Hilda R' Heady, 2005 NRHA President Associate Vice President for Rural Health West Virginia Universi

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"Sweet Success Approaching Chronic Disease
Through Cultural Understanding"

• Hilda R. Heady, 2005 NRHA PresidentAssociate
  Vice President for Rural HealthWest Virginia
  University

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• Presented to the
• Bridging the Gap with Education Diabetes
  Symposium and Workshop 2008
• September 12, 2008
• Embassy Suites Hotel
• Charleston, WV

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Todays message

• We can succeed at stemming the impact of chronic
  disease by understanding cultural context,
  values, and their impact on behavior.
• We can lower the life time risk by intervening
  early.
• WV CARDIAC represents a successful model of
  prevention and intervention.

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We can reduce the risk of chronic disease by

• Engaging in healthy lifestyle behaviors
• Relying on the strengths of our culture
• Engaging our resilience nurtured by our values
• And supporting one another, our families,
  friends, and communities through natural helping

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Rural is.

• Defined by tradition and history
• Defined by geography and politics
• Defined by legend and myth
• Defined by culture and values

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Rural is both.

• An objective quantitative measure
• And
• A subjective state of mind

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Disease Management in Rural Populations

• A 3 year study of 6 of health plans providing DM
  to rural populations
• Plans were in IL, WI, PA, TX, OH-WV, AZ
• Percent of patients being treated
• Diabetes 48
• Depression 12
• COPD 21
• CHF 35

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Challenges to DM in Rural Communities

• Limited number of health providers and those
  trained in Chronic DM models
• High rate of uninsured patients
• Long distances to travel for treatment
• Limited local community resources for support

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Impediments to DM care for all patients urban
and rural

• Motivation and denial
• Insufficient attention to diet and exercise
• Lack of understanding

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Impediments to DM care for rural patients

• Limited access to care
• Costs of drugs and medications
• Lack of transportation
• Social conditions compounding disease state,
  unemployment, depression, poverty, etc.

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Advantages for Rural Patients

• Rural patients may find DM activities more
  important
• Respond well to telephone case management
• Receive support of family, friends, and neighbors

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Cultural Differences that may facilitate DM

• Importance of family
• Importance of religion
• Importance of beliefs of older family members
• Ability to understand directions and instructions
  when provider is culturally competent
• Greater appreciation and respect expressed by
  rural patients

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Understanding Cultural Facilitators Can come
from examining your own roots
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And recognizing your generations of influence
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Your cultural strengths
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And Cultural Weaknesses
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Families and Food

• Food insecurity impact food choices
• Budget
• Practice and tradition
• Definitions of health
• Generational transitions lost in the larger
  culture

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Eating By ColorMy childhood Food Pyramid
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The White Food Group

• Sugar
• Salt
• Lard
• Churned butter
• Grits
• Bama Mayonnaise
• Biscuits
• Gravy
• Store bought bread
• Corn bread

• Raw whole milk
• Mashed Potatoes
• Boiled Potatoes
• Baked Potatoes
• Home-made cheese
• Cottage cheese
• Light Kayro syrup
• Oatmeal
• Fried catfish
• Onions

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The Brown Food Group

• Pinto Beans and corn bread
• Fried Chicken
• Fried Beef Steak
• Fried Pork Chops
• Pull pork shoulder barbeque

• Bacon
• Fresh ham
• Sausage
• Dark giblet gravy
• Dark Kayro Syrup
• Sorhgum Molasses
• Pecan Pie
• Chocolate cake

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All Other Food Colors

• Fried green tomatoes
• Green beans
• Collard other greens
• Sliced tomatoes
• Carrots
• Lettuce
• Yeller squash
• Vegetable soup

• Apples
• Blackberries
• Blackberry jam
• Cantaloupe
• Pears
• Pear preserves
• Strawberries
• Strawberry preserves
• Watermelon

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And learn how to appreciate our roots and those
of others
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Just Different?
or Special
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Rural Beatitudes
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Blessed are the rural for they are collaborators
and are self-reliant
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Blessed are the rural for they value their
families
and are friendly folks
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Blessed are the rural for they value
individualism and are personable, independent,
and modest
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Blessed are the rural
for they are direct, authentic, tell you like it
is, and believe in their grandparents front
porch wisdom.
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Blessed are the rural for they are
patriotic, and they go to war
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Diabetes and VA benefits (July 9, 2001)

• Increasing numbers of veterans diagnosed
  especially among aging Vietnam Veterans who
  served in country
• VA assumes Diabetes II to be presumptive
  condition for those exposed to Agent Orange
• Can receive service related disability and health
  care benefits http//www.vba.va.gov/bln/21/benefit
  s/Herbicide/

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The Face of the New American Military Family
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African American Women

• Make up 12.7 of US population
• Make up 37.5 of all women serving in the US
  military forces

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Blessed are the rural for they serve others
without being asked
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Blessed are the rural for they work the earth
And they make stuff for everyone else
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Rural hands touch all that we consume
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Rural hands touch all our raw products and
natural resources world wide
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• Blessed are the rural for they have a deep sense
  of faith

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A Sense of Beauty
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• and a great sense
• of humor.

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• Blessed are the rural for they all deserve an
  appreciation of their culture

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Successful uses of Rural Culture and Values

• Personal engagement
• Frequent contact and in the community
• Educating providers and rural people to the
  strengths of rural life and values
• Limiting the focus on the barriers and poor
  outcomes
• Stop blaming sick people for being sick

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The West Virginia CARDIAC Project

• Coronary
• Artery
• Risk
• Detection
• In
• Appalachian
• Communities

To reduce cardiovascular disease mortality in
West Virginia through research and intervention
in children
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More American Children Are Overweight Than Ever
Before
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OBESITY IN WEST VIRGINIA

• 94 WV citizens consider obesity our most serious
  health problem
• Obese individuals have 67 more chronic disease
  than non-obese
• Annual cost to the state approximately
  558,000,000

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What happens when we visit the school on
Screening Day?

• We measure height and weight
• (in private)
• We calculate Body Mass Index (BMI)
• We check blood pressure
• We measure blood cholesterol
• We examine neck for Acanthosis Nigricans (AN)
• Parents of children with abnormal cholesterol
  eligible for free screening

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Health Care Professionals
Health Science Students
School Nurses
WV RHEP Coordinators
School Principals and Teachers
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CARDIACs 117,000 Kids

• Screened by CARDIAC in 9 years
• 8,669 9th graders
• 52,364 5th graders
• 25,011 2nd graders
• 30,933 kindergarteners

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Screening comparisons show decrease in obesity
risk among WV kids
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Health Beliefs Among Parents of CARDIAC
Participants

• Increased perceived behavioral control
• Fewer perceived barriers to their own health
• Household dietary changes (68) and physical
  activity (50)
• 94 satisfaction rate

Ref Harris, Bradlyn and Neal NHLBI
Dyslipidemia Detection In West Virginia
5ROIWL070120-02
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Attitudes of Child Participants in CARDIAC Project

• More concerned about diabetes than heart disease
• Intention to eat healthier
• No child/parental anxiety related to cholesterol
  screening

Ref Harris, Bradlyn and Neal NHLBI
Dyslipidemia Detection In West Virginia -
5ROIWL070120-02
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Relevance of CARDIAC to Stakeholders

• Identifies children at greatest risk of chronic
  disease
• Sets stage for interventional strategies
• Provides data supporting grant applications
• Promotes healthy lifestyle

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Look for your inspiration, the source of your
passion in the simple and common places first.
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Our faith in the human spirit is to know that
its own sense of innate health can guide us in
all our endeavors. Hilda R. Heady