History

The Centers for Disease Control and Prevention (CDC) Healthy Tribes created “A Comprehensive Approach to Good Health and Wellness in Indian Country (GHWIC)” program in a collaborative effort of six (6) divisions/office within CDC’s National Center for Chronic Disease Prevention and Health Promotion.

Julianna Reece, MD, MPH, MBA, (Dine’/Navajo)
Director, Healthy Tribes

The first Good Health and Wellness in Indian Country (DP14-1421, or GHWIC) funding opportunity, September 2014 -September 2019, had the long-term goals of reducing rates of death and disability from tobacco use, diabetes, heart disease and stroke, and reducing obesity. GHWIC supported a holistic approach to healthy living and chronic disease prevention. GHWIC’s Component 1 recipient activities addressed NCCDPHP’s four domains: epidemiology and surveillance, environmental approaches, health system interventions, and community clinical linkages. Component 2 recipients provided technical assistance to area Tribes, increasing the reach of GHWIC funding to nearly 120 tribes. 

GHWIC is a result of the collaborative effort of six (6) divisions/office within CDC’s National Center for Chronic Disease Prevention and Health Promotion. 

Due to the impact of historical and generational trauma, relocation from loss of land, forced cultural assimilation, AI/AN culture and traditions were severely disrupted resulting in higher chronic disease rates and underlying risk factors such as tobacco use and obesity. GHWIC embraces the ideal that American Indian/Alaska Native (AI/AN) communities have innate strengths and resilience rooted in Tribal culture and traditional ways of life. GHWIC was created as a coordinated approach to chronic disease prevention and healthy living that integrates the cultural values of Tribal communities along with their wisdom and jurisdiction, creating an AI/AN-centered public health initiative where recipients are in charge of their communities’ health promotion outcomes.

GHWIC has the long-term goals of reducing rates of death and disability from tobacco use, diabetes, heart disease and stroke, and obesity. GHWIC is now in the second of two separate 5-year CDC Healthy Tribes funding opportunities (2014 to 2019) and (2019 to 2024).

The strategies, activities, and outcomes of GHWIC build upon the national efforts of the CDC divisions/office to increase the health impact throughout Indian Country. GHWIC combines evidence-informed policy, systems, and environmental change (obesity, tobacco), and clinical-community linkage (diabetes, heart disease and stroke prevention) strategies and activities.  The strategies and activities of GHWIC may be culturally-adapted as appropriate to meet the cultural and health needs of American Indian and Alaska Native communities.

GHWIC.org aims to share the successes across Indian country.

Highlight Dates:

2011 – The Center for Disease Control’s (CDC’s) Tribal Advisory Committee encouraged the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to more thoughtfully address serious health disparities among AI/ANs while respecting and incorporating indigenous knowledge. Good Health and Wellness in Indian Country design began.

The framework for the GHWIC initiative and evaluation approach began to take shape in 2011 when CDC’s Tribal advisory committee, a federally mandated committee, encouraged CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to more thoroughly address serious health disparities among AI/ANs while respecting and incorporating indigenous knowledge and Tribal considerations.

The NCCDPHP staff participated in CDC listening sessions where Tribal health leaders and organizations offered knowledge and wisdom regarding the AI/AN perspective over a few years. Discussed were ideas and considerations on how Tribes and the CDC could work together to impact the chronic disease disparities within Indian country.

2014 – CDC partners with Indian Health Service (IHS) to fund  the first 5 year round of “A Comprehensive Approach to Good Health and Wellness in Indian Country” (GHWIC)

The CDC planned the development of culturally sound programs and evaluation approaches. GHWIC’s mission continues to support healthy behaviors for AI/AN and emphasize strategies to reduce risk factors in Native communities to attain long-term goals by:

  • Supporting a coordinated and holistic approach to healthy living and chronic disease prevention
  • Reinforcing the work already underway in Indian Country to make healthy choices easier for American Indians and Alaska Natives
  • Continuing to support culturally appropriate, effective public health approaches
  • Working with more Tribes and extending the program’s reach and impact through Tribal organizations, including Urban Indian Organizations.

The Centers for Disease Control and Prevention (CDC) commissioned the Urban Indian Health Institute (UIHI) to coordinate a national evaluation plan for Good Health and Wellness in Indian Country (GHWIC). UIHI, CDC evaluation staff, and recipient representatives identified a series of performance measures and evaluation outcomes that would best demonstrate and measure GHWIC efforts, identify successful activities, and provide lessons learned. The CDC continued to partner, listen, and learn from Tribal recipients through 5 year cooperative agreement ending in 2019. 

In the UIHI and CDC compiled findings on the regional and national impact of GHWIC, showing that between 2014 and 2017 approximately 15,000 AI/AN people had better access to healthier foods through 16 new Tribal settings with low sodium nutrition guidelines and 77 new Tribal settings promoting nutritious foods.  More than 14,500 AI/AN people improved access to physical activity with 91 new policies promoting physical activity.

2019 – CDC funds a new 5 year round of GHWIC awards

27 recipients were awarded across Indian Country in 2019 for a second 5 year agreement, 2019-2024. (link to map/list of programs)

As Component 1 recipients, 12 Tribes and 4 Urban Indian Organizations work on community-chosen and culturally adapted strategies to reduce commercial tobacco use and exposure, improve nutrition and physical activity, increase health literacy, improve team-based health care, and strengthen links between community programs and clinical services.

As Component 2 recipients, 12 Tribal organizations provide funding to over 90 additional Tribes and Urban Indian Organizations in their Indian Health Service Area and Urban Area. Many more will receive technical assistance and benefit from Component 2 leadership in chronic disease prevention.

One Tribal organization, the Alaska Native Tribal Health Consortium, serves as the Coordinating Center. The Coordinating Center for GHWIC (CCG) oversees projects and provides organization, logistics, communication, and evaluation support for GHWIC. It also supports Communities of Practice so recipients can share successes and challenges to foster peer-to-peer learning.

In just the first two years of the second round of GHWIC, the CCG and CDC compiled findings on the regional and national impact of GHWIC. The population reach shown for each strategy within just the first two years are is as follows: Physical Activity, Nutrition and Breastfeeding – 199,715, Commercial Tobacco Prevention – 5,500, Diabetes Prevention- 5,144, and Heart Disease and Stroke Prevention – 4,604.

The core Indigenous values that continue to guide the Good Health and Wellness in Indian Country (GWHIC) Project:

  • Centrality of the community and family requires engaging the community when planning and implementing an evaluation, making evaluation processes more transparent, and highlighting the importance of community health in addition to individual achievements.
  • People of place recognizes a Tribal entity’s relationship to land and history, how historical events have shaped current health conditions, and the uniqueness of place and history. What occurs in one place might not be generalizable to other situations or other locations.
  • Recognizing Individual gifts prompts evaluators to take a holistic approach to evaluate while acknowledging that there are different ways of conducting evaluation.
  • Upholding personal and Tribal sovereignty embodies respect for Tribal approval processes, building greater capacity within recipient communities and reporting findings in ways that are meaningful and impactful to recipients.

GHWIC Literature