Donald Warne, MD, MPH, co-directs the Center for Indigenous Health at Johns Hopkins University, where he is also a full professor and Provost Fellow for Indigenous Health Policy. Previously, at the University of North Dakota School of Medicine and Health Sciences, he was Associate Dean for Diversity, Equity, and Inclusion; Director of the Indians into Medicine (INMED) Program; and Director of the Public Health Program, as well as Professor of Family Medicine. At the University of North Dakota, Dr. Warne developed the world’s first PhD program in Indigenous Health. Prior to that, Dr. Warne worked for the National Institutes of Health as a staff clinician, served on the faculty at Arizona State University’s Indian Legal Program at the Sandra Day O'Connor College of Law, served as Health Policy Research Director for the Inter Tribal Council of Arizona, was Executive Director of the Great Plains Tribal Leaders Health Board, and was the inaugural Master of Public Health program director at North Dakota State University (NDSU). Prior to the fellowship, he received his Bachelor’s degree from Arizona State University and his MD from Stanford University’s School of Medicine. Dr. Warne is a member of the Oglala Lakota tribe from Pine Ridge, South Dakota.
Donald Warne, MD, MPH
Professor, Bloomberg School of Public Health; Co-Director, Center for Indigenous Health; Provost Fellow for Indigenous Health Policy, Johns Hopkins University, Baltimore, MD
Strategic Plan for Diabetes Intervention in the Gila River Indian Community
Pima Indians from the Gila River Indian Community in Arizona have the highest incidence and prevalence of Type 2 Diabetes in the world. Prior to 1930, before the Coolidge Dam was built on the Gila River, there were no documented cases of diabetes in this population. For thousands of years the Pima Indians and their ancestors lived a healthy lifestyle with a yearlong water supply from the Gila River in the deserts of what is now Arizona. The members of this tribe were traditional farmers who were very active working in the fields, and their diet consisted of farmed foods, fish and wild game. Following the damming of the river, the lifestyle was dramatically changed to a more sedentary existence with dependence on unhealthy government commodity foods. By the 1970’s, the Pima Indians had the highest rates of diabetes in the world, and the problem continues to worsen each year. There are multiple federal, state and local health agencies working in this community, and there is no comprehensive strategic plan to address diabetes.
To develop a strategic plan for intervention, interviews were conducted with primary care providers who work in this community, tribal health agency leaders, political leaders and experts working in the field of community intervention and translational research. Literature was reviewed in the areas of community engagement, community oriented primary care, prevention methods and public health infrastructure development. Also, I drew upon my personal experience as a family physician in this community as well as my coursework at HSPH.
Political leaders and healthcare professionals agreed that the health programs addressing diabetes in this community are poorly coordinated with minimal accountability for outcomes. The health system is chronically under-funded, there is poor data collection and the programs initiated by the Indian Health Service are paternalistic in nature and rarely involve the community in design, implementation or evaluation of programs. From the community perspective, there is a sense that diabetes is “overwhelming” and inevitable with a strong link to depression and alcoholism. There is also a strong belief that the loss of traditional culture and lifestyle that resulted from the damming of the Gila River is at the root of the current state of poor health.
A comprehensive, culturally relevant strategic plan is needed for diabetes intervention in this community with a focus on the following five areas:
- Cost of Illness Analysis
- Health System Infrastructure Assessment
- Intervention Program Design and Implementation
- Community Engagement
- Collaborations and Sustainability
Robert Nelson, M.D., Ph.D., National Institute of Diabetes and Digestive and Kidney Diseases (NIH)