic and seeking medical care. We also know that the prevalence is highest in 

the age grouping 45–64 years of age. The diabetics in our Community are almost 

all Type 2 diabetics who are obese or severely obese with a majority being diagnosed 

10∂ years ago. There is a high number of these patients who have been diagnosed 

with hypertension (829) and also some patients diagnosed with cardiovascular disease (277). Almost half of those diagnosed with Type 2, have chronic kidney disease. 

Gender: Female = 652; Male = 410 

Age: <20 yr = 12; 20–44 = 278; 45–64 = 547; 65>= 225 

Type Type 1 = 1; Type 2 = 1061 

Duration of Diabetes: Less than 1 year = 33; Less than 10 years = 401; More 

than 10 years = 467 

For those participating in Diabetes treatment, 26 percent use diet and exercise 

to help control their diabetes. They may also use the diet and exercise in combination with insulin 43 percent or metformin 31 percent. 

The SRPMIC Diabetes Services Program, is community based and operates within 

the Department of Health and Human Services (DHHS) Division of Health Services. 

The Salt River Health Clinic is a unique partnership between the Indian Health 

Service Phoenix Indian Medical Center (PIMC) and the DHHS. The Diabetes Services Program collaborates with the SRPMIC Clinic providers to ensure coordination 

of services, and to address the Community members’ need for prevention and treatment at every stage 

SDPI—Youth Focus 

Approximately 3 years ago we had a 6 year old child diagnosed with Type 2 diabetes and we identified the youngest person being dialyzed was age 25. This situation 

led to greater partnering with the schools and families to have a greater impact on 

diabetes diagnoses and prevention. 

Screening in the schools revealed that 52 percent of the students are above the 

95th percentile for weight demonstrating a critical need for more intervention with 

children, youth, and their families focusing on increased fitness to reduce the risk 

for diabetes. The screening data suggests that children’s weight begins to dramatically increase by the age of 9. 

The following diabetes related health issues also impact the youth: 

• The Community experience challenges and barriers for diabetes prevention, including the Community culture. 

• Accessing nutritious food is difficult for Community residents. 

• Existing diabetes intervention services need to be expanded. 

• Programs do not always reach the people that need the services. 

• People need the intervention to fit their needs. 

Why the SDPI is Important to the Salt River Pima-Maricopa Indian 

Community 

Innovative Programming 

The SDPI grant has afforded several opportunities to the Community to explore 

innovative approaches to diabetes prevention and intervention that go beyond the 

traditional nutrition and exercise curricula. The SRPMIC Diabetes Services ProVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 S:\DOCS\26197.TXT JACK
23 

gram has hosted two instances of Yoga Teacher Training (YTT) in partnership with 

the non-profit Conscious Community Yoga to create certified yoga instructors. Yoga 

is a great low-impact introduction to exercise that takes a holistic approach to 

health and wellness. To date, approximately 12 individuals have completed the YTT 

and conduct yoga classes within the Department of Corrections (DOC), Journey to 

Recovery (residential treatment), and at the Fitness Center. Participants at the 

DOC have seen encouraging outcomes related to blood pressure and an increased 

general sense of calmness. Interestingly, the DOC program has a higher attendance 

from the male population than the female population. 

More recently, the SRPMIC Diabetes Services Program is sponsoring a traditional 

Chinese medicine (TCM) approach to health and wellness called the 5 Elements 

Wellness Program. The Community has partnered with a local TCM practitioner, 

Dr. Qingsong Xiao, to conduct a 12-week program that includes exercise, wellness 

education, herbal supplements and acupuncture. Participants report incredible outcomes that include several point decreases in A1c readings, an increase in energy 

and activity level, better and more consistent sleep, and weight loss. This has become a very popular program within the Community, and HHS has included a children’s component to the program that started at the end of February, 2017. 

Collaborations with Women, Infants and Children (WIC) and the School 

The Diabetes Program partners with other programs to reach all ages of the Community. The WIC supervisor has a team of four that works with families to educate 

on the importance of breastfeeding, preparing and eating nutritious meals and managing gestational diabetes. The fitness center staff also assist with offering child 

friendly exercises during FIT WIC sessions so parents learn about the importance 

of starting physical activity at a young age. 

There are two schools on the reservation serving children from pre-school through 

12th grade. The Diabetes program has been able to collaborate with the schools in 

teaching students about eating healthy and staying active. One initiative known as 

#GetFit, aims to teach student athletes in becoming role models, wellness champions, to fellow students. The program this year was expanded to reach the parents 

of student athletes and Physical Education students. Through this program families 

have the opportunity to learn healthy lifestyle behaviors as well as setting healthy 

goals as a family. 

The Diabetes Camp 

The American Indian Youth Wellness (Diabetes Prevention) Camp was established in 1991. Through a collaborative partnership with the University of Arizona 

and other tribes these one week camps are continuing to be offered. Salt River 

Pima-Maricopa Indian Community has been participating in camp since the mid 

1900’s. Every summer in June, the Diabetes Program has been able to pay for and 

send 20 students and 8 volunteers to camp. The camp involves American Indian 

youth from tribes across the Southwest, primarily Arizona, to a one week intensive 

residential camp. At camp, kids learn healthy eating habits and ways to make exercise fun, consistent, and habitual. The best part of camp is that activities take place 

in an American Indian context, deeply rooted in culture. This integration increases 

our effectiveness and makes health fun. 

Community Wellness Activities 

Every year the SRPMIC Diabetes Services Program is able to organize and host 

several walks within the Community to encourage physical fitness and as outreach 

for the program itself. Families are encouraged to walk together, often you will see 

not only the parent, but also the grandparent participating. Additionally, the fitness 

staff are often called upon by other departments to lead warm-up exercises for activities, i.e. the annual Fall Overhaul which is an Administration hosted event as 

a community service project for employees; collaborate on certain awareness campaigns such as walks for domestic violence, and suicide prevention. 

Summary 

The Community appreciates the opportunity to provide testimony on the Special 

Diabetes Prevention Initiative and the impact that it has had on youth wellness. 

We appreciate the support of Congress in ensuring that the program continues to 

be available so that our goal of Community wellness can be achieved. 

The CHAIRMAN. Thank you, Mr. Villegas, that was very good. 

Ms. Seepie. 

Ms. SEEPIE. Good afternoon, Chairman Hoeven, Vice Chairman 

Udall and members of the Committee. 

24 

My name is Rachel Seepie and I am a member of the Salt River 

Pima-Maricopa Indian Community in Arizona. 

It is an honor to appear before you to share my personal journey 

and let you know how important SDPI has been for me and many 

members of the community. My community, the Salt River PimaMaricopa Indian Community, has over 10,000 enrolled members; 

approximately 6,000 members live within the borders of the community. 

Demographically in our community, nearly 40 percent of our 

members are under the age of 18. By gender, 53 percent of our 

members are female, 47 percent are male. As you may be aware, 

the Pima have been the subject of national surveys, news pieces 

and other studies documenting the high rate of diabetes that exists. 

For example, the five-year rolling average age of death of our 

community for 2016 was 48 years old for male and 58 years old for 

female. Many of these deaths are directly related to diabetes and 

its complications. 

For many years, the SDPI grant has approved a program for the 

Committee to give nutritional education and physical activity to 

prevent diabetes and help those with Type 2 diabetes to lead a 

healthier lifestyle. I believe with continuation of the grant, more 

community members of the Salt River Pima-Maricopa Indian Community will learn what is needed to have a healthier lifestyle. 

In my own experience, the program has helped me strive to have 

a healthier life. I am the mother of three children. I learned 

through the years that physical activity is the key to staying 

healthy with Type 2 diabetes. Yes, I do have Type 2 diabetes. I 

have been controlling my Type 2 diabetes with eating well and exercising. 

When I was first diagnosed with Type 2 diabetes, I did take 

medication to control my diabetes. At one time, I decided that I did 

not want to take medication anymore. I used what I learned from 

our program in our community to control my diabetes, healthy eating and physical activity. Some of the physical activities I am involved in are aerobic exercise classes, hiking, and running long distance triathlons. For the past ten years, I have run six marathons, 

10 half marathons and many triathlons. 

The personal achievement I am most proud of is finishing two 

Iron Man triathlons. I will always remember when I crossed the 

finish line after swimming 2.4 miles, biking 112 miles and running 

a marathon which is 26.2 miles, the announcer saying, you are an 

Iron Man. I heard that twice. 

I am also involved in teaching group exercise classes for both 

youth and seniors in my community. As a result, I have felt 

healthier and hopefully the people who come to my classes feel 

healthier also. 

I see my doctor and I have positive results. My blood sugar levels 

have gone down to near normal. My heart rate is low, which means 

my heart is healthy and strong and I have lost weight myself. 

I believe because of the SDPI grant I have more information I 

need to take care of myself and my family and to live a healthier 

life so my children can live their lives without Type 2 diabetes. 

25 

My vision is that the Salt River Pima-Maricopa Indian Community and our members will learn how to become healthier and that 

they will have long, full lives without Type 2 diabetes. 

Thank you for allowing me to share these few words. I am happy 

to answer any questions. 

The CHAIRMAN. Ms. Seepie, your record running marathons and 

the Iron Man contest is remarkable. 

Ms. SEEPIE. Thank you. 

The CHAIRMAN. An amazing achievement and very impressive. 

Again, we appreciate all of our witnesses very much. At this 

time, I will turn to Senator Murkowski. 

Senator MURKOWSKI. Thank you, Chairman Hoeven. I appreciate 

it. 

Thank you to all of our panelists. I think in so many different 

ways, you each are such significant role models for others. Some 

may be doing it in a more high-profile way, like you, Martin, or 

perhaps Alton, it is what you can do as you go back to your classroom and talk to other kids about why it is important to each 

healthy. 

The lessons that have shared with us today are all very real 

takeaways that can make a difference. I think we recognize that 

so much of this is education. We have talked about the significance 

of the SDPI program and all that is. 

Education only goes so far. You have to act on it and take that 

step to do the exercise. You have to take that step to order the 

salad. You have to be proactive with it. 

Martin, I noted that it was not too long ago that you flew back 

up to Juneau to attend the Gold Medal Basketball Tournament 

that is going on there. Again, it is one of these things where you 

are flying incredible distances to go to be somewhere where I guess 

you probably did really love basketball growing up in Yakutat but 

the fact of the matter is this gives you an opportunity to role model 

for these other kids so that they see that exercise can be fun. 

Can you speak a little bit to this whole aspect of being the role 

model to get others to be motivated and change behavior because 

I think this is such an important part of what we are trying to do 

here. 

Mr. SENSMEIER. Yes, we got a gold medal. I think it is one of the 

oldest, if not the oldest, tournament in the United States, the 71st 

annual tournament this year. I grew up going. My dad took me. My 

dad was a Golden Gloves boxer and he started taking me to Gold 

Medal when I was eight years old. 

Basketball has actually become a part of our culture. Physical fitness has always been a big part of my life. 

Growing up and attending the Boys & Girls Club, I always had 

access to that. I had good role models there I looked up to and also 

mentors who encouraged me to dream big. I was always taught 

that physical fitness and applying myself, learning nutritional education and all those things that were provided through the clubs 

would help me get to the level where I am today. I believe that. 

There is a quote by Kevin Spacey that says if you should be so 

lucky to make it to the top, it is your duty to send the elevator 

back down. I think given the platform I have been blessed to have, 

I feel it is important, it is a responsibility to promote healthy and 

26 

active lifestyles in our communities to prevent diabetes and other 

issues we are dealing with. 

Senator MURKOWSKI. We appreciate your leadership and that 

role modeling that goes on. 

I was struck, Mr. Eagle, with your testimony coming from Fort 

Berthold. You talked about lack of access to healthy foods, the fact 

that in your reservation stores, available fresh produce is limited. 

It strikes me that you are in very much the same situation we 

have up north in Alaska where 80 percent of our communities are 

not connected by road, so you have food that is flown in and it is 

expensive, if you can get it. 

Quite honestly, oftentimes it has been sitting somewhere for a 

long period of time. By the time it gets to the main hub and gets 

out to the village, if it is lettuce, it is brown, wilted, or dead and 

nothing that anyone would want to eat. 

Kids do not know what color a banana should really look like because by the time it gets to a village, it is really not fit for consumption. So many of our kids have grown up not only not tasting 

these good, healthy foods, but if they are able to taste it, they are 

bad by then so they do not like it. 

When we think about the education we are building, that is great 

but we also have to be able to have the access. I know that through 

USDA and FDA, we have allowed our schools in Alaska, several of 

our village schools, to accept donated traditional foods that can be 

served as part of the school lunch menu. 

You are having good fish. They are making fish soup instead of 

opening a can of chili made somewhere else and loaded with preservatives and whatever they load it with. Making sure we have 

access to the good, healthy traditional foods I think is so important. 

We also need to make sure that again we have a way to help get 

the good food available at an affordable price. We do have our programs out there through SNAP and some of the others, but I look 

at the connection between the debilitating disease that can be arrested if we are able to focus on diet and exercise. 

If we cannot make that good food available, we are still very, 

very challenged. Know this is something I want to continue to work 

on with the Committee. We have things like essential air service 

that help us lower our prices for food. That is on the budget floor 

right now. It is something we have to address. That is a subject 

for another time. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Murkowski, you are right. I agree. 

Senator Franken. 

Senator FRANKEN. Thank you, Mr. Chairman, again. 

As I said in my opening, I have been working on the fight 

against diabetes since I got here. I, along with Senator Lugar of Indiana, got the National Diabetes Prevention Program into the ACA. 

It is a program that works with people who are pre-diabetic and 

their glucose levels are elevated. It gives them 16 weeks of training 

in both exercise and physical training and 16 weeks in nutritional 

training. It works. 

It has been demonstrated to work. It especially works in older 

people who are pre-diabetic. They are 70 percent less likely to become diabetic in the next five years if they take the 16-week proVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00030 Fmt 6633 Sfmt 6601 S:\DOCS\26197.TXT JACK
27 

gram. That is why CMS covers it under Medicare if you are on 

Medicare. 

Can you tell me, Admiral, about the programs in IHS and how 

the Indian direct program may differ? Are you familiar with the 

National Diabetes Prevention Program? 

Mr. BUCHANAN. I am not familiar. 

Senator FRANKEN. It is something that WISE did with the CDC. 

It is 16 weeks of nutritional training accompanied with 16 weeks 

of physical training. What is the program in Indian Country? 

Mr. BUCHANAN. The program in Indian Country takes a holistic 

approach as was mentioned earlier in some of our discussions. 

Some of the ideas that were mentioned related to education, physical activity, those sorts of things. We cannot forget social economics that play a big part in this. 

Senator FRANKEN. Is there a protocol? Is there a specific protocol? 

Mr. BUCHANAN. Could you ask the question again? 

Senator FRANKEN. Is there a specific protocol to the program? In 

other words, the National Diabetes Prevention Program has 16 

weeks of physical training and then nutritional training. I know it 

encompasses those elements of nutrition and exercise. 

I was wondering is there a period of time in which it is taught? 

Mr. BUCHANAN. With the special diabetes program, we accept applications and it is based on the submissions from the applicants. 

We have tool kits that are developed and utilized. We utilize best 

practices we learned as described in some of the testimony provided earlier. It is really a community-based program. 

Senator FRANKEN. It is different for each area? 

Mr. BUCHANAN. Correct. 

Senator FRANKEN. I understand. 

A few years ago, I was not in Salt River, but I was in Gila River 

and they have a resort there that at the time had the best golf 

course in the Starwood system and the only five-star restaurant in 

Arizona. 

They showed me around their hospital, which was a great stateof-the-art hospital. But they pointed me to three out buildings, I 

think it was three, and they said those are our dialysis buildings. 

They have a five-star restaurant at the resort which is like 15 

miles from where everyone lives, but where everyone lives is a food 

desert. I just think that is an enormous issue. It is hard to eat well 

when that food is not available. Every time I see them, the Gila 

River folks, I ask them what is going on with that. 

It just seems if you have a five-star restaurant 15 miles away, 

wherever you are getting that produce at the five-star restaurant, 

you can get some of it to where you live. I was wondering if anyone 

had any comments on that. Mr. Eagle? 

Mr. EAGLE. Maybe I am answering your question wrong as well 

but as far as SDPI goes and best practices. Those best practices 

allow us to do a multidimensional array of things from grocery 

store tours to having DPP. We run DPP in our program. 

Senator FRANKEN. You do? 

Mr. EAGLE. It is through collaboration with the North Dakota 

Health Department, with our local IHS and we utilize the TRAIL 

Program with the Boys & Girls Clubs. We use that program in our 

28 

schools and have been doing that for over ten years and we are not 

a Boys & Girls Club. 

SDPI allows us to be very multidimensional and to reach all 

those different aspects that meet the needs of our people. As you 

said, nothing is the same in Utah or Montana. Nothing is the same 

in Fort Berthold as it is in Spirit Lake or Belcort. We are all a bit 

different. You meet the needs of your people through the services 

they want to see. 

Senator FRANKEN. Right. Thank you, Mr. Eagle. 

Thank you. 

The CHAIRMAN. Senator Heitkamp. 

STATEMENT OF HON. HEIDI HEITKAMP, 

U.S. SENATOR FROM NORTH DAKOTA 

Senator HEITKAMP. Thank you, Mr. Chairman and Vice Chairman Udall for having this hearing. 

One thing I want to examine is the intersection of diabetes prevention with behavior and mental health and the complications 

that having other challenges in communities presents beyond food 

deserts. 

When someone is suffering from chronic depression, it is not likely they are going to be compliant or even capable maybe at that 

point in their life of doing the great work that our witnesses talked 

about today, running a triathlon or educating a whole family about 

the value of nutrition. 

I would like to talk a bit about how we can do a better job holistically because I think when we just focus on one piece, we miss 

the rest. For instance, some of the highest rates of tobacco usage 

in my State are in Indian Country. You know this, Jared. 

How do we incorporate broadly additional programs to meet all 

the challenges that I think would maybe achieve better results? We 

will start with you, Admiral. 

Mr. BUCHANAN. In 1997, when the program first started, IHS 

awarded $30 million. Thirty percent of our facilities had diabetes 

clinical program teams. Since that time, in 2004, we were currently 

funded at $115 million, that number went up well above 97 percent. 

The diabetes clinical program team can vary depending on the 

resources available and those sorts of things with physicians, 

nurses and behavioral health specialists being a part of that team 

and taking that holistic approach. 

We have come a long way from 1997 to now. Continuing that 

with some of the best practices is an approach forward. 

Senator HEITKAMP. Vinton? 

Mr. HAWLEY. Building public health systems within tribes would 

definitely help assist tribes with behavioral health issues. I think 

with SDPI, it also gives the tribes, as Mr. Eagle stated, the ability 

to create that infrastructure for your own tribe cultural competency. 

If you are encompassing your needs of your tribe and the needs 

of your people based on your cultural relevancy because we are all 

different, we are not all the same, we are not all in the same areas 

and we do our own issues within our own regions, I think with 

29 

SDPI, it gives tribes the ability to look at your culture and incorporate it. 

When you are incorporating those areas within diabetes, all of 

those cultural components are also covered in behavioral health 

issues. It gives you a sense of identity, a sense of well being, a 

sense of this is who I am, this is where I am from. This is historically what our people did that allowed us to live within ourselves, 

within our communities and also to live healthy. 

I think it encompasses a lot when you talk about behavioral 

health and the ability to be well, live well, and live healthy and incorporate it. That is a unique thing with SDPI and behavioral 

health because that is another component that all tribes across the 

Nation have serious issues with. That encompasses a lot. Thank 

you for the question. 

Senator HEITKAMP. Jared? 

Mr. EAGLE. I know I can specifically speak for the work that we 

do in Fort Berthold but as Senator Murkowski and you just said, 

we need to work on getting those food deserts access. 

I think there is another piece though with behavioral health in 

the work that we do with SDPI. That is teaching people how to 

manage when you do not have it. From the example in my testimony, two of the six communities on Fort Berthold have grocery 

stores. The other four do not. They have access to a convenience 

store where you can buy chips and pop. 

One of our local convenience stores is actually the leader in the 

State of North Dakota per capita for chip sales. It is a community 

of less than 700. That says something. 

Through SDPI, we try to focus on that behavior because it is a 

decision to buy what you are buying. If it is not there, yes, that 

is a major obstacle I agree but there are ways to change that behavior into what is a better option. 

All those things are looked at through the different curricula that 

we utilize such as TRAIL and DPP. In all the activities we do, it 

is addressed in some form, but not specifically with a mental 

health provider. 

Senator HEITKAMP. I think my point was that siloing just has not 

worked. 

Mr. EAGLE. Yes. 

Senator HEITKAMP. It is like saying we are going to fix problems 

with youth challenges simply with the housing program and ignoring education and health care. This needs to be a collaborative effort. 

It is good to hear that this program actually encourages the integration and expansion into behavioral health but we need to do a 

better job. 

The CHAIRMAN. Thank you, Senator Heitkamp. 

Admiral, my question for you is we are seeing a decrease in 

adults but not in youth in terms of both the diabetes and obesity 

rates. Why is that and what do we need to do? 

Mr. BUCHANAN. We are seeing an increase in youth? 

The CHAIRMAN. My understanding is we are seeing a decline in 

the rates for adults but not so with youth. Why is that and what 

can we do? 

30 

Mr. BUCHANAN. The youth rate is leveling off for sure. The Special Diabetes Program has had a tremendous impact over the last 

20 years. We are utilizing those lessons learned and best practices 

going forward to address the youth. Of 301 grantees, 252 are tribal 

programs. We are utilizing some of those best practices to address 

the youth. 

The CHAIRMAN. Are there changes, improvements or recommendations that you would make to the program? Are there performance measures that should be employed? 

Mr. BUCHANAN. With the Special Diabetes Program enacted by 

Congress, we are reporting on an annual basis on the outcomes related to the diabetes program. We are happy to work with the 

Committee going forward. 

The CHAIRMAN. Are there recommendations you would make for 

changes or improvements to the program? 

Mr. BUCHANAN. Changes or improvements, we a have a Tribal 

Leaders Diabetes Committee that is an advisory committee to the 

director. Any significant changes that happen through the program, we work through the Tribal Leaders Diabetes Committee to 

provide recommendations to the director. The activities up to this 

point have been recommendations from that committee. 

The CHAIRMAN. Mr. Hawley, how could the SDPI program be improved to help further reduce youth obesity and diabetes rates in 

tribal communities? 

Mr. HAWLEY. I think overall is the education and public health. 

I think the public health is an important tool that can be utilized 

to educate. In the testimony, I talked a bit about how much more 

tribal youth are aware than I was when I was in high school of 

anything that goes on, and the things they are exposed nowadays 

is beyond anything I remember. I just cannot believe they are 

aware of some of the things they are aware of and their ability to 

be engaged, to overcome and get involved, and get active. 

That also is our responsibility to show them and encourage, educate and promote. I think that is the key. We have some activities 

outside of the regular work but then you also have the individuals 

who are managing these programs even at the national level who 

are advocating. 

However, you also have the individuals who are doing things outside on their own time throughout the week to be engaged, educate 

and convey the message that we are advocating at this level. 

I think it goes a long way when you talk about what we can do 

to change. As a tribal leader, I know reductions say a lot and raises 

flags for tribal leaders because we think about tribes doing more 

with less. We have always done that, I think. 

When we talk about those things, the first thing that comes to 

my mind is how are we going to do more with less because we have 

done it before and that is what we are going to have to do again 

but also educating our youth to be active, engaged and the voice 

of change. 

We heard the testimony from the young man down the table and 

what they are able to accomplish. This is one 11-year old. When 

that changes throughout Indian Country, it says a lot for the activities. I think it starts with education. 

31 

The CHAIRMAN. Mr. Eagle, I am very impressed with the variety 

of things you are doing. It speaks to the flexibility of the program 

which is encouraging. Are there other things that you think would 

be helpful as we work to reauthorize this program, things we 

should be looking to try to do? 

Mr. EAGLE. One thing I guess comes to my mind immediately 

when it comes to change would be what Vice Chairman Udall said 

in his opening remarks about continuation funding. The previous 

example from the kidney report they did and the correlation between SDPI starting and how those rates have declined in conjunction with SDPI funding. That has been done, like you said in a one 

to two-year reapplication process. 

The CHAIRMAN. Right. 

Mr. EAGLE. What would happen if this was funded for several 

years, we had this funding and were able to make plans and do 

that kind of work on a long-term basis? 

The CHAIRMAN. The idea of reauthorizing for a longer period of 

time and then even maybe carry over funds or something like that 

would help you, create continuity in your programs and strengthen 

them? 

Mr. EAGLE. Absolutely. 

The CHAIRMAN. I will pause here and turn to the Vice Chairman. 

Senator UDALL. Thank you, Mr. Chairman. 

SDPI is an excellent example of the difference investing in preventative care can make for whole communities. All of you, in a 

way, have demonstrated that. Unfortunately, this Committee hears 

from Native constituents that access to preventative and specialty 

care remains limited in Indian Country. 

Admiral, this is for you. In fiscal year 2017, how many Indian 

Health Service areas can fund, purchase and refer care above medical priority Level 1? 

Mr. BUCHANAN. That is a great question. All of our facilities 

should at least fund between Level 1 in all PRC programs. 

Senator UDALL. All of the facilities are doing that now? 

Mr. BUCHANAN. That is correct. 

Senator UDALL. Where does the money for these preventative 

services come from, direct appropriations or third party billing from 

Medicaid and insurance? 

Mr. BUCHANAN. I need to back up a little bit. 

Senator UDALL. Go ahead. 

Mr. BUCHANAN. You were asking for preventative services related to PRC? 

Senator UDALL. Yes. 

Mr. BUCHANAN. PRC is specifically for the different categories 

and it goes into different sections from Level 1, Level 2, down to 

Levels 3 and 4. The preventative piece is farther down. When I was 

responding, Level 1 is for life and limb types of activity. 

Senator UDALL. Right. 

Mr. BUCHANAN. I do not have the answer for the preventative 

piece of it. I can definitely get back to you on that. 

Senator UDALL. The point of the question I think was how widespread is the preventative service in all the facilities with SDPI? 

I think that is what we were trying to get at. You can answer for 

the record but is it widespread? Is it not in that many areas? 

32 

Mr. BUCHANAN. Currently, we have 252 tribal programs. We 

have about 29 urban programs that are funded and about 15–20 

Federal programs funded through SDPI. All those programs, SDPI 

is all about prevention. Correlating that, we have 782,000 people 

impacted by the SDPI Program. I hope that answers your question. 

Senator UDALL. Is it in every Indian Health Service area? 

Mr. BUCHANAN. Thirty-five States. I am hearing my staff say yes, 

we have SDPI in all of our facilities across the area. 

Senator UDALL. The point was made here and several of the witnesses have asked and been asked, we know it is a key to have 

healthy food but can they access healthy food. To any of you this 

is kind of a yes or no question. 

Those of you living in Indian Country, can you access healthy 

food in Indian Country or are you living in food deserts? Give me 

just a yes or no on that. Can you access healthy food? Jared? 

Mr. EAGLE. At Forth Berthold, we can. Like said, in limited 

areas, there are two grocery stores based on a 250-mile radius. 

Senator UDALL. It is a lot like the Navajo Reservation where we 

have 175,000 people over 27,000 square miles and we have ten grocery stores. Is that true in the rest of your communities? 

Mr. SENSMEIER. In Alaska, in a lot of the communities there, we 

have limited access to fresh produce. 

Senator UDALL. In your community, Martin, limited access? 

Mr. SENSMEIER. It is getting better. You see it is improving but 

up north, well, my mom comes from the Yukon, it is very limited. 

Senator UDALL. Very limited. 

Mr. Hawley. 

Mr. HAWLEY. Very rural, limited access. 

Senator UDALL. Mr. Villegas, do you get that good salad you 

were talking about earlier there? 

Mr. VILLEGAS. Yes. 

Senator UDALL. Okay, good. You two are from the same community. Would you agree with that? 

Ms. SEEPIE. Yes, we live in an area where we are surrounded by 

the city, major cities like Scottsdale, Mesa and Phoenix, so we do 

have access to fresh vegetables and produce. 

Senator UDALL. How about on the reservation? 

Ms. SEEPIE. On the reservation, we do also have a food bank that 

does give out fresh fruits and vegetables that community members 

can also access. 

Senator UDALL. Please. 

Mr. SENSMEIER. I think on some of the reservations you see failing health but they do have access to fresh produce and stuff like 

that. It is really helpful when you have programs like Triple Play 

through the Boys & Girls Clubs of America that educate these 

young kids about nutrition because one of the biggest problems we 

have in Indian Country is the lack of nutritional education. 

Fried bread, for example, a lot of Native people think fried bread 

is a Native traditional food. It is not. That was a ration that was 

given. Now there is a vicious cycle that greatly contributes to diabetes. 

When you educate these kids, and break that cycle, then they 

have a better understanding of how to eat better. Triple Play is one 

of the great programs. It improves the health of club members ages 

33 

6 through 18. The mind component is the biggest one, teaching 

them to eat smart through the power of choice, calories, vitamins 

and minerals and appropriate portion size. 

I think when we have programs like this our chance of breaking 

these cycles is a lot greater. My Club rep actually has some really 

great announcements about that if she can have a chance to speak 

at some point. 

Senator UDALL. Mr. Chairman, I have run over. Thank you. 

The CHAIRMAN. Martin, my question kind of goes to a role model 

in general, not only in terms of healthy eating but in general, good 

habits, a good lifestyle, how you succeed as a young person and so 

forth. 

For a minute, tell us how you got into acting. It sounds like you 

had sports and so forth in your background and the Boys & Girls 

Club but how do you get from that and get into acting particularly 

at such a high level? 

Then talk about it in terms of how you can be a role model or 

how you get other young people to achieve their dreams? It might 

be acting or sports or something else for them. Just talk about your 

own experience for a minute. We are interested to hear, at least I 

am, how you transitioned to acting and what it took to be successful and what you would advise other young people like maybe Mr. 

Villegas, to do to achieve their dreams. 

Mr. SENSMEIER. It has always been a dream of mine ever since 

I was a kid. Billy Mills, who was the only American to ever win 

the 10,000-meter race in the Olympics won in 1964. He was from 

Pine Ridge Indian Reservation. 

I heard him speak one time. He said our children and kids live 

in a poverty of dreams. They are not allowed to dream; they do not 

know how to dream. When you encourage them to dream and make 

them believe in themselves, great things can happen. 

I always had that support system through the Club, my parent 

and role models I saw growing up. That dream was always there. 

Getting access to be able to make that happen was kind of an unrealistic idea. 

I did what a lot of young people do in Alaska. I got into fishing, 

construction and ended up working on an oil rig. While I was working on the oil rig, I had a lot of time off, two weeks on and two 

weeks off, so I started traveling to California. 

I was like, I am going to check out an acting class. I started getting around other people that were dreaming big. I started seeing 

people succeed. I was like, okay, I can do this. I stuck with it and 

stayed persistent and believed in my own ability and started becoming successful. 

One of the ways I would like to encourage youth, I try to do my 

best, is I maintain my connection with the community and make 

myself accessible to the community. I get a lot of requests to travel 

around and visit different Native communities all over the Country. I cannot name how many reservations I have been to. I have 

been in Florida, Connecticut, New York, Washington, Nevada, California, all over the place. 

Whether they pay me or not, I try to make myself as accessible 

as I can. When I am there, I try to promote healthy lifestyles. Senator Murkowski mentioned the Gold Medal tournament in Alaska 

34 

and I made it a point to go home to that, because everybody at 

home, all the kids look up to me. 

When they see me actively living a healthy lifestyle and also participating in a sporting event, they want to do that too. I wore a 

Mohawk in the movie and I had ten kids surrounding me and half 

of them had Mohawks. 

I have never set out to be a leader. I do not think of myself as 

a leader. I think of myself as an example and I strive to be that. 

The CHAIRMAN. There is no question you are a leader and that 

you are having a very powerful, positive impact on your peers and 

young people. I just want to encourage you to keep it up. Your coming here today shows you care and you are willing to give back. 

Given where you, that is a remarkable and wonderful thing. 

Mr. SENSMEIER. Thank you. I appreciate that. 

The CHAIRMAN. Thank you so much. 

Mr. Villegas, I am going to turn to you and ask how do you get 

kids your age tuned in to just what you are doing and talking 

about? How do you do it? How do you get other people your age 

to start thinking about health, diet and the right kind of lifestyle 

as you are doing at a pretty darned young age? Any ideas how you 

get them interested in it? 

Mr. VILLEGAS. I do not know. It is kind of hard. 

The CHAIRMAN. It is hard. 

Mr. VILLEGAS. Yes. 

The CHAIRMAN. Do you talk to them about it? 

Mr. VILLEGAS. Yes, I talk to many people about it saying they 

should really go to the camp and why they should start eating 

healthy and all that stuff. I tell them all the time but not a lot of 

people care because they have to give up hot Cheetos. 

The CHAIRMAN. Can’t they have hot Cheetos once in a while if 

the rest of the time they are following a really good diet? 

Mr. VILLEGAS. No, it is up to them, hot Cheetos, they are addicted to it. I see kids buy at least four bags a day from the ice 

cream man. 

The CHAIRMAN. I think the fact that you are a good example and 

talking to them about it really does help so I encourage you to keep 

doing it just as you are today. 

Mr. VILLEGAS. There is one thing they have to do to get to that. 

The CHAIRMAN. Okay? 

Mr. VILLEGAS. We must destroy the ice cream man. 

The CHAIRMAN. Okay. We will make sure we get that in the 

record. 

Mr. VILLEGAS. I also think we should have more flyers everywhere saying a good start is to go the camp. Put up a whole bunch 

of flyers. The reason I found out about the camp was because of 

a lady named Ms. Mary Lynn. She gave me a flyer and I thought, 

this sounds like fun and when I was there, I was like, yay, I know 

how to exercise. 

I think that people should know about it and at least consider 

it and go to the camp. I want to encourage people to go and tell 

them all the fun stuff that we have. 

The CHAIRMAN. That sounds like very good advice. Thank you. 

Thanks for being here today. 

35 

Ms. Seepie, I would ask you the same question that I asked some 

of the other witnesses. Your record with the training and discipline 

it takes to run marathons and participate in the Iron Man is just 

unbelievable. Clearly, if you can get other people to think in terms 

of that kind discipline and perseverance, it is going to make a huge 

difference to them not only in their health but in everything they 

do. 

Are there other things we can do with this program that you 

think would help, that would strengthen the program or encourage 

people to do some of the things you have done? 

Ms. SEEPIE. I can only talk about my community, what they have 

given me, the knowledge and education about diabetes, physical fitness and eating healthy. With the SDPI, we do have a few programs like Lifestyle Balance which is a 12-week based program. It 

is based on nutrition, exercise and behavioral health. It gets pretty 

much all the components. 

As an individual who was diagnosed with diabetes, I know, from 

feeling depression and knowing that you have diabetes at a young 

age, it can affect your life. 

Also, I am a physical fitness specialist in my community. I teach 

different group exercise classes, pre-school and elementary students and seniors also. I teach a group of age groups. All I can say 

is, I think I am pretty much encouraging them as a regular. I think 

of myself as just a regular community member in my community. 

When they see me, some of the kids will say, oh, you are the lady 

that teaches Zumba. I say, yeah, I am the lady that teaches 

Zumba. When can you come to Zumba class or when are you going 

to come to the Boys & Girls Club and teach Zumba? 

I think just being a role model and encouraging people to come 

to our program, the Diabetes Prevention Program in Salt River is 

important. One good program that we have been doing is with one 

of our nutritionist, Maggie Fisher, is Young Wellness Warriors. I 

am a part of it too, as a physical fitness-exercise person. I am also 

in the program with my daughter. 

We are educated on nutrition and also make healthy food goals 

in that program. They see other families in that program learning 

about healthy eating. We do hands-on activities. They get the 

chance to also help out in the kitchen cooking healthy meals. Whatever they have in the home, we provide that education and learning together as a family. I think that has helped me and some of 

the participants. 

The CHAIRMAN. Good. I am encouraged both as I hear about your 

program and certainly, Mr. Eagle, about your program in terms of 

SDPI helping make a difference because of what you are out there 

doing. I appreciate it. 

Senator Cortez Masto, we would turn to you at this point if you 

have questions. 

Senator CORTEZ MASTO. Thank you, Mr. Chair, so much. 

I have competing hearings going on so I have had to step in and 

out. But that does not mean that this topic is not important for me, 

particularly in the State of Nevada where we have tribal communities. I have worked with as Attorney General looking at issues 

affecting the health of Native communities, particularly our youth. 

36 

I have a quick question for Chairman Hawley. This whole concept of food deserts concerns me. I say that because most people 

do not realize in Nevada, the distance between Las Vegas and Reno 

is over 400 miles. That is an eight-hour drive. There is nothing but 

desert in between. 

Just to get to an urban area, many of our tribal communities 

have to drive four hours with desert everywhere. I completely understand. 

Can you elaborate, you may have talked about this, the food 

deserts and what we have done in Nevada to address this to bring 

healthy lifestyles but more importantly, fresh produce and fresh 

food to some of our communities? 

Mr. HAWLEY. The concept of food deserts even in Arizona, a lot 

of communities, Native communities nationwide are in food 

deserts. A lot of our Native communities are anywhere from half 

a hour to four hours away from a town or what have you. 

Some reservations have grocery stores on them; others do not. 

Some of them have local C stores. They have the local junk food 

and that type of thing where you go in and get your basic needs 

and that is about it. It is interesting that the concept exists for Natives nationwide and the access you have or do not have. 

We talked about traditional resources, traditional gathering, you 

have hunting and fishing, all those sources but then we also will 

tap into the food banks where you do have the commodities. But 

commodities have changed over the years. The quality of the food 

that is provided has gotten better. Food banks have been there. 

A lot of communities will refer to a town day. You have your 

families who will have one day out of a month designated to making those trips to town to buy everything in bulk, bring it back and 

store it, preserve it or freeze it. You do what you have to do. That 

is how you survive for the month off a town day. 

You think about those things and also you consider the fact that 

you utilize the traditional methods of hunting and gathering. It is 

a real situation and it is concerning. Sitting on the panel is the 

first time that I have heard the term. 

I started thinking about all the different things, the town days 

and all the planning Natives do just to go get the food you need 

to survive or have the nutritious meals that you count on every 

day, the seasonal gathering and the day-to-day activities if you are 

hunting or fishing, that type of thing. 

I really believe that is an issue but tribes are being creative, 

communities are being creative. As I said, we do tap into the resources, Meals on Wheels for elders, those types of social programs 

that we tap into the same as any State or city taps into social service resources and human services. They are all very much a huge 

component of how tribes operate daily. 

Senator CORTEZ MASTO. Thank you very much. 

Thanks to all the panelists for being here and discussing this important topic. I do think it is an area that needs to be addressed. 

I think when we are talking just in general about healthy living, 

healthy choices, having access is the key to prevention and addressing so many of the health care issues we see in some of our 

tribal communities. 

37 

I appreciate all the comments today and look forward to working 

with all of you. Thank you again for being here. 

The CHAIRMAN. Thank you, Senator. 

I would turn to Vice Chairman Udall for any other questions. 

Senator UDALL. Thank you. 

SDPI has been flat funded for over a decade now despite the high 

return on investment. Admiral Buchanan and Chairman Hawley, 

how has the flat funding limited the impact of SDPI over the 

years? 

Mr. BUCHANAN. The results speak for themselves. As far as the 

20 years of progress we have made, the chart that was shown, activities going down to continue that process, again, it is a high priority for the agency moving forward. 

Senator UDALL. When you talked about the progress going down, 

was that for adults and children? 

Mr. BUCHANAN. That was for adults. 

Senator UDALL. Adults. Is there the same number for children? 

Since this was authorized as a pilot program in 1997, have the 

numbers gone down for children? 

Mr. BUCHANAN. There has not been a study that specifically focuses on children related to that for more data, but with the graph, 

the funding was implemented. In 1997, you can see a sharp spike 

coming down from that point forward. 

Senator UDALL. Chairman Hawley. 

Mr. HAWLEY. I can definitely say that with the flat source of 

funding for x amount of years, our tribal communities are growing 

and with the flat source of funding, I can definitely also say that. 

I made the statement earlier that we sometimes expect more for 

less. When our communities continue to grow and we have growing 

populations of elders and youth coming up and then you have the 

unborn coming up, you think about how over a year a tribe or even 

a community population can increase. 

There is definitely an impact but the percentage, as the Admiral 

said, we do not know the direct impact or the percentage because 

we have not looked at those studies yet. Just thinking about the 

previous comments about doing a little bit more with a little bit 

less, figuratively in my mind that is what I am thinking. 

We are doing a little bit more every time our populations get bigger but with the same amount of funding. How big an impact does 

that really have except for we are doing a little bit more work because we are addressing a larger population. 

Do we have the same outputs? Possibly. We do not know. Are we 

doing the same thing over and over? Not likely because of the flexibility that the SDPI programs have nationwide. A lot of ideas are 

being implemented in different areas that are working for some 

areas. 

Ideas are being passed back and forth. Tribes are being very creative within their programs to provide the service. 

Senator UDALL. Admiral, did you have something to add on that? 

Mr. BUCHANAN. I would agree that the tribes are truly the partners that are driving the innovations and changes going forward 

making those programs specific to their needs moving forward. 

That is the success behind the SDPI programs. 

38 

Senator UDALL. On the success, the numbers I have, tell me if 

any of you disagree with these. SDPI has supported a 61 percent 

growth in the use of culturally-tailored diabetes education programs which we have heard today make a real impact, if it is culturally-tailored, it is in the community and addressing the community’s needs. 

The CDC has linked SDPI to a 54 percent decrease in diabetesrelated kidney failure in the population. Is that what was on the 

chart you showed us? 

Mr. BUCHANAN. Yes, sir. 

Senator UDALL. Thank you, Mr. Chairman. 

The CHAIRMAN. I have just one follow-up question. Are you doing 

studies of the effect of SDPI on Native youth? You have adults and 

youth. Are you actually looking at the impact SDPI is having on 

Native youth and are you measuring that? 

Mr. BUCHANAN. We are working with adults, that is what the 

SDPI program is designed to do, to work with the adults to reduce 

diabetes, since 1997. We are utilizing our programs, as mentioned 

earlier, related to the National Congress of American Indians. 

Doing specific studies right now, we are not doing that as I understand it. 

The CHAIRMAN. Why? 

Mr. BUCHANAN. That is a great question. We are utilizing the information we are getting from our adults. I can mention the holistic approach, going forward and utilizing those best practices as 

mentioned on the panel today to address our youth. 

The CHAIRMAN. At this point, I would ask are there other questions from the Senators? 

[No audible response.] 

The CHAIRMAN. I want to turn to the panel and say to all of you, 

thank you very much for being here. 

Members may also submit follow-up questions for the record if 

they so desire. The hearing record will be open for two weeks. 

To all of our witnesses, thank you for the good work you are 

doing out there. We appreciate you being here so much. 

With that, we are adjourned. 

[Whereupon, at 4:20 p.m., the Committee was adjourned.] 

(39) 

A P P E N D I X 

PREPARED STATEMENT OF HON. W. RON ALLEN, TRIBAL CHAIRMAN, JAMESTOWN

S’KLALLAM TRIBE; BOARD CHAIRMAN, SELF-GOVERNANCE COMMUNICATION & 

EDUCATION TRIBAL CONSORTIUM

The Self-Governance Communication & Education Tribal Consortium1 (SGCETC), 

representing more than 360 Self-Governance Tribes, writes to enthusiastically endorse the success of the Special Diabetes Program for Indians (SDPI) and to support 

the National Indian Health Board’s (NIHB) written testimony. SGCETC appreciates 

that the Senate Committee on Indian Affairs (SCIA) convened a hearing to highlight 

the success and challenges of SDPI and we submit this testimony to be included in 

the hearing record. 

Though many issues were discussed during the hearing, SGCETC would like to 

provide comments and recommendations based on the proposals and priorities SelfGovernance Tribes outline in the 2017–2019 Self-Governance Strategic Plan. In particular, Self-Governance Tribes would like to highlight the SDPI Diabetes Prevention Initiative’s (SDPI DPI) success record and the flexibility SDPI allows for community driven solutions. We have also provided a few recommendations about how 

to improve the program in anticipated legislative reauthorization efforts. 

Recent data illustrates SDPI is curbing the rate of Type 2 diabetes and related 

diseases through a lifestyle intervention program adapted from the National Institutes of Health Diabetes Prevention Program and implemented in many Tribal communities. By 2014 the structured lifestyle program showed significant improvements 

among participants in key behaviors and diabetes risk factors, including weight loss, 

BMI, healthy eating, and regular physical activity. See Table 1 below. 

Overall, SDPI is producing a significant return on the federal investment and has 

become an effective federal initiative to combat diabetes and its complications. In 

Fiscal Year (FY) 2016, more than one-third of the SDPI grants and nearly fortyfive percent of the total grant funds were administered by Self-Governance Tribes. 

SDPI has become a crucial preventative and clinical program Self-Governance 

Tribes use to prevent longterm illness. In fact, many Self-Governance Tribes have 

integrated SDPI so fully into their clinical day-to-day responsibilities it is hard to 

determine where one begins and the other ends. It is precisely this flexibility that 

has made SDPI a successful program across more than 300 unique Tribal communities. 

1 The SGCETC consists of Tribal Leadership whose mission is to ensure that implementation of Tribal Self-Governance legislation and authorities in the Bureau of 

Indian Affairs (BIA) and Indian Health Service (IHS) are in compliance with the 

Tribal Self-Governance Program policies, regulations, and guidelines. 

Table 1. SDPI DPI Changes in Diabetes Risk Factors 

MEASURE RESULTS RESULTS 

Baseline 1 

(n=7,097) 

Follow-up 2 

(n=4,549) 

Weight Loss 

Mean Weight (lbs) 218 208 

Mean BMI (kg/m2) 35.9 34.4 

Lifestyle Behaviors 

Ate healthy foods once or more per week 77% 87% 

Ate unhealthy foods less than once per week 53% 81% 

Regular physical activity 30% 53% 

SPDI allows Tribes to implement diabetes related programs within their clinic or 

as part of other health outreach programs that are separate from the physical facilities—providing access to the services no matter where the patient is located. While 

40 

programs vary in their operation, each Tribe is required to identify at least one of 

eighteen best practices and report on the key measurements of that best practice 

semi-annually and annually. Additionally, SDPI grantees are required to submit to 

an annual Diabetes Care and Outcome audit, review the results, and adjust programs as necessary. Grantees are also required to participate in training and IHS 

offers free Continuing Medical Education opportunities virtually and in-person as a 

resource to meet that requirement. The IHS Division of Diabetes Treatment and 

Prevention also provides Standards of Care and Clinical Practice recommendations 

for clinicians to use in the treatment of patients with or at risk of developing Type 

2 Diabetes—all of which are available, for anyone to access, on their website. 

Self-Governance Tribes assert that the difference between maintaining the current status and decreasing rates of Type 2 Diabetes in Tribal communities largely 

depends on implementation of the program in the future. As such, we have a number of recommendations for Congress to consider as they plan to reauthorize the legislation prior to its expiration in September of 2017. 

Permanently reauthorize SDPI. Congress established the SDPI in 1997 as part of 

the Balanced Budget Act to address the growing epidemic of diabetes in American 

Indian and Alaska Native communities. SDPI programs have become the nation’s 

most strategic and comprehensive effort to combat diabetes. Self-Governance Tribes 

believe the success of these programs requires the permanent reauthorization of 

SDPI. We also assert that a permanent reauthorization would decrease burdensome 

administrative constraints SDPI grantees currently experience, such as the ability 

to recruit highly qualified staff on a permanent basis. 

Provide a $50 million increase for SDPI. Funding for SDPI has not increased since 

2001, when Congress increased support from $100 million to $150 million. An increase in funding is necessary to maintain SDPI and make a difference in the rates 

of Type 2 Diabetes among American Indian and Alaska Native Youth. As such, SelfGovernance Tribes request that the Committee consider increasing the authorization for SDPI to $200 million. A $50 million increase will essentially level the field 

for SDPI grantees, as that increase only reflects inflation to 2017. As a few panelists 

stated, Tribes are used to doing more with less, but the time has come to provide 

a substantive increase that would give Tribes the room to sufficiently administer the 

program. 

Limit oversight and administrative burden. Although improved delivery of care 

and increased primary prevention of Type 2 Diabetes over the past 20 years is readily documented, the annual grant application process remains cumbersome and time 

consuming. Tribes and Tribal Organizations are required to submit lengthy applications describing the activities and best practices on which they will report, even 

when the activities and funding do not significantly change. The short-term authorizations for SDPI detracts IHS and grantees from creating a long-term strategy. 

Self-Governance Tribes assert that, in combination with a longer or permanent authorization, longer grant periods would create more substantive change in Tribal 

communities, because it would encourage Tribes to track their performance over a 

longer period of time and set attainable goals that are based on health-related outcomes. Self-Governance Tribes also ask that a limited amount of reporting be required. Though currently data is only collected a few times a year, data collection 

and entry are burdensome and time consuming. The grant application process and 

required reporting merely result in a diversion of federal funds from their intended 

purpose—serving patients who have or at risk of developing Type 2 Diabetes. 

Allow grantees to collect contract support costs. IHS has maintained that Tribes 

can only collect indirect costs related to the performance and delivery of services 

from within the grant award. This ultimately results in fewer services being delivered in Tribal communities. As we described above, the administrative requirements 

to properly implement a SDPI grant is quite burdensome. Allowing Tribes to properly account for indirect and direct costs related to the program would effectively 

provide grantees with an increase in funding. 

SDPI continues to illustrate that healthier and stronger Tribal communities are 

possible with community driven, culturally applicable action plans and national best 

practices. As the Committee looks forward to reauthorization, we hope that you account for the flexibility needed to properly implement a prevention and treatment 

program in Tribal communities across the country and consider the positive effects 

a long-term reauthorization, funding increase, and simplification of oversight could 

have in the success of SDPI. 

In closing, SGCETC would like to thank the Committee for the opportunity to 

submit testimony. We look forward to working with you on the successful SDPI reauthorization. 

41 

PREPARED STATEMENT OF ALLISON BARLOW, PH.D, MA, MPH, DIRECTOR, CENTER

FOR AMERICAN INDIAN HEALTH, JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC

HEALTH

Dear Senators Hoeven and Udall, 

I am writing as Director of the Center for American Indian Health at the Johns 

Hopkins Bloomberg School of Public Health, to request that my written testimony 

be included in the record for the hearing on March 29, 2017 entitled ‘‘Native Youth: 

Promoting Diabetes Prevention through Healthy Living.’’ In my expert opinion, the 

Special Diabetes Prevention Initiative (SPDI) has produced very positive results and 

I urge you to encourage your colleagues to consider level funding at $150 million 

in the FY17 and FY18 budgets. 

Congress’s continued support for SPDI will yield tremendous return on investment by hastening the discovery of cost-effective solutions for preventing diabetes 

for all Americans through a proven program that has demonstrated sound evidence 

and accountability. 

The Johns Hopkins Center for American Indian Health has held a Memorandum 

of Understanding with Indian Health Service (IHS) since its founding in 1991. 

Johns Hopkins and IHS leverage research findings and disseminate best practices 

to overcome tribal health disparities. The Center also works to scale up solutions 

found effective with American Indian communities to other vulnerable American 

communities. 

In terms of of public health impact, my colleagues and I at the Johns Hopkins 

Center for American Indian Health cannot overstate the importance of the 1997-enacted SPDI to American Indian and Alaska Native health and well-being. The 

achievements that have occurred over the past 20 years are of tremendous public 

health significance: these achievements include a decrease in type 2 diabetes in 

American Indian and Alaska Native youth, a 54 percent reduction in end-stage 

renal disease between 1997–2013, and the levelling off of obesity levels in American 

Indian children. 

This progress has occurred through congressionally-appropriated resources ($150 

million/year) that Indian Health Service has been able to extend to 301 tribal communities across 35 states. Through the leadership of the IHS Diabetes Program director, Ann Bullock, MD, these dollars have materialized into comprehensive, creative, and effective prevention strategies that are now being recognized as a model 

for the nation and the world. For example, a leading international journal just published a reference to SPDI impact: 

A promising new report demonstrates a substantial decline in the incidence of 

diabetic end-stage renal disease among American Indians and Alaska Natives, 

coinciding with a public health intervention targeting diabetes management in 

this population. This success may offer a model for interventions to improve kidney disease outcomes in other high-risk populations.—C. Wyatt, Kidney International (2017) 91, 766–768 

However, the work of SPDI is not done. American Indian and Alaska Native children and families still shoulder the greatest disparities in obesity, diabetes, and related health and workforce consequences of any racial or ethnic group in the nation. 

This constellation of disease is the result of forced lifestyle changes brought about 

through colonization. The degradation of American Indian health due to commercialized diets and sedentary lifestyles forecasts what will be the fate of the majority 

of Americans if we don’t continue to discover effective public health intervention to 

curb obesity and diabetes. Further, building interventions with the highest risk, 

lowest-income population makes the most scientific and economic sense. 

Sustained investment in SPDI will continue to produce fruitful innovations for 

high-risk populations and ultimately save our nation inestimable costs in human 

suffering, lost productivity, and health care and workforce dollars. Indeed, Dr. Bullock’s latest work through SPDI to support intervention with expectant parents 

through children’s early life (0 to 3 years) is designed to prevent diabetes starting 

in the womb. Early life intervention could revolutionize how we will protect children’s health and our nation’s prosperity. 

Thank you for including these comments in the record. 

PREPARED STATEMENT OF UNITED SOUTH AND EASTERN TRIBES SOVEREIGNTY

PROTECTION FUND (USET SPF) 

United South and Eastern Tribes Sovereignty Protection Fund (USET SPF) is 

pleased to provide the Senate Committee on Indian Affairs (SCIA) with testimony 

for the record of its March 29th oversight hearing, ‘‘Native Youth: Promoting DiabeVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00045 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
42 

1 USET SPF member Tribal Nations include: Alabama-Coushatta Tribe of Texas (TX), Aroostook Band of Micmac Indians (ME), Catawba Indian Nation (SC), Cayuga Nation (NY), 

Chitimacha Tribe of Louisiana (LA), Coushatta Tribe of Louisiana (LA), Eastern Band of Cherokee Indians (NC), Houlton Band of Maliseet Indians (ME), Jena Band of Choctaw Indians (LA), 

Mashantucket Pequot Indian Tribe (CT), Mashpee Wampanoag Tribe (MA), Miccosukee Tribe 

of Indians of Florida (FL), Mississippi Band of Choctaw Indians (MS), Mohegan Tribe of Indians 

of Connecticut (CT), Narragansett Indian Tribe (RI), Oneida Indian Nation (NY), Passamaquoddy Tribe at Indian Township (ME), Passamaquoddy Tribe at Pleasant Point (ME), Penobscot Indian Nation (ME), Poarch Band of Creek Indians (AL), Saint Regis Mohawk Tribe (NY), 

Seminole Tribe of Florida (FL), Seneca Nation of Indians (NY), Shinnecock Indian Nation (NY), 

Tunica-Biloxi Tribe of Louisiana (LA), and the Wampanoag Tribe of Gay Head (Aquinnah) (MA). 2 USET, or United South and Eastern Tribes, is the 501(c)3 sister organization to USET SPF, 

which is a 501(c)4. USET provides programmatic and technical support to our 26 member Tribal 

Nations. 3 IHS SDPI 2014 Report to Congress. 

tes Prevention Through Healthy Living.’’ USET SPF appreciates the SCIA for making the reauthorization of the Special Diabetes Program for Indians (SDPI) a priority for this Congress. The SDPI program has made inroads in diabetes care and 

prevention in Indian Country, including in the development of youth education and 

prevention initiatives. The program must be reauthorized this Fiscal Year. 

USET SPF is a non-profit, inter-tribal organization representing 26 federally recognized Tribal Nations from Texas across to Florida and up to Maine. 1 USET SPF 

is dedicated to enhancing the development of federally recognized Indian Tribal Nations, to improving the capabilities of Tribal governments, and assisting USET SPF 

Member Tribal Nations in dealing effectively with public policy issues and in serving the broad needs of Indian people. This includes advocating for the full exercise 

of inherent Tribal sovereignty. 

Special Diabetes Program for Indians (SDPI) and Diabetes Prevention 

Programs 

In response to the disproportionately high rate of type 2 diabetes in American Indians and Alaska Native (AI/AN) communities, Congress passed the Balanced Budget Act in 1997 establishing the SDPI as a grant program for the prevention and 

treatment of diabetes at a funding level of $30 million per year for five years. After 

extensive Tribal consultation, the Indian Health Service (IHS) distributed the funding to over 300 IHS, Tribal and Urban AI/AN health programs. In 2001, Congress 

increased the amount of SDPI funding to $100 million per year, and then again increased it to $150 million per year from 2004–2010, which was then extended for 

an additional 3 years through Fiscal Year (FY) 2013. Since FY 2013, SDPI had been 

extended in one year increments, however, the most recent extension as a part of 

the ‘Doc Fix’ legislation in June of 2015, authorized two additional years at $150 

million/year through September 30, 2017. With SDPI set to expire this year, it is 

critical that this Congress prioritize its reauthorization. 

In the Indian Health Service (IHS) Nashville Area, the prevalence rate of diabetes 

is 23 percent, which is 3.6 times higher than the U.S. all races age-adjusted rate 

of 6.4 percent. Rates can be even higher in individual USET SPF states, like Louisiana and Mississippi, where prevalence rates for our member Tribal Nations are 

at 29.5 percent and 36.7 percent, respectively. Despite the severity of the epidemic, 

Tribal Nations have implemented successful and culturally relevant diabetes prevention and treatment activities through the SDPI grant program. 

USET2 has been an SDPI grantee since its inception, and is unique in that it applies for the SDPI grant on behalf of 20 of its member Tribal Nations as the primary 

grantee. USET then enters into subcontract agreements with participating Tribal 

Nations for local program implementation. Our member Tribal Nations continue to 

feel this is the easiest and best grant option for them, as many are small communities with limited staffing and resources to write a grant of this magnitude. USET’s 

administration of grant dollars allows local level staff to focus on the prevention, 

care, and treatment of diabetes within their communities. 

Through SDPI and its Diabetes Prevention Program (DP, a program piloted as 

part of the larger SDPI), Tribal Nations have built significant infrastructure to address the health needs of their pre-diabetic and diabetic citizens. This includes diabetes specific health providers, regular testing and monitoring, nutritionists, fitness 

programs, and patient education. In addition to avoiding the more costly consequences of diabetes, like End Stage Renal Disease and limb amputations, among 

the diabetic population, Tribal SDPI programs have successfully prevented the disease among at-risk groups. In fact, after steadily increasing over the preceding two 

decades, between 2000 and 2011, incidence rates of ESRD in AI/AN people with diabetes decreased 43 percent—more than for any other racial group in the U.S. 3

43 

In 2004, through the SDPI program, IHS piloted the DP program to implement 

lifestyle interventions, which were found effective through clinical trials in the National Institutes of Health-led clinical trial on diabetes prevention throughout the 

federal system. By May 2014, approximately 4,549 high-risk AI/AN participants 

completed program courses on healthy lifestyle interventions. Among those that 

completed the program, 87 percent of participants ate healthy foods once or more 

per week versus the pre-intervention baseline of 77 percent and 53 percent engaged 

regularly in physical activity compared to 30 percent pre-intervention. IHS estimates that the incidence rate of diabetes for participants in the SDPI DP was 6.5 

percent compared to the 11 percent for the NIH Placebo group. The lower rates of 

diabetes incidence show the efficacy of SDPI DP interventions and the success of 

diabetes prevention infrastructure in Indian Country. 

Challenges with Diabetes Prevention Program Certifications 

Although we acknowledge the importance of evidence-based Diabetes Prevention 

Programs (DPP) through the Centers for Disease Control and Prevention (CDC), we 

do not believe this is the only approach for Indian Country in administering quality 

prevention programs. This is because many USET SPF member Tribal Nations do 

not have the capacity to meet the strict eligibility criteria and program requirements. USET SPF is currently aware of at least one Tribal Nation health program 

with CDC DPP certification at risk of losing its certification due to on-going challenges with recruitment of patients meeting the eligibility criteria, as well as overly 

narrow quality and reimbursement indicators. These indicators have unrealistic target thresholds and should be subject to individual targets that better meet the 

health objectives of a particular program. Additionally, the current criteria omits indicators on behavioral change, which are important for measuring the success of 

these lifestyle interventions. Indicators should include behavioral change measures 

related to diet and exercise, which are major factors in diabetes prevention and were 

proven effective through the SDPI DP pilot. In order for our Tribal Nations to continue programming with CDC DPP certification, these flexibilities are necessary to 

account for the unique circumstances and challenges of diabetes prevention work in 

Indian Country. 

Similar challenges exist for our smaller member Tribal Nations which operate 

SDPI programs and may wish to seek CDC DPP certification in the future. Under 

the current criteria, many USET SPF member Tribal Nations would be precluded 

from participation due to a lack of capacity, staffing shortages, and small populations of patients meeting patient eligibility criteria. Many of these Nations do not 

have the staffing bandwidth to undertake the administrative burdens of applying 

for CDC DPP or American Diabetes Association recognition. 

SDPI Advancements 

Like other Tribal Nations across the country, USET SPF Tribal Nations suffer 

disproportionately from a variety of health issues, leading oftentimes to a severely 

reduced quality of life and life span. AI/ANs suffer from obesity, hypertension, heart 

disease, and diabetes at rates much higher than the general U.S. population. Data 

shows that AI/ANs have the highest rates of diabetes in the U.S. and are more than 

twice as likely as white adults to have diabetes. IHS’ SDPI grant program is beginning to turn these statistics around. Recent data shows that through SDPI, USET 

Tribal Nations have made significant progress. Between 2013 and 2015, USET Tribal Nations increased the percentage of: 

• Healthy blood sugar in our diabetes patients from 45 percent to 49 percent; 

• Normal blood pressure from 60 percent to 62 percent; and 

• The rate of annual eye exams from 45 percent to 55 percent. 

Through collaborations, best practices, and prevention initiatives resulting from 

SDPI, our Tribal Nations are making strides. Nashville Area AI/ANs are living 

longer with diabetes, with increased access to specialty care and better control of 

the disease, all due to this essential program. 

For example, the Passamaquoddy Tribe of Maine (USET SDPI sub contractor) is 

working in partnership with the University of Maine’s Cooperative Extension Program and the Pleasant Point Health Center SDPI Program collaborated on two community programs, the first being a 4-week program called Dining with Diabetes 

Down East. The program was adapted to include information specific to the Passamaquoddy community, culturally specific foods, and some use of the Passamaquoddy 

language. Each session included a presentation, cooking demonstrations, and facilitated discussion. An overview of the Diabetes ‘‘ABCs’’ (A1C, Blood Pleasure and 

Cholesterol) was presented during the first session and the other sessions covered 

other aspects of diabetes prevention. The program gave many participants a new 

44 

outlook on traditional foods and culture within their communities, while developing 

healthy habits for long-term prevention. 

The second program was teaching the Diabetes Education in Tribal Schools 

(DETS) curriculum to pre-school, kindergarten, first, and second grade students 

from October 2015—March 2016. The children and teachers learned about more and 

less healthy foods and activities; and about diabetes. One of the last classes involved 

bringing in a community member with diabetes so that the students could ask them 

questions about the disease. The success of the program is due to the collaborative 

effort between the teachers, students, Pleasant Point Health Center SDPI program 

and the University of Maine Cooperative Extension. These collaborations are only 

some of the impacts that SDPI has had on Tribal communities, including youth. 

Native Youth: Obesity and Diabetes Rates 

The impacts of obesity and diabetes on Native youth are troubling. In the IHS 

Nashville Area, Tribal Nations have been able to maintain the low rates of diabetes 

for youth under 20 years of age (accounting for less than 1 percent of the total diabetes population) within our communities. However, many USET SPF Tribal Nation 

battle high youth obesity rates, with over half of the youth between the ages of 2 

and 5 years falling into the obese body mass index ranges. Some initiatives that 

USET SPF Tribal Nations are utilizing through SDPI to decrease these rates are: 

• Teaching the DETS curriculum in schools or after school programs; 

• Making healthy food choices available and fun/interesting to Native youth; 

• Learning about traditional Tribal Nation foods and incorporating them into 

diets; 

• Providing healthier foods in vending machines; 

• Providing healthy cooking and/or snack preparation classes for kids; and 

• Limiting fast food meals for kids and providing quick, easy, healthy options for 

families on the go. 

SDPI plays an important role in ensuring USET SPF Tribal Nations are able to 

reduce high rates of obesity among our youth. These types of interventions reduce 

the incidence of risk factors for diabetes, such as obesity, providing long-term health 

benefits. 

Access to Healthy Food and Fresh Vegetables 

Tribal Nations are located in some of the most rural and impoverished communities, lacking overall access to health care and healthy food options. Limited access 

to healthier foods, such as fresh vegetables, is often times a barrier to maintaining 

a healthy diet. USET SPF member Tribal Nations vary in their ability access to 

healthier food options, but through SDPI, all are utilizing methods to increase traditional foods and healthier options available to Tribal communities. SDPI has allowed for community and school gardens, providing access to healthier and fresh 

foods, while encouraging physical activity. Tribal Nations are incorporating traditional foods and language into these gardens as a means to maintaining community 

and youth cultural knowledge and the foods our ancestors consumed. 

Reauthorize SDPI 

Despite its documented success, funding for SDPI has been flat since 2004, even 

as inflation and medical costs rise. Tribal Nations and Congress have made significant investments in preventing and managing diabetes. In order to continue making 

progress in the fight against the disease in Indian Country, SDPI must be reauthorized this Fiscal Year to avoid the loss of Tribal programs, prevention, and progress. 

Any lapse in reauthorization will cause the costs of diabetes and its complications 

to increase again for Tribal communities, and precious jobs created by this program 

will cease. USET SPF is urging Congress to reauthorize the SDPI for multiple years 

at no less $150 million/year, with incremental increases each year based on medical 

inflation rates. Congress must not allow this successful investment to lapse, just as 

its effects arebeing realized in the form of strong data and widespread lifestyle 

changes. Timely reauthorization will ensure that Tribal Nations can continue the 

fight against this epidemic without interruption. 

Conclusion 

USET SPF appreciates the opportunity to provide comments following the SCIA 

hearing on Native Youth: Promoting Diabetes Prevention through Healthy Living. 

Over the past 19 years, Indian Country has been leading the fight against the diabetes epidemic, and assisting patients and communities affected by the disease. 

Congress and IHS, along with Tribal Nations, recognize the importance and effectiveness of SDPI interventions in improving and maintaining the health of Tribal 

45 

1See OFFICE OF HAWAIIAN AFFAIRS, NATIVE HAWAIIAN HEALTH FACT SHEET 2015, 

VOL.1, CHRONIC DISEASE, available at http://i19of32x2y133s8o4xzaOgf14.wpengine.netdnacdn.com/wp-content/uploads/Volume-1-Chronic-Diseases-FINAL.pdf. 2 2See UNIVERSITY OF HAWAI’I AT MANOA JOHN A. BURNS SCHOOL OF MEDICINE 

CENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH DEPARTMENT 

OF NATIVE HAWAIIAN HEALTH, ASSESSMENT AND PRIORITIES FOR HEALTH & 

WELL–BEING IN NATIVE HAWAIIANS & OTHER PACIFIC PEOPLES, available at http:// 

www.hicore.org/media/assets/JABSOMStudyreNHHealthl20131.pdf 3 3See OFFICE OF HAWAIIAN AFFAIRS, NATIVE HAWAIIAN HEALTH FACT SHEET 

2015, VOL.1, CHRONIC DISEASE, available at http:// 

19of32x2y133s8o4xzaOgIl4.wpengine.netdna-cdn.com/wp-content/uploads/Volume-1-ChronicDiseases-FINAL.pdf 4See CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR 

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, DIABETES REPORT 

CARD 2014, available at https://www.cdc.gov/diabetes/pdfs/library/ 

diabetesreportcard2014.pdf 

communities. USET SPF urges this Congress to reauthorize SDPI before it expires 

on September 30, 2017, and looks forward to working with the Committee on advancing this vital legislation. 

PREPARED STATEMENT OF KAMANA’OPONO M. CRABBE, PH.D. (KA POUHANA)/CEO, 

OFFICE OF HAWAIIAN AFFAIRS (OHA) 

Aloha e Honorable Chairman John Hoeven, Vice Chairman Tom UdaIl, and members of the Senate Committee on Indian Affairs, 

Mahalo (thank you) for the opportunity to submit testimony regarding the Committee’s March 29, 201 7 Oversight Hearing on ‘‘Native Youth: Promoting Diabetes 

Prevention Through Healthy Living.’’ The Office of Hawaiian Affairs (OHA) is a 

public trust and independent state agency established through the Hawai’i State 

Constitution to improve the lives of Hawai’i’s indigenous people (Native Hawaiians). 

OHA’s enabling statute charges it to advocate on behalf of Native Hawaiians, and 

to assess policies and practices as they may affect Native Hawaiians. OHA is also 

named in various federal statutes as a recognized Native Hawaiian organization 

with standing to be consulted with on matters pertaining to Native Hawaiian rights 

and cultural resources. With that kuleana (responsibility) in mind, our agency is 

pleased to submit testimony for the record. 

OHA operates under a strategy plan which includes Mauli OIa (health) as a strategic priority of the agency. Our agency collaborates with various organizations to 

strengthen our community’s resources in six strategic priorities, including health. 

We employ the Native Hawaiian framework of Mauli Ola in our work to advance 

the health and well-being of Native Hawaiians. In this framework, individual health 

is connected to a number of environmental and social factors, also known as social 

determinants of health. We focus on physical, emotional, mental, and spiritual 

health, as well as social, economic, and environmental factors influencing health and 

wellbeing at each stage of our beneficiaries’ lives. Ancestral wisdom as well as mainstream historical record and scientific research reflects that prior to regular Western 

contact, Native Hawaiians were a thriving, abundantly healthy people living in 

what Congress, through Public Law 103–1 50 described as ‘‘a highly organized, selfsufficient, subsistent social system based on communal land tenure with a sophisticated language, culture, and religion.’’ 

Unfortunately, Western contact and the erosion of Native Hawaiian control over 

our resources greatly disrupted the land-based social determinants of health that 

Native Hawaiians had established. Since then, the health challenges laced by the 

Native Hawaiian community have greatly evolved. While communicable diseases 

were once the greatest threat facing the Native Hawaiian community in the late 

eighteenth through early twentieth century, noncommunicable diseases pose a serious threat today. In this respect and others, we share many of the needs and concerns of our American Indian and Alaska Native brothers and sisters. Many chronic 

diseases, especially asthma, hypertension, and diabetes, have a higher prevalence 

within the Native Hawaiian community in comparison with the general population 

of the State of Hawai’i. 1 It has been estimated that one in three Native Hawaiian 

adults have or are at-risk for diabetes or pre-diabetes. 2 In 2010, the age-adjusted 

prevalence rate of Native Hawaiians living with diabetes was 84.4 per 1,000 people, 

while the State of Hawai’i’s overall prevalence was 59.9 per 1,000 people. 3

According to the Centers for Disease Control and Prevention (CDC), there are a 

number of risk factors that increase the likelihood of developing diabetes. Obesity 

is one such factor strongly linked with the development of Type 2 Diabetes. 4 PaVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00049 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
46 

5 Ibid. 

6See OFFICE OF HAWAIIAN AFFAIRS, NATIVE HAWAIIAN HEALTH FACT SHEET 2015, 

VOL.1, CHRONIC DISEASE, available at http://19of32x2yl33s8o4xzaOgf14.wpengine.netdnacdn.com/wp-content/uploads/Volume-l-Chronic-Diseases-FINAL.pdf 7 Ibid. 

8 Ibid. 

9 9See UNIVERSITY OF HAWAI’I AT MANOA JOHN A. BURNS SCHOOL OF MEDICINE 

CENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH DEPARTMENT 

OF NATIVE HAWAIIAN HEALTH, ASSESSMENT AND PRIORITIES FOR HEALTH & 

WELL–BEING IN NATIVE HAWAIIANS & OTHER PACIFIC PEOPLES, available at http:// 

www.hicore.org/media/assets/JABSOMStudyreNHlHealthl20131.pdf 

tients who are obese and diagnosed with Type 2 Diabetes often have poor control 

of their blood sugar, blood pressure, and cholesterol, which can all lead to severe 

health complications. 5 Obesity is a problem facing the Native Hawaiian community. 

In 201 2, the Native Hawaiian obesity rate in Hawai’i was 44 4% 6 This rate is in 

stark contrast to the State of HawaVi’s relatively low obesity rate of 23.6 percent, 

which is much lower than most of the nation. 7 Native Hawaiian youth are also affected by obesity, and Native Hawaiian public school students have a rate that is 

much higher than their peers in the State. 8

OHA currently funds a number of programs in Hawai’i that use the Mauli Ola 

framework for diabetes treatment and prevention for Native Hawaiians. One such 

program, the Hua Ola Project, is managed by the Boys & Girls Club of the Big Island, and instills lifelong fitness and dietary habits in youth through culturally responsive experiential education. Another program currently funded by OHA is I Ola 

Lahui’s KUlana Hawai’i project, which provides comprehensive, culturally-minded 

weight and chronic disease management services to Native Hawaiian adults and 

their families. The continued delivery of innovative programs that focus on Native 

Hawaiian adults and emphasize youth education is critical to addressing the health 

disparities of Native Hawaiians. Beyond these critical initiatives, Papa OIa Lokahi 

and the five Native Hawaiian Health Care Systems located within the State provide 

research, education, and other services, as well as foster and encourage collaborations for a holistic approach to health care in the Native Hawaiian community 

broadly. 

Significant health improvements have been achieved in programs integrating cultural practices into health interventions. 9 To create a lasting effect on the health 

of Native Hawaiians and decrease diabetes prevalence in the Native Hawaiian community, Native Hawaiian adults, youth, and families must be provided the opportunity to engage in these types of healthy living programs, diabetes management 

education, and other diabetes prevention programs and culturally-grounded services 

in the Mauli Ola framework. 

OHA once again thanks the Committee for holding this oversight hearing on Native youth and the promotion of healthy lifestyles. This important topic needs to 

continue to be addressed in Native American, Alaska Native, and Native Hawaiian 

communities. We humbly ask that Hawai’i’s indigenous people also be considered in 

whatever legislative and oversight initiatives Congress engages in to address these 

important issues. I look forward to continuing to work with you on these issues and 

others affecting our Native people. 

PREPARED STATEMENT OF PATRICK M. ROCK, MD, CEO, INDIAN HEALTH BOARD OF

MINNEAPOLIS, INC. 

Dear Senator: 

On behalf of the Indian Health Board of Minneapolis, I thank you for your interest in the issues that are important to American Indian/Alaska Native (AI/AN) people. My clinic is also a proud member of the National Council of Urban Indian 

Health, which represents the interests of the more than 40 urban Indian health providers (UIHPs) the Congress has established in far-flung locations across the nation 

to serve urban Indians, who constitute more than 70 percent of all AI/AN people. 

AI/AN adults are 2.3 times more likely to have diabetes compared with non-Hispanic whites and the death rate due to diabetes for AI/AN is 1.6 times higher than 

the general U.S. population. SDPI, which is an indispensable part of the solution 

to this scourge, supports over 330 diabetes treatment and prevention programs in 

35 states, which have led to significant advances in diabetes education, prevention, 

and treatment. 

The good news is SDPI works and it saves money in the long run. In 2000–2011, 

the incidence rate of End-Stage Renal Disease (ESRD) in AI/AN people with diabeVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00050 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
47 

tes declined by 43 percent—a greater decline than any other racial or ethnic group. 

ESRD is the largest cost-driver of Medicare costs. 

Reduction in the incidence rate translates into significant cost savings for Medicare, the IHS, and third party payers. 

S. 747 would reauthorize SDPI for seven years—from fiscal year 2018 through fiscal year 2024—at no increase in cost other than taking into account health care inflation. I urge you to cosponsor The Special Diabetes Program for Indians Reauthorization Act of 2017 (S. 747), which was recently introduced by Senator Tom Udall 

(D–NM). SDPI will be shut down on September 30 if the program is not reauthorized in time. If SDPI’s reauthorization is not to fall through the cracks, it is imperative that Senator Udall’s bill be supported through co-sponsorships. 

SDPI has become the most comprehensive treatment and prevention programing 

available to NA/AI in the Minneapolis-St Paul Metro area. We are one of the longest 

funded programs in the United States. We have also been recognized nationally and 

locally in providing innovative diabetes programing. 

Thanks for your consideration of my views. Please let me know if you will cosponsor S. 747, so I can share the news with our clinic’s patients and providers. I will 

check in with your staff in two weeks on this matter because so much is at stake 

for Indian Country. Please let me know if you have any questions. 

PREPARED STATEMENT OF ASHLEY TUOMI, PRESIDENT, NATIONAL COUNCIL OF URBAN

INDIAN HEALTH

On behalf of the National Council of Urban Indian Health (NCUIH), which represents urban Indian health care programs (UIHPs) across the nation that provide 

high-quality, culturally-competent care to urban Indians, who constitute more than 

70 percent of all American Indians/Alaska Natives (AI/AN), I, Ashley Tuomi, 

NCUIH’s President, submit this testimony for the record in relation to the March 

29, 2017, oversight hearing held by the Senate Committee on Indian Affairs on the 

Special Diabetes Program for Indians (SDPI). 

I thank Chairman Hoeven for holding this hearing as well as his interest in SDPI 

and Ranking Member Udall for his recent introduction of the Special Diabetes Program for Indians Reauthorization Act of 2017 (S. 747), which NCUIH strongly supports. S. 747 would reauthorize SDPI for seven years-from fiscal year 2018 through 

fiscal year 2024—at no increase in cost other than taking into account health care 

inflation. NCUIH urges Senators to cosponsor this important legislation in order to 

show the support necessary to secure SDPI’s timely reauthorization. 

It is imperative that SDPI be reauthorized before its expiration on September 30. 

Grants to health care providers in Indian Country made pursuant to SDPI have 

been instrumental in the marked reduction in the incidence rate of diabetes-and the 

related savings to Medicare, the Indian Health Service (IHS), and third party providers. 

At NCUIH’s recent Washington Summit, timely reauthorization of SDPI was one 

of our organization’s top legislative priorities, even with a broad and comprehensive 

legislative agenda. The failure to reauthorize this program would severely undermine the promising progress UIHPs and Indian Country have made against diabetes. UIHPs are proud of their role in the fight against diabetes,—Out of the 301 

SDPI grants, 30 grants (out of 43 urban programs) went to UIHPs, or 6.65 percent 

of the $136,074,763 SDPI funds awarded nationally. 

The Committee is very familiar with the grim statistics of the toll that diabetes 

inflicts on Indian Country. AI/AN adults are 2.3 times more likely to have diabetes 

compared with non-Hispanic whites and the death rate due to diabetes for AI/AN 

is 1.6 times higher than the general U.S. population. And the costs in dollars are 

also extraordinary—in 2012 alone 11 percent of AI/AN with diabetes accounted for 

37 percent of all IHS adult treatment costs. 

However, the Committee also knows that SDPI achieves outstanding results and 

that the program saves significant money in the long run. SDPI supports over 330 

diabetes treatment and prevention programs in 35 states, which have led to significant advances in diabetes education, prevention, and treatment. In 2000–2011, the 

incidence rate of End-Stage Renal Disease (ESRD) in AI/AN people with diabetes 

declined by 43%—a greater decline than any other racial or ethnic group. ESRD is 

the largest cost-driver of Medicare costs. Reduction in the incidence rate translates 

into significant cost savings for Medicare, third party payers, as well as IHS. 

Let me tell the Committee how seven UIHPs have used SDPI funds to provide 

valuable services which have transformed and saved their patients’ lives. 

First, we can start in the northeast to Detroit, Michigan where my own program, 

American Indian Health and Family Services, resides. Last year we attempted to 

48 

refer clients for services outside of the agency that we sponsored with SDPI funds 

for diabetic testing, but we found that program unsuccessful, as patients were unlikely to follow-up with the referral. During this fiscal year we changed course and 

decided with SDPI funds we would purchase a retinal camera that now allows us 

to do undialated eye exams in the clinic. Now that we have our own equipment in 

house, we are able to catch the patients right when they enter our facility and there 

has been an immediately increase in retinal eye exams. We are catching diabetes 

as soon as it enters the door, thanks to SDPI funding. 

Then we can travel to the Great Plains, at the South Dakota Urban Indian Health 

(SDUIH), which serves both Pierre and Sioux Falls with full-time primary and behavioral health clinics. 

SDUIH has participated in the SDPI program for fifteen years. Throughout this 

time, SDUIH, with its accreditation from the American Diabetes Association, has 

provided direct diabetes patient education, prevention and treatment services that 

benefits those who have diabetes as well as those who are at high-risk of getting 

diabetes. 

SDPI funds have made it possible for SDUIH to add physical fitness centers located on-site within the clinic facility that offer new and state-of-the-art equipment. 

SDUIH has also added a fully operational teaching kitchen that allows patients to 

participate in cooking classes and learn how to improve their diets. 

SDPI funds support the program’s grocery store tours during which patients are 

accompanied by a care manager who teaches them how to shop for healthier and 

more nutritious food. Funds have also been used to purchase the lab equipment necessary for operating a high-level diabetes program, including Piccolo machines, DCA 

Vantage Analyzers, and HemoCue testing devices. 

SDPI funds allow SDUIH to employ highly-qualified staff to prevent and treat diabetes, including certified educators, registered dieticians, licensed nutritionists, fitness/yoga class instructors, and child care providers. 

Ms. Donna LC Keeler, the SDUIH Executive Director, reports that SDPI funds 

have allowed her program to provide a wide array of services to the diabetic patients serviced by SDUIH. According to the most recent Indian Health Service Annual Diabetes Audit, 59 percent of the program’s patients have had diabetes less 

than 20 years and 79 percent are diagnosed with comorbidity of hypertension which 

demonstrates the need of continued funding and services. Positive results from 

SDPI for the SDUIH program include 55 percent of their patients having blood 

sugar (A1c) control of 7.9 or less and 77 percent having blood pressure of 140/90 

or less, so progress is being made but there still is so much left to do. 

Thanks to SDUIH’s use of SDPI funds, 100 percent of all diabetic patients are 

screened for tobacco use; 97 percent have comprehensive foot exams; 77 percent 

have retinal imaging eye exams; 71 percent have annual dental exams; 99 percent 

have diabetes education; 97 percent have physical activity education; 85 percent 

have flu/pneumococcal vaccines; 73 percent have hepatitis B immunizations; and 

100 percent of diabetic patients are screened for depression. 

Ms. Keeler sums up the fight being waged by SDUIH against diabetes: ‘‘While, 

clearly, SDPI has been a success—lives of patients have been saved and their health 

status has been improved—much work remains to be done. Without SDPI funds, 

SDUIH would not be able to retain the dedicated diabetes staff that have accomplished so much for so many patients. It is critical to continue funding in order to 

fight against diabetes in Indian County.’’ 

Let’s shift our focus to Tulsa, Oklahoma, where the Indian community is served 

by the Indian Health Care Resource Center of Tulsa (IHCRC), a comprehensive clinic which cares for almost 12,000 patients annually. Accredited by the American Association of Diabetes Educators, IHCRC has used SDPI funds for almost 20 years 

to offer a variety of programming, including diabetes case management, fitness and 

exercise, nutrition counseling, and diabetes education. 

Ms. Carmelita Skeeter, the program’s chief executive officer, reports that during 

FY2016 alone, IHCRC’s diabetes program served 1,410 duplicated patients in the 

clinic for diabetes case management (63), diabetes education (649), diet management 

(604), and exercise/fitness education (94). Specific program goals include glycemic 

control, nutrition education, and physical activity education. IHCRC’s public health 

nurse, originally funded through the Healthy Heart program and now through 

SDPI, coordinates community efforts and the integration of diabetes case management into primary care, especially for repeatedly non-compliant patients. 

A chart audit of 881 patients with diabetes revealed that 77 percent had known 

hypertension and 72 percent had a Body Mass Index (BMI) of 30.00 or above (obesity). Based on BMI, one-third of IHCRC’s 3,700 patients under the age of 18 are 

overweight or obese. With this information in mind, IHCRC knows that helping paVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00052 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
49 

tients to develop a healthy lifestyle can also help to end the vicious cycle of this 

disease. 

IHCRC’s diabetes programs have been enhanced in recent years to include prevention, especially for youth and families. Collaboration with the N7 Fund, Southern Plains Tribal Health Board, and an area funder have helped to further expand 

the programs. 

Programs range from summer wellness camps to training teachers and youth 

workers to use physical activity in teaching. This teaching style has proven to activate the brain, improve on-task behavior during academic instruction time, and increase daily physical activity levels among children. The Sit Less, Move More, Learn 

Better program, attended by approximately 60 teachers and youth workers each 

year, has helped more than 70,000 youth across Oklahoma. 

The youth fitness and diabetes prevention program includes Summer Wellness 

Camp, a youth run club (initially funded by the N7 Fund), youth fitness programs, 

and two annual Family, Fun and Fitness Days. Each year, more than 300 youth attend the camp which focuses on diabetes prevention, healthy lifestyles, leadership, 

team-building, cultural experiences, and problem-solving. 

The annual family fun and fitness festival, attended by more than 450 people 

since inception, brings families together in an active environment. The day’s highlight is the One Mile Fun Run and Walk. The program’s fight against diabetes has been further enhanced by engaging 

youth and families in a running club in which 25 youth and their family members 

participate. The club meets every Saturday morning to run together and participates in approximately six community runs during the year. During the winter 

group members work out at the YMCA and participate as a club in social activities 

and community service. 

‘‘No one could have ever anticipated the changes that occurred in the running club 

participants,’’ reports Ms. Skeeter. ‘‘Youth have become stronger and healthier. They 

have become socially connected with one another and with others they have met 

through community races. Families have begun running and working out together. 

Youth self-esteem has improved. Youth have learned to provide encouragement to 

others including their own family members. Community volunteers including members of American Electric Power’s Native American employee group have become extremely involved with the club. Overall, the diabetes education program has made 

significant strides in diabetes prevention for youth and families.’’ 

Like Ms. Keeler, her counterpart in South Dakota, Ms. Skeeter is a passionate 

supporter of SDPI, having seen modest amounts of money turn around the lives of 

so many Tulsans in such meaningful ways, and she is also determined to see the 

program reauthorized. 

Let’s take the I–44 west and learn how the Oklahoma City Indian Clinic (OKCIC) 

has used SDPI funds for 18 years to provide essential services to its 2,948 patients 

with diabetes, 2,994 patients with prediabetes, and 4,672 youth patients, out of an 

active patient clinic population of 18,077. 

Beginning in 2001, reports Ms. Robyn Sunday-Allen, OKCIC’s chief executive officer, SDPI funds began paying for the program’s first Teaching Urbans Roads To 

Lifestyle & Exercise (TURTLE) Camp for children. This initial day camp for OKCIC 

youth was focused on diabetes prevention for children 12 to 16 years of age. Sessions on nutrition, exercise, diabetes education, drug and alcohol abuse, tobacco 

abuse have been held by OKCIC for the past 16 years. 

SDPI funding has also allowed OKCIC to add a wellness center to the clinic’s 

campus. Patients are able to work out individually, participate in group activities 

or meet with a personal trainer/life coach. In fact, the wellness center has become 

the social community for OKCIC patients as they participate in group fitness classes, diabetes prevention/education meetings, cooking classes, and cultural activities. 

Recognizing the importance of good nutrition, OKCIC began holding cooking demonstration classes in 2013, and SDPI funding helped to equip a kitchen. All patients 

and their families are welcome to learn from the registered dietitian/chef to see how 

to prepare healthy foods within a reasonable budget. Participation in the cooking 

classes has increased from 560 visits in 2013 to 1670 in 2016. 

In addition, OKCIC provides annual back-to-school physicals, immunizations and 

screening at the program’s Children’s Health Fair. Through these screenings, youth 

at risk are referred to follow-up services where parents and their children receive 

education to make the necessary changes to develop healthy lifestyle habits. ‘‘SDPI 

funding,’’ reports Ms. Sunday-Allen, ‘‘allows OKCIC to go beyond being simply an 

ambulatory health care facility, which helps to endow our patients with the courage 

to move towards healthier lifestyles.’’ 

OKCIC, thanks in large part to SDPI funds, provides disease prevention programming to AI/AN children in an effort to prevent Type 2 diabetes and related coVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00053 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
50 

morbidities. These programs include weekly afterschool programs, school break programs and 1:1 nutrition and physical activity counseling. Afterschool programming 

includes boxing, adventure sports, running, golf, and tennis. School break programs 

include, in addition to TURTLE Camp: Kids in the Kitchen, swimming lessons, 

NYPD Camp (Native Youth Preventing Diabetes), jump rope camp, basketball camp, 

dance clinic, culture camp and NKOG Camp (Native Kids on the Go!). All interventions assess children for weight status, acanthosis nigricans, blood 

pressure and obesity-causing behaviors such as sugar-sweetened beverage intake, 

fruit and vegetable intake, physical activity engagement and screen time. The 

OKCIC staff uses this information to create fun and effective nutrition-and physical 

activity-based activities that re-enforce the lifestyle modifications necessary to maintain a healthy weight and reduce the risk for Type 2 diabetes. Each disease prevention experience includes a nutrition and physical activity component. 

Ms. Sunday-Allen reports that outcomes after post-programming demonstrate that 

the ‘‘patient population experienced a substantial decrease in BMI percentile, the 

pediatric gauge for weight. In fact, the average BMI percentile dipped less than the 

level used for overweight classification (80th percentile), which is an encouraging 

sign of positive disease prevention progress. The change in BMI percentile may be 

a result of the significant decrease in sugar-sweetened beverage consumption and 

a decrease in sedentary screen time usage. While time in physical activity did decrease, the average remains above the Center for Disease Control’s recommendation. 

These programs are made possible by SDPI funds for health educators, which include registered dietitians, physical activity specialists and support personnel as 

well as for venue rental, program supplies, and food.’’ 

Ms. Sunday-Allen recognizes that OKCIC’s significant anti-diabetes effort would 

not have been possible without SDPI funds, and she strongly urges the Congress 

to reauthorize the program before the end of the fiscal year. 

Let’s finish our survey of how specific UIHPs are using SDPI funds by heading 

to the west coast. First, let’s hear from the Native American Rehabilitation Association of the Northwest (NARA), which serves eight locations in the Greater Portland 

Area. NARA focuses its diabetes efforts on screening, prevention, early diagnosis, 

and mitigating against complications caused by diabetes. Using SDPI funds since 

1999, NARA has established a stable, cohesive, multi-disciplinary clinical group 

with more than 65 years of combined experience that serves over 500 people with 

diabetes and 1,000 patients with prediabetes. 

NARA celebrated the success of its diabetes prevention program in 2016, receiving 

plaudits from lawmakers and public health experts alike. Since NARA first offered 

prevention classes in June 2006, the 133 graduates who completed the 20-week lifestyle balance curriculum—which includes weekly group meetings, tracking food intake, and increasing physical activity—collectively lost 1,350 pounds and 213 inches 

from their waist. NARA reports that prevention program graduates eat less 

unhealthy food, and more fruits, vegetables, and whole grains. NARA staff continue 

to meet with graduates monthly and support them as they strive to change their 

lifestyles. 

NARA sees cultural competency and community partnerships as keys to its success in its fight against diabetes, striving to achieve a visible presence at community 

gatherings, cultural activities and powwows, in order to provide diabetes education 

and outreach. 

NARA partners with the Casey Eye Institute’s Outreach Team at Oregon Health 

Sciences University, which uses the team’s mobile eye van to provide free dilated 

eye exams and prescriptions for glasses twice a year to the program’s patients with 

diabetes. NARA also partners with the Mount Tabor podiatry office, which often 

treats the program’s uninsured patients free of charge. 

NARA shares best practices with the Northwest Portland Area Indian Health 

Board and local tribal organizations as well as the American Diabetes Association. 

And through a partnership with mental and behavioral consultants, almost forty 

patients with poorly controlled diabetes (i.e., A1C greater than 9.0 percent) have 

been screened using a culturally-specific trauma examination process. The results 

indicate a strong correlation between a history of personal, past and/or 

intergenerational trauma and poorly-controlled diabetes. When patients screen positive for trauma, the behavioral health consultant coordinates referrals to a mental 

health consultant. 

NARA successfully uses Saturday diabetes clinics, which are the program’s convenient ‘‘one-stop-shop’’ clinic for people with diabetes to receive their annual diabetes ‘‘tune-up.’’ Services provided at these clinics are podiatry, nutrition and exercise 

counseling, foot and nail care education, immunizations, laboratory testing, medication adjustments, diabetes education, and digital retinal screening. In fact, the percentages of patients completing a foot exam (97 percent vs 80 percent), eye exam 

51 

(78 percent vs 51 percent) and diabetes education (96 percent vs 84 percent) were 

higher for Saturday diabetes clinic participants than the general NARA diabetes patient population. 

If the Congress fails to reauthorize SDPI, NARA would no longer be able to provide the Portland Indian community with the following services: diabetes screening; 

diabetes prevention; diabetes self-management education classes; nutrition and exercise counseling, podiatry services, retinal imaging services, and dilated eye exams 

for diabetics; and case-management for patients with prediabetes and diabetes. 

Now, let’s head south to California, where the Indian Health Center of Santa 

Clara Valley (IHCSCV) has established a holistic anti-diabetes program for education, prevention, and treatment that is an example for the general population of 

northern California. 

IHCSCV’s education effort is led by a registered nurse and it is further staffed 

with health educators, who provide one-on-one and group education about diabetes, 

teaching patients how to prevent the onset of the disease and mitigate against its 

complications—whether at the patient’s home, at the program’s wellness center, or 

at other health care facilities. Almost one-third of the budget for the wellness center 

has been paid for by SDPI funds. 

IHCSCV’s diabetes program, which was originally funded by SDPI, works to prevent or delay the onset of diabetes through manageable lifestyle changes. Although 

the SDPI grant expired last year, IHCSCV continues its fight against diabetes because of its continued harshly disproportionate impact on the Indian community in 

Northern California. 

IHCSCV’s primary care staff at the main facility as well as at three family practice clinics, and one pediatric clinic used SDPI funds to provide patients with the 

tools they need to manage their condition, including glucometers, test strips, 

lancets, blood sugar logs, pill cutters, diabetes socks, feet mirrors, and oral health 

supplies. Patients whose condition is more problematic benefit from intensive casemanagement. 

IHCSCV’s anti-diabetes effort is impressive in its comprehensiveness. IHCSCV 

has a fitness center that is free for all patients and available to patients at all skill 

levels. Many fitness classes are designed for patients who are elderly or have limited mobility, including Zumba and chair exercise classes. IHCSCV’s fitness coordinator is also a personal trainer, who is able to offer one-on-one personal training 

to patients of all ages and skill levels. 

IHCSCV helps its diabetes patients overcome transportation barriers imposed by 

limited mobility and social isolation. The program provides transportation for medical, dental, counseling, and specialty appointments, as well as to the wellness center and community events that are hosted for the Indian community by IHCSCV 

and its partners. 

IHCSCV’s diabetes patients often have many health complications and are facing 

other obstacles to their health—including homelessness, mental disabilities, limited 

income, and lack of health insurance. IHCSCV’s case management team works 

closely with the patients and their primary care providers to coordinate the care 

within and outside of the program. The case management team arranges appointments with dentists, licensed clinical social workers, and psychiatrists at the program as well as with outside specialists like cardiologists, endocrinologists, 

nephrologists, and oncologists. In fact, some IHCSCV managers speak with their patients almost daily. 

Like other UIHPs, IHCSCV believes it is imperative to reauthorize SDPI. Despite 

its accomplishments in the fight against diabetes, the program continues to treat 

new Indian patients with diabetes. Loss of SDPI funds would result in a significant 

decrease in access to transportation, which could mean that many patients would 

be less likely to receive the regular care necessary to control their diabetes. Loss 

of SDPI funds would also prevent IHCSCV from engaging in its aggressive, comprehensive case management or providing diabetes refreshers, which are two hour 

education classes specifically tailored for Indian patients with diabetes. 

Finally, let’s head north, to the Seattle Indian Health Board (SIHB). Thanks to 

the SDPI funds, they have a diabetic team that provides a comprehensive case management team consisting of a nutritionist, RN, MA, case manager, and PharmD. 

This team has been able to provide robust case management services that supplement the care our patients receive from their primary care provider. 

The services they provide because of the SDPI program include diabetes and lifestyle education, assistance developing and reaching self-care goals, support for wellbeing, referral assistance, etc. The program has also provided group education classes on topics including exercise, diet, and general diabetes education. SDPI funding 

has also provided onsite optometry and podiatry specialty services for our diabetic 

patients. 

52 

Without SDPI, SIHB would anticipate at least a 75 percent reduction in the diabetic case management services that they currently provide. They would also lose 

the ability to track and follow up with diabetic patients who were lost from care 

or have poor follow-up. This would inevitably lead to poorer outcomes for the patients and increased medical costs for the entire health system. 

NCUIH appreciates the opportunity to testify about the challenging but promising 

work of UIHPs in educating against, preventing, and treating diabetes which have, 

literally, saved and transformed lives in Indian Country. So much of that work 

would not have been possible without SDPI, which is why NCUIH strongly urges 

the Committee to ensure that the program continues without any interruption. 

Quite simply, SDPI must be reauthorized if Indian Country is to educate against, 

treat, and prevent the terrible scourge that is diabetes. Thank you for your consideration. Please contact NCUIH if you have any questions about our testimony. 

*Here is an appreciative note Ms. Keeler received from one SDUIH patient about 

the program’s SDPI-funded diabetes treatment: 

‘‘I just wanted to touch base with you and thank you for getting me involved 

in the program. If you ever had any doubts about the importance of it, I want 

to let you know I did go to my eye exam and they did find I had cataracts due 

to my diabetes. So this program, in the long run will have saved my life. I just 

wanted to let you know what they found. This has certainly, with no pun intended, opened my eyes to my responsibility in regards to my diabetes. Againjust a call to say thank you. Also, my children both have pre-diabetes and would 

like them to start coming to your facility. But anyway, this work is so important 

and thank you again!’’ 

*Sally is a 12-year-old participant in IHCRC’s Running Strong youth run club. A 

wonderful but unexpected outcome of the club is that many parents are inspired to 

participate with their children, and Sally’s mother registered to run alongside her 

daughter in a 5K. 

‘‘I did my first 5K!!! I was not in the front of the pack but I wasn’t the last 

one either so I will take that as a win!!! I did it for my amazing daughter Sally 

who of course kicked my butt. She did great in her first 5K also. I am so proud. 

Wished I could have seen her come over the finish line. I did meet some very 

sweet ladies that helped me along the way. And a huge thanks to Sally’s run 

club!!! You all are rock stars.’’ 

One week later, there was another 5K—this one in brutally cold weather. Sally’s 

mom commented: 

‘‘Today I finished another 5K with the help of my amazing daughter. She ran 

back and got me and helped me finish strong. She is such an amazing kid. Although the running is hard I love that we are doing it together. Even if she 

kicks my butt (lol). It is something we can enjoy and push each other with. All 

of it wouldn’t be possible without her amazing run group and coach Jennie 

Howard. We could never thank you enough.’’ 

*Here is the success story of one family in which every member weighed in excess 

of 250 pounds when they began IHCRC’s program: 

‘‘I wanted to let you know what a positive move this has been for our whole 

family. The first positive is our weight loss. Our oldest son lost 109 pounds during the past year. His younger brother only lost 17 pounds but his grades increased as his weight has decreased. I can’t thank you enough for the changes 

that you have brought to my family! I just can’t believe the positive outcome 

of exercise! 

‘‘We have stopped drinking sweet tea and we haven’t eliminated sweets but we 

only have them on special occasions. We have also tried to limit our bread/other 

sugar intake. A big deal for us was portion size, we seen nothing wrong with 

eating 2 or 3 plates. Now we try to only have 1. We work out at least 5 times 

a week. We try to go 7 days a week but sometimes other activities interfere 

(work/school). We also play volleyball and basketball. 

‘‘We are a healthy family and working towards improving that even more and 

we enjoy it!!! I began using my Facebook page as an exercise log to help keep 

me accountable. This in turn has encouraged many of my friends to begin walking or working out. I am motivating others and it feels awesome! I have people 

private message me about what they are trying to do because they don’t want 

to go public in case they fail, and I encourage them that a little exercise is better than none and there is no failing when you are doing something to move 

your body around. 

53 

‘‘My husband was diagnosed borderline diabetic. Diabetes runs on his side of 

the family and he has seen all the struggles his dad has before he passed away 

from it. We are hoping that all of the things we have done will defeat that disease and break the cycle.’’ 

*Here are five testimonials from patients who have been treated for diabetes by 

OKCIC. 

1. GS, a proud ‘‘great great grandpa’’ and an OKCIC patient for more than 30 

years, states: 

‘‘Different foot doctors all wanted to cut off my foot. I would take off my shoes 

and show them my foot and they all said if they didn’t take off my foot, they’d 

have to take off my leg up my knee’’. I came to Oklahoma City Indian Clinic 

and saw the Wound Care Team. They said, ‘We can save that!’ Everyone was 

so positive here. OKCIC gave me support care, the podiatrist and other doctors 

have been a great help.’’ 

2. ‘‘Six years ago I was approached by a member of the Steps to Achieve Results 

(STAR) program in the Oklahoma City Indian Clinic wellness center. I was told 

about an upcoming Diabetes Alert Day.I was given an appointment with my 

provider and I found out I was pre-diabetic. I have seen diabetes at its worst. 

So, of course when I learned I was pre-diabetic, I wanted to learn as much as 

I could in order to keep from becoming diabetic. I did not want my children to 

see me like I saw my dad. I knew they would take care of me, but I did not 

want them to have to. I enrolled in the STAR program where I learned how 

to count my daily fat grams and calories. I also learned how to prepare my food 

differently. I learned how to lose 7 percent of my starting weight and how to 

keep it off by adding activity with my food choices. I learned a lot and after 

16 weeks finished the program. After being in the program, I thought it would 

be interesting to work in the medical field helping my Native people. In time, 

an opportunity arose and a life coach position became available. I applied and 

now am a proud member of the STAR team for a little over 4 and half years. 

In the process, I have also obtained a certified personal trainer certificate. I get 

to help my Native brothers and sisters in a rewarding capacity by using my experience and the strength of the curriculum. Through the many acquaintances, 

I have made some lifelong friendships.’’ 

3. ‘‘I have lost a total of 15 pounds with the Star program. I have increased 

my activity and I feel amazing as the result. I feel I’m not out of breathe anymore when doing cardio. I am an active runner and with all the pounds being 

taken away my legs don’t hurt like they use to when running last spring. I have 

also seen results as my pull ups are looking a lot better than they ever have 

because I am down 15 pounds from what I had started with. The benefits are 

incredible. I get compliments from so many people wondering what I am doing. 

This program does not make me feel like it is a diet but a true lifestyle change. 

This class has truly helped me with my diet completely. This class has helped 

me learn about proteins and I don’t have to get it from chicken. My recipes and 

lunches have been so much more creative because of this class and I am so 

thankful it has brought me to this place of being healthy and happy. I love how 

the program is setup because it’s in baby steps and the staff has been amazing 

because when I would slip, they got me back on track so now it’s just a habit 

to stay on the healthy lifestyle.’’ 

4. ‘‘STAR cooking and Get SET has helped me out a lot. It has motivated me 

to come into the clinic and exercise. STAR cooking has taught me how to cook 

properly for my health and to stay on the right diet plan to continue my health 

management. The reason I come to STAR cooking is because I have high blood 

pressure, which caused my kidneys to fail. The diet plan for diabetics is similar 

for what I need to do on my diet plan with my health issues. I’m a 74-yearold woman and this helps me to keep healthy.’’ 

5. BL has managed to lose 20 pounds since she began the STAR program. By 

the end of the initial 8 weeks, she managed to lose 12 pounds: 

‘‘Prior to my participation in the STAR Program I felt that I would be unable 

to make significant changes to my weight and to my overall health. I have tried 

other methods and programs that were not effective. The life coaches celebrated 

even the smallest improvements and gave me different options to overcome obVerDate Mar 15 2010 14:25 Jul 13, 2017 Jkt 026197 PO 00000 Frm 00057 Fmt 6601 Sfmt 6621 S:\DOCS\26197.TXT JACK
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stacles as well. The STAR program has equipped me with tools and resources 

so that I can make informed changes that will result in a healthier future.’’ 

Æ