American IndianAlaska NativeOutreach Program

Promoting aHealthier

American Indian andAlaska Native Community

MISSION STATEMENTPatient Advocate Foundation (PAF) is a nationalnon-profit organization that serves as an active liaison between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters relative totheir diagnosis through professional case managers,doctors and attorneys. PAF seeks to safeguardpatients through effective mediation assuring access to care, maintenance of employment, andpreservation of their financial stability.

PATIENT ADVOCATE FOUNDATIONAMERICAN INDIAN/ALASKA NATIVE

OUTREACH PROGRAMMISSION STATEMENT

The PAF American Indian/Alaska Native (AI/AN)Outreach Program is designed with the goals of reducing healthcare disparities among underservedcommunities and by providing them the resourcesnecessary for the best quality of life. The programtargets high risk health areas for the American Indian and Alaska Native Community such ascardiovascular disease, stroke, heart attack, diabetes, along with specific types of cancer: breast, lung, colorectal and prostate cancers.

CO-PAY RELIEFMISSION STATEMENT

PAF’s Co-Pay Relief (CPR) program provides co-payment assistance for pharmaceutical products to insured Americans who financially and medically qualify. The CPR program providesdirect financial assistance to qualified patients toassist them in the ability to afford the co-paymentstheir insurance requires.

The Program offers personal service to all patientsthrough the use of CPR call counselors.

ACKNOWLEDGEMENTS

Promoting a Healthier American Indianand Alaska Native Community

has been prepared by the Patient Advocate Foundation (PAF).

PAF is a national network for healthcare reformand patient services stationed out of

Newport News, Virginia.

PAF would like to acknowledge and thankthe many resources that provided invaluable information for this

publication revised October 2009.

Principle Writing:

Courtney JonesLiveStrong Partnership Program Director

Patient Advocate Foundation

Jamilla Williams Virginia Cares Uninsured Program Director

Patient Advocate Foundation

Judith StoreyCase Manager

Patient Advocate Foundation

Michelle ShanksSurvivorship of Cancer in Underserved Populations

Program DirectorPatient Advocate Foundation

Tammy NeiceSenior Clinical Case Manager Patient Advocate Foundation

Principle Editing:Kendra Bluhm

Chief Program Management OfficerPatient Advocate Foundation

Tami Lewis Training Coordinator, CM ServicesPatient Advocate Foundation

NOTES

TABLE OF CONTENTS

Introduction ........................................................ 2

Heart Disease ...................................................... 3

Stroke .................................................................. 3

Heart Attack ....................................................... 4

Colorectal Cancer ............................................... 6

Lung Cancer ....................................................... 7

Breast Cancer ...................................................... 8

Diabetes ............................................................ 10

Conclusion ........................................................ 12

Resources .......................................................... 13

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INTRODUCTION

Heart disease and cancer are the leading causes ofdeath among American Indians/Alaska Natives(AI/AN). The prevalence of diabetes among thispopulation is more than twice that for all adults inthe United States. It is significant to note thatAmerican Indians and Alaska Natives frequentlycontend with issues that prevent them from receiving quality medical care. These issues include cultural and/or language barriers, geographic isolation, weather factors, inadequate or no running water, low incomes/decreased jobs,and lack of health education.

The shortage of health care professionals workingin Alaska Native communities (less than 90 doctorsper 100,000 people) compared to national statistics(229 for every 100,000 people), makes health careaccess an even more challenging issue.

Risk factors such as age, gender and family historycannot be changed. It is important to control therisk factors where you have control.

These basic health habits are the foundation of lifelong health and well-being:

� Eat right.

� Physical Activity� Maintaining a healthy body weight.� Be tobacco-free.� Avoid drugs and/or alcohol to include tobacco

� Manage stress.� Take care of your teeth, brush regularly.� Stay up to date with immunizations and� Health screenings.� Practice safety.� Practice good hygiene.� Love and respect your body, mind, andspirit.

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HEART DISEASES

Heart disease includes coronary artery disease,heart attacks, stroke, and high blood pressure.These conditions are quite prevalent among theAlaska Native population and are major causes ofearly death.

High Blood Pressure is a silent killer and occurswhen the pressure of blood against the walls of theblood vessels increases. Poorly controlled highblood pressure is a leading cause of heart attacksand strokes.

High blood pressure can be treated effectively withmedications, and the basic good health habits todecrease risk factors for the disease.

Coronary Artery Disease

Coronary Artery Disease is a narrowing of theblood vessels that supply blood and oxygen to theheart. This is caused by a build-up of plaque thatnarrows the blood vessel causing decreased bloodflow or clot formation. This can lead to a heart attack or stroke if too much of the vessel is damaged.

Monitoring your diet, maintaining a healthyweight and regular exercise can help minimize the risk factors for developing the disease.

Stroke

Strokes result when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. The affected part of the brain starts to die because it cannot get the blood and oxygen it needs.

When a portion of the brain dies, the area of thebody it controls is affected. Strokes can cause acomplete or partial loss of movement or sensation,effect speech or vision. Side effects of a stroke maybe permanent or temporary and will be differentwith each patient.

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Recovery is dependent on the severity of the stroke,location of the blood clot, and how soon treatmentis received.

Signs and Symptoms:

� Sudden numbness or weakness of the face,arm or leg, especially on one side of thebody

� Sudden confusion, trouble speaking or understanding

� Sudden trouble seeing in one or both eyes

� Sudden trouble walking, dizziness, loss ofbalance or coordination

� Sudden, severe headache with no knowncause

Heart Attack

Heart Attacks occur when the blood supply to asection of the heart muscle is severely reduced orstopped. This happens when one or more of thecoronary arteries supplying blood to the heart muscle is blocked.

If the blood and oxygen supply is cut off for more than a few minutes, heart muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged.

If you experience any of these symptoms or haverisk factors for heart disease, do not ignore them.

Signs and Symptoms:

� Discomfort or mild pain in the center ofthe chest. The pain can come and go and is often described as pressure, squeezing, or indigestion

� Pain can spread to one or both arms, neck,jaw, back or stomach

� Shortness of breath, sweating, dizziness ornausea

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Risk Factors:

� Family history

� Tobacco use

� High cholesterol

� High blood pressure

� Physical inactivity

� Overweight/obesity

� Drug and/or alcohol use

� Diabetes

� Stress

New treatments are available for heart attack andstroke victims. It is important that you do notdelay seeking medical care when symptoms appear,since treatment must be given as soon as possible tobe effective.

CANCERS

It is difficult to accurately present comprehensivecancer data for American Indians and Alaska Natives (AI/AN) due to limitations such as undercounting, racial misclassification and coding errors.

However, according to the National Cancer Institute (NCI) American Indians/Alaska Natives continue to have the poorest survival from “all cancers combined” than any other racial group. Colorectal cancer, lung cancer, and breast cancer are among the leading types of cancer in the American Indian/Alaskan Native population.

It is important to review the signs and symptoms,risk factors, and prevention methods of these cancers that plague the AI/AN community.

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Colorectal Cancer

According to the American Cancer Society, Lungand colorectal cancer incidence rates for AI/AN(both men and women) are significantly higherthan they are for Caucasians.

Colorectal cancer is highly preventable and is curable when caught early. Most cases of the disease begin as non cancerous polyps, which aregrape-like growths lining the colon and rectum.These polyps can become cancerous. Upon detection, removing the polyps, can prevent colorectal cancer from ever developing.

It is difficult to detect colon cancer in the earlystages, because there are few symptoms. Someonecould have colon cancer and not know it. This iswhy it is extremely important to be tested regularly.

Signs and Symptoms:

� Rectal/anal bleeding

� Blood in or on the stool (bright red)

� Change in bowel habits

� Stools that are thinner than usual

� General stomach discomfort

� Diarrhea or constipation

� Recurrent gas pains

� Weight loss for no apparent reason

� Fatigue

� Vomiting

Risk Factors:

� Personal or family history of colon cancer

� Personal or family history of inflammatorybowel disease (Ulcerative Colitis orCrohn’s disease)

� Lack of fiber in the diet

� Age

� Heavy alcohol use

� Smoking

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Prevention/Best Defense:

� Diet high in fiber, fruits and vegetables

� Increased fluid intake of non-alcoholicbeverages

� Screening tests beginning at age 50

� Limit intake of red meat to once a day

� Smoking cessation

Lung Cancer

The American Cancer Society (ACS) reports lungcancer as the leading cause of cancer death. LungCancer is the most common type of cancer deathin eight of the nine Indian Health Service (IHS)areas.

In addition, the ACS indicates lung cancer as thesecond most common cancer among AI/AN and87% of all lung cancer deaths can be linked to tobacco smoking.

The Center for Disease Control and preventiondata shows that adult smoking among AmericanIndians/Alaskan Natives is the highest (40%) of the five racial/ethnic groups.

Signs and Symptoms:

� Difficulty breathing

� Chronic cough/coughing up blood

� Chest pain

� Loss of appetite/weight loss

� Extreme fatigue

� Chronic cough

� Fever without a known reason

� Wheezing/Hoarseness

� Repeated bouts of bronchitis and/or pneumonia

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Risk Factors:

� Tobacco use

� Age

� Family history

� Diet and lifestyle

� Exposure to asbestos, radon, or other hazardous chemicals found in the workplace (miners, etc.)

� Little/too much Vitamin A in diet

� Air pollution

Prevention/Best Defense:

� Don’t smoke/quit smoking

� Avoid second hand smoke

� Eat lots of fruits/vegetables

� Make your home/workplace safe fromharmful exposures (asbestos, radon)

� If symptoms exist, get screened/tested

Breast Cancer

Breast Cancer is the most common cancer amongwomen in the United States. Breast cancer affectsindividuals in all ethnic groups; however, there is adifference in mortality rates among these groups.

According to Susan G. Komen for the Cure, if youare AI/AN, you are less likely than women of anyother ethnic group in the U.S. to be alive five yearsor longer after a breast cancer diagnosis. Susan G.Komen for the Cure reports only an estimated

Alaska Native Medical Center (ANMC)Anchorage, Alaska

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37% of AI/AN women age 40 and older get mammograms, which could contribute to the poor survival rate.

Signs and Symptoms:

� A lump is present/found, which is usuallyfirm and most often painless

� A portion of the skin on the breast or underarm swells and has an unusual appearance

� Veins on the skin’s surface become moreobvious on one breast

� The breast nipple can become inverted, de-velop a rash, change skin texture, or have adischarge other than breast milk

� A dent/impression is found in an area ofthe breast surface

Risk Factors:

� Family history of breast cancer

� Not having children, or having them later in life

� Race and ethnicity

� Genetics

� Dense breast tissue

� Previous chest radiation

� Use of oral contraceptives

Prevention/Best Defense:

� Personalized risk assessment

� Early screening - Annual mammographyshould begin at age 40 (or as directed bydoctor) and then as recommended

� Annual clinical breast exam by medicalprofessional beginning at age 20

� Monthly self breast exam

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DIABETES

Diabetes is a condition in which the body is unable to properly process blood sugar. Problemscan occur if blood sugar is too high or too low. Diabetes occurs when the body is either unable tomake enough insulin or it becomes unable to usethe amount of insulin produced. Uncontrolledblood sugar can lead to a number of damagingconditions in the body.

There are two main types of diabetes.

� Type I diabetes or “juvenile-onset” usually begins during childhood or early adulthood. This type occurs when the body does not produce enough insulin. As a result, the patient will need insulin injections.

� Type II diabetes, often called “adult-onset”or “non-insulin dependent” diabetes, canbe diagnosed among children and teens although is typically diagnosed in adults.It is common in people who are over-weight and has a tendency to run infamilies. Usually the body makes enoughinsulin but cannot use it properly.

Self-educating about the symptoms of diabetes canaid in the prevention of developing this condition.Educating oneself about the treatments of diabetescan aid in maintaining this condition. If left un-treated, diabetes can lead to kidney failure and/oramputation of limbs.

Signs and Symptoms:

� Increased thirst and dry mouth

� Increased urination, especially at night

� Increased fatigue

� Increased hunger

� Blurry vision

� Unexplained weight loss

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� Tingling or numbness in hands and/or feet

� Increased skin infections and/or slow healing of wounds

� Recurring vaginal yeast infections

Risk Factors:

� Overweight/obesity

� Age

� Family history

� History of having a large birth weight baby(over 9 lbs) or having gestational diabetes

� Low physical activity

� High blood pressure

� Poor diet

Prevention/Best Defense:

� Type I diabetes cannot be prevented since this condition is usually linked to a family history.

� Type II diabetes cannot always be prevented, however a healthy diet and regular exercise can lower the risk of developing this condition.

If you have diabetes:

� See your doctor regularly

� Check your blood sugar as recommended

� Eat a healthy diet

� Maintain a healthy weight

� Have your blood pressure checked often

� Take all prescribed medicines as ordered

� Do not smoke or use tobacco

� Limit alcohol intake

� Exercise regularly

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CONCLUSION

In summary, research shows that most diseases impacting the Alaska Native/American Indiancommunity can be controlled and/or prevented by:

� Maintaining a healthy lifestyle

� Exercising regularly

� Early detection of illness thru regular medical exams and screenings

� Patient education

Understanding your condition and how to manageit can increase your confidence in making changesto improve and maintain your health. Any seriousillness can raise important financial and emotionalconcerns for both the patient and their family.

It can be beneficial to seek financial assistance or guidance through National and Local organizations. For instance, the Patient AdvocateFoundation, the American Heart Association, prescription assistance programs, Federal, State and local Human Services offices.

Familiarize yourself with your health insuranceplan by obtaining a copy of the policy and readingit over so you know the coverage and benefits available to you.

The most important thing to remember is that youare not alone. These diseases are manageable andthere are many people and organizations that careand are available to assist you.

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WHERE TO FIND HELP FOR SUPPORT

Alaska Native Health Board (ANHB)www.anhb.org1-907-562-60061840 Bragaw St, Suite 220Anchorage, Alaska 99508

� Promotes spiritual, physical, mental, social,and cultural well-being and pride of AlaskaNative peoples.

Alaska Native Medical Center (ANMC)www.anmc.org1-907-563-26624315 Diplomacy DriveAnchorage, Alaska 99508

� Provides services, health information andresources for Alaska Natives.

Alaska Native Tribal Health Consortium(ANTHC)www.anthc.org1-907-729-19004000 Ambassador DriveAnchorage, Alaska 99508

� Provides services, health information andresources for Alaska Natives.

Prostate Cancer Resource • US TOO! International, Inc.www.ustoo.org1-800-808-7866

� Provides support, counseling, and education to assist men, their partners and families, in understanding prostatecancer.

Road to Recovery-American Cancer Society1-800-227-2345

� Help find volunteers to drive people tocancer related appointments in Anchorage.

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Social Security Administrationwww.ssa.gov1-800-532-1223

� Federal benefits may be available if certaincriteria and guidelines are met. People thathave disabling conditions and can nolonger work because of a health conditionwould need to go through an applicationprocess with the SSA.

Southcentral Foundation (SCF)www.southcentralfoundation.org1-877-837-4251/1-907-729-49554501 Diplomacy DriveAnchorage, Alaska 995081-907-729-4955

� Provides services, health information andresources for Alaska Natives.

Stanford Diabetes Self-Management On-Linefor Native Americanshttp://indiandiabetes.stanford.edu1-800-366-2624

� Provides free diabetes self-managementmaterials and receive free lab tests.

Susan G. Komen Breast Cancer Foundationwww.komen.org1-800-462-9273

� People supporting people who are committed to fighting breast cancer.

National Indian Council on Aging, Inc.Diabetes Educational Outreach Strategies (DEOS)www.nicoa.org1-505-292-2001

� Works with tribal organizations to plan,design, and assess the feasibility of implementing a culturally appropriate Diabetes Prevention model for AmericanIndians and Alaska Native Elders.

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National Indian Health Boardwww.nihb.org1-202-507-4070926 Pennsylvania Ave SEWashington, DC 20003

� Advocating on behalf of all Tribal Governments, American Indians andAlaska Natives in their efforts to providequality health care.

National Patient Travel Centerwww.PatientTravel.org1-800-296-1217

� This center provides free or discountedmedical air transport service.

Native Cancer Information Resource Center andLearning Exchange (C.I.R.C.L.E.)www.nativeamericanprograms.org1-877-372-1617

� A cancer resource center for American Indian and Alaska Native people.

The National Office of Native Cancer Survivorshipwww.oncs.org1-800-315-8848/1-907-333-207113790 Davis StreetAnchorage, Alaska 99516

� Works as a liaison between providers andpatients to improve care and access to cancer support services.

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Patient Advocate Foundationwww.patientadvocate.org1-800-532-5274

� PAF offers many programs and educational opportunities for patients nationwide including direct case management assistance to ensure access to healthcare, maintenance of employment and preservation of financial stability.

Lance Armstrong Foundationwww.cycleofhope.orgwww.livestrong.org1-866-235-7205/1-512-236-8820

� Provides information and resources forpeople living with cancer.

National Alliance of Breast Cancer Organizations (NABCO)www.nabco.org

� NABCO is an information and educationresource.

National Breast and Cervical Cancer Early Detection Programhttp://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp1-800-232-4636

� The Center for Disease Control launched amajor initiative in 1994 to fund AmericanIndian/Alaska Native organizations directlyto establish comprehensive screening programs to improve our capacity to reachAmerican Indian/Alaska Native women.

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National Cancer InstituteCancer Information Service (CIS)www.cis.nci.nih.gov/www.cancer.gov1-800-4-CANCER /1-800-422-6237

� Provides accurate and up-to-date cancer information and materials. Caring peopleanswer your questions about cancer, andcan mail you free brochures and posters if requested.

National Diabetes Education Programwww.ndep.nih.gov1-888-693-6337/1-301-496-3583

� Provides information and resources aboutpreventing and controlling diabetes.

Cancer Hope Networkwww.cancerhopenetwork.org1-877-467-3638

� Matches patients with trained volunteerswho have experienced cancer. Providessupport and hope for cancer survivors.

Centers for Medicare and Medicaid Services(CMS)www.medicare.gov1-800-MEDICARE/1-800-633-4227

� Explains your Medicaid and Medicarequestions, new Medicaid and Medicareservices, and any questions regarding Medicaid and Medicare services.

State of Alaska: Chronic and Acute Medical Assistance (CAMA)http://www.hss.state.ak.us/dhcs/cama/1-888-804-6330/1-907-269-5777

� CAMA pays for select health care servicesfor adults and children who do not qualifyfor Medicaid.

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Colon Cancer Alliance, Inc.www.ccalliance.org1-877-422-2030

� The Colon Cancer Alliance battles colorectal cancer through patient support,education, research, and advocacy.

Diabetes Prevention Programwww.preventdiabetes.com(505) 368-6345Northern Navajo Medical CenterP.O. Box 160 Shiprock, New Mexico 87420

� Provides information and resources aboutpreventing and controlling diabetes.

IHS Division of Diabetes Treatment & Preventionwww.ihs.gov/medicalprograms/diabetes1-505-248-4182

� A system to assure quality diabetes servicesfor your community. Free materials andpublications.

American Cancer Society (ACS)www.cancer.org1-800-227-2345/1-907-277-86961057 West Fireweed Lane, Suite 104Anchorage, Alaska 99503

� The ACS provides cancer information,support services and has a program to loan wigs.

American Diabetes Associationwww.diabetes.org

� Provides information and resources aboutpreventing and controlling diabetes.

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American Lung Association (ALA)www.lungusa.org1-800-586-4872/1-907-276-58641057 West Fireweed Lane, Suite 201Anchorage, Alaska 99503-1736

� ALA works to prevent lung disease andpromote lung health through education,community service, advocacy and research.

Awakening the Spirit: Pathways to Diabetes Prevention and Controlwww.diabetes.org1-800-DIABETES/1-800-342-2383

� Organization established by the AmericanDiabetes Association created to improvethe lives on Native Americans with diabetes. Provides advocacy, educationalmaterials, consultation, and latest research.

Cancer Carewww.cancercare.org1-800-813-HOPE/1-800-813-4673

� Helps people face the many challenges of acancer diagnosis. Provides free telephoneeducation workshops.

This publication was supported by Cooperative Agreement Number DP001705-01from the Centersfor Disease Control and Prevention. Its contents, findings and conclusions are those of the authors(s)and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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