Reducing disparities in cardiovascular diseases and diabetes: A National evaluation of policy, systems and environmental change approaches in Tribal communities

Racial and Ethnic Approaches to Community Health (REACH) grantees were funded by the Centers for Disease Control and Prevention (CDC) to address Healthy People 2010's goal to eliminate health disparities in vulnerable populations. CDC funded communities and institutions at two levels, Centers of Excellence for the Elimination of Health Disparities (CEED) and Action Communities (AC) to tackle health disparities in various racial and ethnic groups in select chronic diseases. REACH grantees implement culturally tailored programs to improve health outcomes and are required to expand their programmatic efforts to address health disparities using a policy, systems and environmental change (PSE) approach.

PSE change efforts were identified and evaluated using the composite logic model. The composite logic model is a robust tool designed to visualize, plan, and evaluate progress towards social change and improving services and systems. Using qualitative methods, constructs of the composite logic model and content from grantee reports, including goals, strategies, and approaches, achievement towards PSE change were assessed in five REACH tribal communities that addressed cardiovascular diseases and diabetes. The findings record: 1) common approaches in relation to PSE change; 2) common goals and strategies identified; and 3) grantee accomplishments. This paper also describes similar practice-based approaches used by REACH tribal communities in the development of policies to increase access to healthy food choices and to establish healthier lifestyles in worksites and tribal communities.