Integrating Culture and History to Promote Health and Help Prevent Type 2 Diabetes in American Indian/Alaska Native Communities: Traditional Foods Have Become a Way to Talk About Health

PURPOSE AND OBJECTIVES: The purpose of the Traditional Foods Project (TFP) was to implement and evaluate a community-defined set of strategies to address type 2 diabetes by focusing on traditional foods, physical activity, and social support. The TFP sought to answer 2 questions: first, how do we increase and sustain community access to traditional foods and related activities to promote health and help prevent type 2 diabetes? Second, how do we evaluate interventions across culturally and geographically diverse communities to demonstrate success? INTERVENTION APPROACH: Public health interventions are most effective when communities integrate their own cultures and history into local programs. The food sovereignty movement among American Indians/Alaska Natives and indigenous populations globally offers ways to address public health issues such as chronic diseases like type 2 diabetes. Historical, economic, social, and environmental determinants of health are critical to understanding the disease. EVALUATION METHODS: During 2008–2014, seventeen tribal TFP partners implemented locally designed interventions and collected quantitative and qualitative data in 3 domains: traditional foods, physical activity, and social support. Partners entered data into a jointly developed evaluation tool and presented additional program data at TFP meetings. Partner observations about the effect of the TFP were gathered in planned discussions. RESULTS: Quantitative results indicate collaborative community engagement and sustained interventions such as gardening, availability of healthy foods across venues, new health practices, health education, and storytelling. Qualitative results demonstrate the importance of tribally driven programs, underscoring the significance of traditional foods in relation to land, identity, food sovereignty, and food security. IMPLICATIONS FOR PUBLIC HEALTH: Traditional foods and food sovereignty are important areas for American Indian/Alaska Native communities to address the public health issues of chronic disease, specifically type 2 diabetes, locally and nationwide.