Special Diabetes Program for Indians reauthorized

WASHINGTON - Indian health officials are hailing Congress; July 15 vote to extend the Special Diabetes Program for Indians through September 2011 at a level of $150 million.

Following a veto by President George W. Bush on a Medicare package that included the two-year extension of the program, the House and the Senate voted to override the veto. The House passed the legislation 383 - 41, which is 30 more votes than it received upon its original passage in 1997; the Senate passed it 70 - 26.

The passage of the legislation is significant in terms of Indian health promotion, especially given the slow nature of the House to follow the Senate's passage of the Indian Health Care Improvement Act in February.

''The reauthorization of SDPI is critical for us to continue to be able to offer all of the progress that's been made since the funding started 10 years ago,'' said Yvette Roubideaux, a professor in the College of Medicine at the University of Arizona.

Roubideaux, a member of the Rosebud Sioux Tribe, said she and many other health experts had been concerned numerous times in recent months that the funds might not be re-upped, especially given the current federal budgetary and bureaucratic climate - even though several members of Congress have long voiced their support of the program.

Over the years, the funding has supported numerous grants to IHS and tribal and urban Indian health organizations for diabetes prevention and treatment programs. The SDPI monies go directly to IHS and then are distributed based on recommendations of the agency's director.

The American Diabetes Association, the Juvenile Diabetes Research Foundation and the National Indian Health Board and many Native groups have long been proponents of the program.

To date, 333 community-directed diabetes-focused efforts have been funded as a result of SDPI. Of those, 66 received competitive grants for demonstration projects as a result of monies authorized by Congress in 2002.

Indian health experts point to specific developments involving better diabetes outcomes that they say are likely attributable to SDPI funding. For instance, a report by the Centers for Disease Control and Prevention in 2007 indicated that in Native populations, new cases of dialysis due to diabetes have actually been decreasing since 1996. Also, 93 percent of Indian communities served by SDPI now report that they offer primary prevention of diabetes services to children and youth, versus less than 10 percent in 1996 before SDPI was implemented.

Other government-sponsored studies have highlighted results of the program's prevention efforts, including increased physical activity programs in schools, wellness programs and increased nutrition education.

Despite the successes thus far, American Indians and Alaska Natives still have the highest age-adjusted prevalence of diabetes among all U.S. racial and ethnic groups, according to research by the CDC.

Jerilyn Church, executive director of the American Indian Health and Family Services in urban Detroit, said that her organization would be dramatically harmed without SDPI funds, which amount to a little over $200,000 a year for her organization.

The program has helped fund treatment methods, including blood sugar testing, as well as prevention work with young Native people. The organization also offers a biweekly beading circle, headed by a Native community member, which coincides with health education and promotion efforts.

Church plans to soon bring traditional dancers to the agency to help incorporate cultural fitness programs - an innovation that she notes wouldn't likely be found at a typical community health center. Members of more than 100 different tribes have been served by the Detroit facility alone.

''It's really made a difference,'' said Church, a member of the Cheyenne River Sioux Tribe. ''Without it, our program would be devastated.''

IHS officials are also pleased by the passage.

''The reauthorization is great,'' said Kelly Acton, director of IHS' Division of Diabetes Treatment and Prevention. ''It allows us to continue the work we have been doing with SDPI for over a decade to build diabetes capacity and infrastructure in Indian communities.''

Acton said she believes ''this is the only way that we will turn back the tide'' of the diabetes epidemic in Indian country. She called SDPI the ''backbone of [IHS'] strategy at this point.''

''We are on the cutting edge of developing new strategies and solutions for this problem at the community level,'' These strategies may have implications worldwide someday.''

While Indian health officials are happy with the current turn of events, the program is still funded at the same level as when it was reauthorized in 2002. Since that time, diabetes in Indian country has continued its negative progress, so there is increased competition for a limited pot of funds.

''It's clearly not enough money,'' Roubideaux said. ''And the problem of diabetes isn't solved very easily.''