Good Health and Wellness in Indian Country

Twila Cassadore

Twila Cassadore, from the Traditional Western Apache Diet Project, holding San Bitsitsin, an Apache wild parsnip.

CDC’s largest investment to improve health among American Indians and Alaska Natives is the Good Health and Wellness in Indian Country (GHWIC) program, a $78 million initiative that started in 2014 and continues through 2019. This program supports 35 tribes, tribal organizations, and Tribal Epidemiology Centers (TECs) across the United States.

  • 12 tribes work on community-chosen and culturally adapted strategies designed to reduce commercial tobacco use and exposure, improve nutrition and physical activity, increase health literacy, and strengthen team-based health care and links between community programs and clinical services.
  • 11 tribal organizations, one in each of the 10 Indian Health Service (IHS) administrative areas and one in the Urban Indian Health Institute, work to provide leadership, assistance, and resources to over 100 tribes and tribal organizations in their IHS area, as well as to GHWIC funded tribes.
  • 12 TECs support surveillance and evaluation activities.

GHWIC addresses the following long-term goals:

  • Reduce rates of death and disability from tobacco use by 5%.
  • Reduce the prevalence of obesity by 3%.
  • Reduce rates of death and disability from diabetes, heart disease, and stroke by 3%.


Eleven TECs provide technical assistance to tribes and tribal organizations in their area to evaluate the effect of program activity at the tribe and area level. TECs perform a variety of functions in consultation with, and at the request of, tribes and tribal organizations to monitor the health of American Indians and Alaska Natives and support evaluation activities. The Urban Indian Health Institute coordinates a national evaluation of GHWIC, while the TECS support individual program and area-wide evaluation.

Program Activities

The following are some of the program activities of GHWIC grantees:

The Yellowhawk Tribal Health Center of the Confederated Tribes of the Umatilla Indian Reservation in Pendleton, Oregon, set up a walking program called Walk the Rez, which is modeled after national walking programs and Let’s Move in Indian Country. The health center has added information about local places and traditional culture along trails that cross tribal land. People who walk or run on the trails learn about local landmarks, history, and lifeways of the Umatilla, Walla Walla, and Cayuse people, while enjoying physical activity.

The Albuquerque Area Southwest Tribal Epidemiology Center partners with the University of New Mexico’s Project ECHO to train tribal health care paraprofessionals in the 27 Albuquerque area tribes to help tribal members prevent and manage type 2 diabetes, heart disease, stroke, and associated risk factors. The training is offered to as many as 25 tribal paraprofessionals twice a year during each of the 5 project years, with the goal of training and mobilizing up to 200 people. These trained community health representatives (CHRs) work with community members with or at risk of chronic diseases to reduce their risks and improve their health. Tribal members who work with the CHRs will be followed over time to understand the extent to which the training improved the CHRs’ ability to motivate clients to make behavior changes.

The Lower Brule Tribal Council of the Lower Brule Sioux Tribe in South Dakota adopted a policy in June 2016 that gives its employees 1 hour of administrative leave 3 days a week to attend Diabetes Prevention Program classes or activities. Class participation has increased 186% since this policy change.

The Winnebago Tribe of Nebraska will begin allowing members of IHS health care teams to see information collected by CHRs. Previously, this information was not accessible to IHS’s proprietary electronic health record system, which prevented health care providers from seeing potentially critical and helpful observations of patient conditions during CHR home visits. CHR notes will be made available to providers in real time, which will promote early intervention and could help patients avoid hospitalizations and untimely death.


Good Health and Wellness in Indian Country: FY 2017 Investments (35 Awards)

National Center for Chronic Disease Prevention and Health Promotion

Good Health and Wellness in Indian Country: FY2017 Investments (35 Awards) map
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(Component 1)
  1. Catawba Indian Nation
  2. Fort Peck Community College
  3. Kickapoo Tribe in Kansas
  4. Lower Brule Sioux Tribe
  5. Nez Perce Tribe
  6. Pueblo of Santa Ana
  7. Red Cliff Band of Lake Superior Chippewa
  8. San Carlos Apache Tribe
  9. Sault Ste. Marie Tribe of Chippewa Indians
  10. Winnebago Tribe of Nebraska
  11. YellowHawk Tribal Health Center
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Tribal Organizations
(Component 2)
  1. Alaska Native Tribal Health Consortium
  2. Albuquerque Area Indian Health Board, Inc.
  3. California Rural Indian Health Board, Inc.
  4. Great Lakes Inter Tribal Council, Inc.
  5. Great Plains Tribal Chairmen’s Health Board
  6. Inter Tribal Council of Arizona, Inc.
  7. Montana and Wyoming Tribal Leaders Council
  8. Navajo Nation Tribal Government
  9. Northwest Portland Area Indian Health Board
  10. Oklahoma City Area Inter Tribal Health Board
  11. United Indian Health Services, Inc.
  12. United South and Eastern Tribes, Inc.
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Tribal Epidemiology
Centers (TEC)
  1. Alaska Native Epidemiology Center
  2. Albuquerque Area Southwest TEC
  3. California TEC
  4. Great Lakes Inter Tribal Epidemiology Center
  5. Inter Tribal Council of Arizona TEC
  6. Navajo TEC
  7. Great Plains TEC
  8. Northwest Portland TEC
  9. Oklahoma Area TEC
  10. Rocky Mountain TEC
  11. United South and Eastern TEC
  12. Urban Indian Health Institute