A Fork in the Road - Inter-Tribal Council of Michigan's 4 x 4 Coalition

Detroit Fitness Class Hula Hoops Steve was really struggling with his weight. Stressed out about his job and coping by drinking alcohol and overeating, he didn’t think about his health much outside of the doctor’s office. But in the back of his mind, Steve knew something was very wrong. And then one day, a friend told him something that would change his life.

Steve lives in urban Detroit where circumstances were causing him to worry about his health. He knew he had a family history of high blood pressure and heart problems, and knew he should be more engaged in his health and strive for balance in wellness. He also knew that he should find positive outlets to be more physically active and eat better. Like many of us, he knew what he should do, but he just didn’t know where to start or who to ask for help. He just knew that he had reached a fork in the road and had to make some real changes.

Steve is not alone. The rise in obesity and its related chronic diseases is particularly distressing to Michigan’s Native American population who suffer from higher-than-average rates of diabetes, heart disease and stroke. Many of Michigan’s Native Americans lack resources, live far from grocery stores and mainly shop for food at local convenience stores or gas stations. These small stores have little fresh produce and offer highly processed, low nutrient food, untraditional to Native American culture. Like Steve, these residents find it challenging to regularly participate in physical activity especially when weather is less than ideal and access to fitness facilities is limited. If Native Americans become ill, they may visit their local Tribal Health Centers for basic medical care and treatment of disease or illness. Unfortunately, these centers have little resources to implement preventative activities for their community members to keep them from getting sick in the first place.

But that was about to change. In 2013, the Michigan Department of Community Health’s 4 x 4 Initiative requested applications from community-based coalitions across the State. The Inter-Tribal Council of Michigan (ITCM) and its consortium of 12 Federally Recognized Tribes and 1 urban American Indian Health and Family Services Agency applied and were funded to address barriers to healthy living in 13 Tribal communities, to help people just like Steve. ITCM’s 4 x 4 Initiative approach was to promote balanced, realistic and manageable goals to increase healthy eating and exercise, and to use education and media to promote a healthier lifestyle as a social norm. The project embraced holistic wellness and utilized community assets such as a history and knowledge of highly nutritious Native American traditional foods along with regular physical activity. Prevention became the focus through the use of the 4 x 4 Tool to promote healthier behaviors. The Tool encourages the practice of four key habits: maintain a healthy diet, engage in regular exercise, get an annual physical examination, and avoid tobacco use. The 4 x 4 Tool also encourages awareness of four key health measures: body mass index (BMI), blood pressure, cholesterol level, and blood sugar (glucose) levels.

Tribal Health Centers chose activities which were the best fit for their own unique communities and worked on improved policies and environments to help tribal employees and community members make positive health behavior choices. Tribes used social media and tribal newsletters to increase awareness and knowledge of healthy lifestyles and promoted the message that “small changes can end up with big results.” Several Tribes made healthy eating easier by replacing items in the vending machines of tribal buildings with healthier options, or included healthier food at tribal events. Many Tribes offered nutritional education “Lunch and Learns” and wellness support groups. Other Tribes offered easy access to new fitness classes, such as Zumba, Yoga, and Sculpting, free of charge to employees and community members, taught by trained Native American community instructors.

So, what happened to Steve? He found the support and guidance that he needed through the American Indian Health and Family Services (AIHFS) agency in Detroit. In 2013, through the Inter-Tribal Council of Michigan’s 4 x 4 Initiative, the AIHFS conducted a variety of new fitness and nutrition classes and held two, twelve-week healthy challenges where 27 participants lost a combined weight of 170 pounds. Steve was one of the participants. He described his journey to wellness. “I had never given much consideration to health and I enjoyed a lifestyle of overindulgence, including alcohol, commercial tobacco, and food. I have a family history of high blood pressure and heart problems and was unhappy with my life, as I struggled with alcohol addiction, financial problems and job dissatisfaction. My turning point came when a friend invited me to take part in the AIHFS weight loss challenge. Honestly, I wasn't overly excited about it at first, but I figured it couldn't hurt. Fortunately through the program, I discovered my blood pressure was dangerously high, so I saw the doctor, was placed on medication and safely started the challenge.”

“During the course of the 12 week challenge, I realized how my disposition towards life affected my physical and mental state. I realized what people had been trying to tell me for years: health is not a one-time issue to be dealt with and then disregarded. It's a one-day-at-a-time process of keeping yourself balanced,” Steve added.

The Inter-Tribal Council of Michigan’s 4 x 4 program continues in 2014, now working with 6 Tribal Agencies to fit this year’s funding. The program is a continued success; each participating Tribe implements those activities which are the best fit for their unique communities. Tribal Health Centers continue to share positive updates regarding their communities, such as increased participation in physical activity programs, clinic screenings, and readiness to adopt healthier lifestyle habits.

As for Steve, he is grateful to his friend and proud of what he has accomplished during the challenge. Native Americans recognize health as more than the absence of disease. They know that growing food, eating as a family, and participating in daily physical activities are integral to their culture and to finding and maintaining balance, in body, mind and spirit. And the 4 x 4 Initiative provided the needed resources to make the healthy choice, the easy choice for Steve and all of the citizens that were reached.

Steve added, “By making healthier food choices and taking the exercise classes at my local AIHFS agency, I lowered my blood pressure, lost roughly 15 pounds, and dropped a pant size. I feel great about myself, and am glad our community provided me a way to find and maintain overall wellness. I still have a lot to learn, but I feel as though I have a solid foundation to build upon”.

For more information about ITCM’s 4 x 4 Initiative, please contact Intertribal Council of Michigan’s Health Education and Chronic Disease Department, at 906-632-6896.

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