Practicing Tribal Sovereignty Through a Tribal Health Policy: Implementation of the Healthy Diné Nation Act on the Navajo Nation
IMPLEMENTATION EVALUATION — Volume 19 — November 23, 2022
PEER REVIEWED
The 5 regions/agencies of the Navajo Nation extend into Arizona, Colorado, New Mexico, and Utah.
Figure 1.
The 5 regions (also known as agencies) of the Navajo Nation: Chinle, Eastern, Fort Defiance, Northern, and Western. Sources: Esri, Esri China (Hong Kong), Esri Japan, Garmin, General Bathymetric Chart of the Oceans, GeoBase, GIS User Community, HERE Technologies, Institute Geographique National Increment P Corporation, Intermap Technologies, Kadaster International, Ministry of Economy, Trade and Industry, National Park Service, Natural Resources Canada, OpenStreetMap contributors, Ordnance Survey, United Nations Food and Agriculture Organization, and US Geological Survey.
Figure 2.
Timeline for implementation, evaluation, and reauthorization Healthy Diné Nation Act of 2014. Abbreviations: DCAA, Diné Community Advocacy Alliance; IHS, Indian Health Service; RDC, Resources and Development Committee: NABI, Nabikiya Committee.
| Date | Activity |
|---|---|
| 2011 | Health champions recruited by IHS formed the Diné Community Advocacy Alliance (DCAA) to organize and collect reservation-wide health data. |
| 2012 | With assistance from Navajo leaders, DCAA developed the Healthy Diné Nation Act (HDNA) legislation. |
| 2012–2014 | DCAA worked to gain Navajo chapter and agency council resolutions that supported and approved the proposed HDNA legislation. |
| Jan 30, 2014 | The Navajo Nation Council approved the HDNA legislation by a vote of 12 to 7, but it was vetoed by the president. |
| Feb-Nov 2014 | DCAA held work sessions with tribal council members, resulting in override of veto (10 to 4) by the 23rd Navajo Nation Council. |
| Nov 2014 | 10 days after tribal approval, HDNA was signed into law (CN-54-14). |
| 2015 | Start of HDNA implementation in the Navajo Nation in third quarter 2015. |
| 2015–2019 | HDNA implementation, evaluation of tax revenue, store implementation and pricing, chapter wellness projects, and surveys. |
| Early 2020 | Initiated reauthorization process; Sponsor Delegate Amber Kanazbah-Crotty. |
| Mar–Dec 2020 | HDNA reauthorization passed the Resources and Development Committee (RDC) and the Nabikiya (NABI) Committee during October–December. Initial Navajo Nation Council vote December 13 was 18 to 3; Navajo Nation Council voted 21 to 0 on Dec 23 to reauthorize. |
| Dec 31, 2020 | HDNA reauthorization signed by President Jonathan Nez, removing sunset clause. |
This figure consists of 2 maps. One map shows HDNA funding distributed to Navajo Nation chapters by categories of funding. The other map shows the prevalence of diabetes in the 5 Navajo regions: Chinle, Eastern, Fort Defiance, Northern, and Western. The Eastern region (prevalence of diabetes, 15.0%, the lowest prevalence of diabetes among the 5 regions) received the least HDNA tax revenue; each chapter received $20,000 or less. The Western region (prevalence of diabetes, 25.6%, the highest prevalence of diabetes among the 5 regions) received the most funding; each chapter received at least $55,000. The prevalence of diabetes was 15.6% in Chinle, 17.1% in Fort Defiance, and 19.4% in Northern.
Figure 3.
HDNA tax revenue, by chapter, and baseline diabetes prevalence, by region, on the Navajo Nation. Tax revenue was collected from fourth quarter of fiscal year 2015 through fourth quarter of fiscal year 2019. Baseline data collection of diabetes prevalence took place from 2013 through 2016. Abbreviation: HDNA, Healthy Diné Nation Act of 2014.
| Category of HDNA funding received | No. of chapters |
|---|---|
| $20,000 or less | 31 |
| $20,001 to $40,000 | 19 |
| $40,001 to $55,000 | 28 |
| $55,001 to $75,000 | 21 |
| More than $75,000 | 11 |
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.