My last two posts have discussed the increasing levels of obesity and related diseases due to addictive fast and processed food. Disadvantaged and poor people are especially vulnerable and Native Americans are especially severely impacted. A medical study examining almost a quarter of a million American Indians of Medicare age found that nearly 40% came from the lowest 20% of economically distressed communities. Native Americans are 50% more likely to be obese compared with whites. That level of obesity causes much more cardiovascular disease.
Twice as many Native Americans on Medicare have heart artery disease compared with other racial groups. Forty-five percent have diabetes. Seventy-two percent have high blood pressure and thirty-seven percent have heart artery disease. Twenty-three percent have heart failure. Fifty percent of Native Americans on Medicare have a serious heart disease including heart artery disease, heart failure, atrial fibrillation, or stroke. The five-year mortality for American Indians on Medicare is 25%.
These people have not received the same improvements in health care in the US as other Americans. The gaps in the quality of care and health outcomes seems to be worsening. The percentage of Native Americans with diabetes and high blood pressure is getting worse compared with other American communities. Access to healthy food is a big part of the problem. “Of the 27 000 square miles of land on the Navajo Nation, the largest US reservation, there are only 13 grocery stores”.
These facts come from a study of a Native American Medicare population. Medicare is funded with tax dollars. That means, whether you like it or not, you have a stake in this problem. Taking care of these cardiovascular and related health conditions in the broader American system is very expensive, but here is the good news. Better care is less expensive care and I have real experience that proves we can do better.
I have written repeatedly that optimal medical therapy provides much better clinical and financial outcomes for patients with heart disease and related conditions like diabetes and high blood pressure. I have been working with a worksite clinic that serves the Coushatta Casino Resort in rural Southwest Louisiana. Their clinicians are all trained in optimal medical therapy for diabetes and related conditions. The Coushatta are a Native American tribe. Patients who are seen in the clinic cost half as much as those seen in the broader community. They are in the hospital one fifth as often. They are in the emergency room one third as often. They have care that costs less and is more convenient because it is better care. Optimal medical therapy brings together improved systems of care based on protocols. The results are documented with robust clinical and financial analytics. The lifestyle advice and generic medications are delivered by advanced primary care teams. Nurses and nurse practitioners do this work exceptionally well. The systems and structure needed to deliver optimal medical therapy are worked out. We could scale these systems very quickly to protect this vulnerable population, but we have not done it. We could save billions of dollars doing it, but we have not done it. Why not?
People who are close to me say they have no responsibility for our dark history when it comes to the treatment of the natives who had been here 20,000 years when the first Europeans showed up. I say the dark history continues. Race is an artificial distinction. It is a social construct. Native American DNA and European DNA are 99.9% identical. It is time to treat other Americans like we would want to be treated. We know how to reduce the toll of cardiovascular disease in American Indians now. We can improve their healthcare now, and we can save money doing it. It is past time to make that a national priority!
The settlers took their land to build America as we know it. The country is indebted to the native citizens for the best possible health care and access to quality whole foods. Our “government” has failed miserably in almost everything, primarily how we treat the native citizens.
Oh god, those are some shocking numbers.