Your Health Matters (April 2023) [Volume 1, Issue 1]

INSIDE THIS ISSUE

THEME: AMERICAN INDIAN/ALASKA NATIVE HEALTH

In this quarterly newsletter, you will fi nd materialsregarding training opportunities, department updates andadditional tools related to community engagement. Thegoal of this newsletter is to disperse valuable informationon ways to ensure that every person has the opportunityto “attain his or her full health potential.”

• Term of the Quarter Inipi
• Quarterly Article "Integrating Indigenous HealingPractices into Mainstream Primary HealthInterventions for American Indian Patients"
• Community Engagement Champion Spotlight
• Community Engagement Unit Collaborations
• Special Populations American Indian/Alaska Native Population
• Training Opportunities and Resources
• Book of the Quarter
• Quote of the Quarter
• Contributions to this Issue

TERM OF THE QUARTER

INIPI (pronounced "ee-nee-pee")

means 'to live again.' Inipi is the Lakota spiritual purification ceremony of rebirth, rejuvenation and awakening; it is a sacred communion and reconnection with The Creator. The ceremony is also referred to as sweat lodge - or 'sweat' or 'lodge' for short. It is also referred to as the Stone Peoples Lodge. All terms are acceptable, but 'inipi' should be used when speaking with a medicine man/woman, an elder, or in the lodge during the ceremony. Everything said in the ceremony is confidential and must never be discussed outside the ceremony, as what is spoken are people's deepest sufferings, hopes and prayers.

QUARTERLY ARTICLE

INTEGRATING INDIGENOUS HEALING PRACTICES INTO MAINSTREAM PRIMARY HEALTH INTERVENTIONS FOR AMERICAN INDIAN PATIENTS

Written by: Valentina Asiedu, Community Engagement Unit Graduate Assistant & Ruth Nwatu, Community Engagement Public Health Associate

Many American Indians (AI) believe in a holistic approach to health, aligning harmony of the mind, body and spirit. In this tradition, healing operates in the context of a relationship to four constructs: spirituality (Creator, Mother Earth, Great Father); community (family, clan, tribe/nation); environment (daily life, nature, balance); and self (inner passions and peace, thoughts and values). Some AI individuals have a shared understanding that physical and spiritual health are intimately connected; hence, body and spirit must heal together. Although healing practices vary widely from tribe to tribe, there are shared health beliefs and interventional strategies. The primary difference between AI healing and conventional medicine is the role of spirituality in the healing process. AI people believe that all things in nature are connected and that spirits can promote health or cause illness. These principles emphasize that healing includes an individual's physical parts, emotional wellness and harmony with their community and environment.

AI healing practices communicate vital cultural perspectives and influence the identity development of AI individuals. These healing practices, based on traditions and philosophies, significantly impact the sense of well-being. Some of these practices include
Powwow, smudging, storytelling, etc.

A Powwow, commonly practiced and observed by AIpeople, is a healing practice that includes a combination of the social and sacred gatherings of the Indian population. This celebration typically happens in a circular arena accompanied by drumming, singing and dancing in traditional regalia. Also, it communicates a sense of solidarity as AI communities, creates a connection between each other and the culture, and conveys cultural values such as caring, support and opportunities for participation.

As an indigenous healing practice, smudging means purification using sage, cedar or sweetgrass. In this practice, the smoke of burning cedar, or sage, is passed over healers or those seeking healing to dispel negative energies. At the same time, sweetgrass is used in the same process to attract positive energies. Smudging, as a sacred practice by AI people, provides a feeling of sacredness and safety. This is an essential mechanism in healing trauma that helps the individual focus attention and intention, and diverge thinking, from negative to positive.

Storytelling, a notable mode of transmission of information, is widely used in the AI culture as a healing practice. A majority of AI tribes use this approach of storytelling to transfer information from one generation to the next. This healing practice conveys and clarifies cultural values, contributes to the individual’s sense of identity and a path toward healing, and influences one's perception of reality.

A research study published in the American Journal of Preventive Medicine states, "Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices.” Being culturally competent allows one to care for clients with diverse values, beliefs and behaviors. AI communities face significant inequity in health care and health status compared to other populations in the United States. Integrating traditional AI healing practices into mainstream interventions is recommended when working with AI patients.

In a 2022 article published by Harvard Gazette, an anthropologist and AI health expert, Joseph P. Gone, details the importance of traditional practices in treating Indigenous mental health issues. With over 25 years of experience in research about Indigenous community mental health, his research explains the importance of mental health services that address traditional culture and Indigenous practices that could benefit both AI communities and the broader field.

Mitigating these health inequities and disparities is a necessary step to improve and advance the health of the AI population. This program aims to promote AI health and prevent type 2 diabetes. Additionally, The Johns Hopkins Centers for Indigenous Health developed an evidence-based intervention called the Family Spirit Home Visiting Program to alleviate the intergenerational impacts on the behavioral health of the AI population. This program was "designed for, by, and with AI/ANfamilies. It is used in over 100 tribal communities across 16 states and several other low-income urban environments in Chicago and St. Louis." More importantly, this program incorporates cultural assets and "encourages the use of paraprofessionals to deliver the program and addresses behavioral health disparities, emerging globally as an urgent priority."

Additionally, healthcare providers can put efforts into developing cultural understanding and/or competence of AI culture to serve this population better. Furthermore, The Tribal Training and Technical Assistance Center (the Center), funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), developed Healing-Informed Care that is consistent and has a lot in common with the SAMHSA trauma-informed approach. This approach provides prevention workers and practitioners with a deeper understanding of the cultural strengths that guide cultural resilience. This approach also informs on how to formulate prevention and healing strategies that tap into the innate resilience of AI individuals and communities.

The Community Engagement Unit (CE Unit) within North Dakota Health and Human Services (NDHHS), works closely with four Tribal Health Liaisons (THL). The THLs serve North Dakota’s five Tribal nations and urban tribal entities to build relationships and partnerships across the state. The THL's role includes connecting the Tribal Nations with state partners and collaborating with AI non-profit programs to help increase the health and well-being of all AIN in North Dakota. TheTHLs also assist with conducting disease investigations and interventions and contribute to improving overall health awareness.

Despite these ongoing interventions, there is more work to be done. Public health research recommends that using evidence-based strategies that incorporate culturally appropriate methods as well as a collaborative approach with Indigenous communities and organizations to examine health issues faced by the population is the right step in understanding Indigenous health and reducing adverse health outcomes.
 

Interested in this topic? Check out these resources:
 

Tribal Government   Indian Affairs   Culture Card

COMMUNITY ENGAGEMENT CHAMPION SPOTLIGHT

Each quarter, we recognize North Dakota individuals working as champions to ensure that every person has the opportunity to “attain his or her full health potential.” This is your chance to be featured for your work or to nominate someone you know!

NOMINATE A CHAMPION

This quarter, we highlight individuals in the state who are working to improve AI/AN health. Please read on to learn more about them and their fantastic work.

JACOB DAVIS, MPH

Written by: Agnieszka Mason, Public Health Support Specialist

Jacob Davis is a Turtle Mountain Chippewa Nation citizen, currently living with his family in Fargo, North Dakota. Jacob attended a tribal college and was the first Indigenous student in the United States to graduate from an accredited Master’s in Public Health program from North Dakota State University with an American Indian (AI)specialization. Jacob's primary focus is serving Indigenous populations through his work. With over fifteen years of experience working with Indigenous people, he currently serves as the Tribal Programming Director for Prevent Child Abuse North Dakota (PCAND).

A foundational element of much of Jacob's work uses the Self-Healing Community Framework. The purpose of this framework is to empower communities to be self-healing and trauma-informed. This framework was first successfully used in the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Project. As part of this work, Jacob’s team received an Innovation Award in 2016; this work continued until the project ended in 2019. Over the long term, this approach aims to create social change through community healing by acknowledging individual and societal trauma’s impact on a population. In 2018, funding was secured through the Centers for Disease Control and Prevention (CDC)High Obesity Program (HOP) to carry on the tenets of the self-healing community framework within that project. Due to the success of the MIECHV Innovation project, Jacob was approached to serve as the program lead.

Jacob is passionate about the self-healing framework and the impact this approach has on the communities he and his team serve. When asked about things he feels most proud of in his professional life, Jacob said:

“ONE OF THE THINGS THAT I AM MOST PROUD OF IS THE WORK THAT OUR TEAM DOES AROUND UTILIZING A SELF-HEALING COMMUNITY FRAMEWORK, WHICH ALLOWS US AN OPPORTUNITY TO PLAY AN ACTIVE ROLE WITHIN SOCIETAL CHANGE.”

Professionally, Jacob recognizes that the success of the projects he is a part of comes from a team effort. Indeed, Jacob commented that his position stems from the relationships he has cultivated over the years, relationships within his team and with the communities and partners he serves. In his words:

“OUR SUCCESS CAN BE ATTRIBUTED TO OUR TEAM APPROACH AND THE PASSIONATE PEOPLE THAT I AM HUMBLED TO WORK WITH.”

 When asked about one thing everyone should know about his work, Jacob also stressed the importance of teamwork and being surrounded by people who are as passionate about Indigenous communities as he is. He commented that:

“THE MOST IMPORTANT THING ABOUT THE WORK I DO, IS THAT I AM PART OF A TEAM OF PEOPLE THAT HAVE A SHARED PASSION TO LEAVE THE WORLD A BETTER PLACE FOR OUR CHILDREN. I AM EXTREMELY HONORED THAT I GET TO WORK WITH AMAZING PEOPLE ON A DAILY BASIS AND CREDIT THE SUCCESS WE HAVE TO THAT TEAM DYNAMIC.”

Jacob works tirelessly on developing and maintaining relationships. He serves on various committees, coalitions, alliances, associations, advisory boards and work groups at national, tribal and state levels to help create more equitable systems. On a national level, he serves as a member of the No Kid Hungry Early Childhood Strategic Advisory Group. At a state level, Jacob is a member of the North Dakota Health Equity Committee, a governor-appointed member of the Autism Spectrum Disorder Task Force and serves as the North Dakota Public Health Association’s IndigenousPublic Health Section chair. Jacob also helped found and served as a member of the Turtle Mountain Healthy Living Coalition, the GoodHealth Together Coalition and the Turtle Mountain Community Development Task Force. He is also a member of the North Dakota Behavioral Risk Factor Surveillance System (BRFSS) workgroup and a member of the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) advisory committee. These are just a few examples of the many areas of Jacob’s contributions. Jacob believes that education is the key to ensuring every person can attain their full health potential. In his words:

“I FEEL THAT EDUCATION IS THE MOST IMPORTANT. IF WE CAN FIX THIS SYSTEM, IT WOULD ALLOW US TO CREATE AN HONEST AND TRANSPARENT LOOK AT OUR SHARED HISTORY TO PROVIDE AN EQUITABLE FOUNDATION THAT FUTURE LEADERS CAN THRIVE IN.”

In his free time, Jacob likes staying active. He enjoys playing volleyball, walking and lifting weights. He also likes playing board games, going to the arcade and fixing puzzles with his three boys, Chase, Niibwin, Morrow, and his partner, Shelly.

RUTH BUFFALO, MPH MA

Written by: Payton Drent, Community Engagement Undergraduate Research Assistant

Ruth Buffalo is the epitome of hard work paying off. In 2018, she became the first American Indian/Alaska Native (AI/AN) Democratic woman to be elected to the state legislature in North Dakota. As a child, Ruth had challenging experiences with the Indian Health Services (IHS). In her own words:

“I WITNESSED MANY HEALTH DISPARITIES AND PREMATURE DEATHS WITHIN MYFAMILY THAT CHANGED MY PERSPECTIVE OF INDIAN HEALTH SERVICES.”

Her experience of IHS gave her the passion for working in the legislature to prevent chronic illness and improve the quality of life for everyone in the state.

Ruth earned her Master of Public Health at North Dakota State University(NDSU). She views public health as “looking at the historical context and how that affects our lives today.” Throughout her master’s program, Ruth learned many vital concepts about public health. She reiterated how the NDSU program showed that at times, “poor health is a result of poor policy and zip code determines life expectancy.”

“ZIP CODE DETERMINES LIFE EXPECTANCY”

One of Ruth’s main focuses is improving the disparities of low-income populations because they are seen as having the most disparities and are at the highest risk for poor health outcomes and often lack access to care. Buffalo affirms that low-income populations are “seen as an afterthought and expected to pick themselves up and take care of their health.”

Ruth highlights that low-income populations are prevalent among reservations, which offer IHS as their primary form of health care. Further, she described the impact of loan repayment on individuals relying on IHS. According to Ruth, loan repayment is a system where providers work on reservations and leave once the repayment is complete. Ruth indicates that this system detrimentally impacts how patients trust IHS staff and that people view IHS as a last resort. Ruth believes IHS needs adequate funding and should host community feedback sessions. She states, “If there were community sessions and individuals in the community speak up, it is more representative of what is needed.”

“HISTORICAL EVENTS PROVIDE BETTER INSIGHT INTO HOW AND WHY THINGS ARE THE WAY THEY ARE TODAY … THE DISRUPTIONS IN LIFE FOR HEALTHY WAYS OF LIVING LEADS TO UNHEALTHY COPING MECHANISMS.”

Furthermore, Ruth explained how generational trauma plays a role in the health and behaviors of individuals living on reservations. She explains that when AI/ANs were forcibly removed from their homes to live on reservations or go to boarding schools, they had to develop ways to cope with their trauma. Some of these coping mechanisms are either beneficial or adverse.

Ruth’s information is important because the research study published by Journal of Addictive Diseases shows that AI/ANs have the highest rates of substance use disorders compared to other racial/ethnic groups in the United States.

With this knowledge and personal experience, Ruth will not stop to improve health inequities for individuals in the state, especially those who utilize IHS. She will continuously work to improve IHS and be an advocate for underrepresented populations in the state.

MELANIE NADEAU, PhD MPH

Written by: Ruth Nwatu, Community Engagement Public Health Associate

Dr. Melanie Nadeau, aka Dr. Mel, is an accomplished researcher, a community-engaged scholar and an individual who exemplifies perseverance. An enrolled citizen of the Turtle Mountain Band of Chippewa, she is a first-generation college student and the fifth American Indian (AI) to ever graduate with a Ph.D. in Epidemiology. Although she never imagined herself teaching at an academic institution, experiencing the loss of many family members, including her mother, who passed away from cancer, motivated her to pursue a health career. Dr. Mel currently serves as Interim Chair for the Department of Indigenous Health as well as Graduate Program Director and Assistant Professor for the Indigenous Health Ph.D. program at the University of North Dakota School of Medicine & Health Sciences (UND SMHS). She discovered her love for research as an undergraduate student at TurtleMountain Community College. As a Research Technician at the tribal college, she recruited over 400 AI women for a genetic epidemiologic study on preeclampsia. According to Dr. Mel, graduating from a tribal college helped her stay culturally grounded and gave her the community support she needed to be successful.

Her commitment to making a difference in her community was recognized by the Bush Fellowship Program - a distinctive grant awarded to people who show leadership accomplishments and “extraordinary potential.” Through this fellowship, she completed a Master of Public Health in community health education with a concentration in health disparities at the University of Minnesota’s School of Public Health.

When asked about her proudest personal successes, stories, or experiences, she responded:

"I AM MOST PROUD OF THE WORK THAT I DO WITH MY COMMUNITY, THE TURTLE MOUNTAIN BAND OF CHIPPEWA INDIANS. I AM ALSO PROUD OF THE WORK I DO AT UND. I HELPED TO LAUNCH THE FIRST INDIGENOUS HEALTH PH.D.PROGRAM IN THE WORLD. LOOKING BACK, I NEVER THOUGHT I WOULD ONE DAY BE WORKING AT AN ACADEMIC INSTITUTION, TEACHING AND WORKING WITH NATIVES ACROSS THE COUNTRY."

As an advocate for community-driven research, Dr. Mel engages tribal communities to inform all aspects of her research projects, ensuring her research builds community capacity and creates long-term strategies for change. She believes that tribal members should lead data-driven research in tribal communities. She emphasizes that taking a community-driven research approach requires the following:

"ENGAGING THE COMMUNITY”
“BUILDING CAPACITY”
“MEANINGFUL DATA COLLECTION”
"CREATING CULTURALLY GROUNDED PRODUCTS”

Regarding her work, she believes everyone should know that it is essential to focus on the "process, not the outcome."

For her dissertation, Dr. Mel conducted a case-control study on breast cancer risk factors among AI women. This work was groundbreaking because it was the first time in history that a case-control study on breast cancer risk factors had been conducted with an AI population. After examining over 400 medical charts, electronic records and radiology files from the Indian Health Service (IHS), study findings showed that the breast cancer risk factors likely differed from those indicated in the Breast Cancer Risk Assessment Tool for white women. From this experience, Dr. Mel learned that AI communities are seldom involved in the data collection process, significant data gaps exist for AI people, and there is a need to build capacity for data collection at the tribal community level.

Currently, Dr. Mel is working with her community, the Turtle Mountain Band of Chippewa Indians, to build a data collection tool that evaluates cancer-related youth risk and protective factors. Once data is collected, Dr. Mel plans to work with the community to inform intervention efforts and identify ways to build protective factor-rich environments in hopes of closing the health disparities gap.

Thank you, Dr. Mel, for your passion and dedication to serving your community.

COMMUNITY ENGAGEMENT UNIT COLLABORATIONS

1. IDEAA Committee. Team ND is made up of a diverse population of individuals and strives to foster an inclusive workplace that enables team members to share their unique identities and perspectives. To support this diversity, the IDEAA committee has been formed. IDEAA stands for Inclusion, Diversity, Equity, Access and Action. An 'IDEAA Starts with I' video was created to captures the diverse population that makes up Team ND—the ways we are similar, ways we are different and the challenges we face. Celebrate the uniqueness that makes us great by watching and sharing this cross-collaborative video today. And remember, #IDEAAStartsWithI!

    

2. Johns Hopkins University’s Center for Indigenous Health. The CE Unit is partnering with Johns Hopkins University’s Center for Indigenous Health to deliver in-state families and organizations free children’s books on COVID-19 resiliency. Copies can be ordered here. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).

    

3. North Dakota University System (NDUS). NDUS students are partnering with the CE Unit as Ambassadors! The Student Ambassadors program supports public health activities, spotlights public health knowledge and promotes positive health behaviors throughout the state. Morgan Pizur-Kranc, a former HHS graduate assistant from North Dakota State University, presented on the program during the American Public Health Association's annual meeting in November 2022. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).

    

4. North Dakota Women’s Network (NDWN). The NDWN is creating their project plan for 2022-2023, which includes the development of a women’s health task force. This task force aims to create and provide preventive women’s health resources to the Tribal and New American/Foreign-born/Immigrant (NFI) communities. One goal of the task force is to provide women with information on resources such as Women, Infants and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), annual exams, cancer screenings and more. NDWN will also be connecting with Standing Rock Tribal programs to reach women in their reservation and promote task force activities. The CE Unit is a collaborative partner of the NDWN and is participating in the development of the women’s health task force. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).

SPECIAL POPULATION HIGHLIGHT

AMERICAN INDIAN/ALASKA NATIVE POPULATION

Written by: Jorden Laducer, CE Unit Special Populations Coordinator

Welcome to Special Population Highlight! This section of the newsletter provides specialized health and cultural awareness information about a population. In this issue, the AI/AN population will be highlighted.

When referring to AI/AN people, the importance of the diversity of AI/AN peoples' cultures, traditions and languages must be acknowledged. The words chosen to be written and/or to be spoken have significant power; words are fraught with meaning and importance. The words used day in and day out convey messages to others. When talking about a particular Tribe or Nation, learning and using accurate terms specific to the community can prevent stereotypes and encourage cultural understanding and sensitivity among the AI/AN population.

American Indian/Alaska Native Population in North Dakota

There are 574 federally recognized AI/AN tribes in the United States. North Dakota is home to five federally recognized tribes and one AI/AN community located at least partially within the state:

• Mandan, Hidatsa and Arikara Nation (Three Affiliated Tribes)
• Standing Rock Sioux Tribe
• Spirit Lake Nation
• Turtle Mountain Band of Chippewa Indians
• Sisseton-Wahpeton Oyate Nation

There are approximately 46,000 AI/ANs living in North Dakota. This demographic represents the largest minority population (6.4%) in the state. Approximately 70.5% of AI/ANs live in rural counties and 29.5% live within urban communities.

Health Inequities in North Dakota

Compared with other racial/ethnic groups, national statistics report AI/ANs well below the average for access to health care and in the highest rankings for poor health outcomes of any ethnic or racial group. Even though members of federally recognized tribes have a legal right to healthcare, life expectancy is lower, and a disproportionate disease burden exists due to factors such as inadequate education, poverty, discrimination in healthcare delivery and cultural differences. These inequities are associated with economic adversity and poor social conditions. Social driversof health (SDoH), the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life (e.g., education, housing, environment, employment opportunities) affect a person’s ability to earn a good living, work in a safe and healthy environment and effectively utilize healthcare resources. SDoH have created health disparities among the AI/AN population.

Based on the North Dakota 2017-2020 State Health Assessment (SHA) report, AI/ANs had the second highest(5.7%) score of total mortality by race. The Data in the SHA indicates that the primary causes of death differ within the AI/AN population in the state. Among those aged 64 and younger, heart diseases and accidents were the top two primary causes of death. Among AI/ANs older than 65, heart diseases and cancers were the top two primary causes of death. AI/AN life expectancy is significantly lower than other North Dakota racial groups. The average age at death for AI/ANs living in North Dakota is 57.2 years, while the white population is considerably higher at 76.3 years.

The 2017-2020 North Dakota SHA report also showed that in 2020 the five leading causes of death for AI/AN include heart disease (26.8%), COVID-19 (22.6%), cancer (16.3%), unintentional injuries (14.2%) and diabetes (6.3%). Diabetes rates in the AI/AN population are disproportionately higher than in other racial and ethnic groups in North Dakota. Among the AI/AN population, the rate of diabetes is four times higher than all other races in North Dakota. The 2020 SHA report indicated that other leading causes of death for AI/AN’s were suicide (4.7%), cerebrovascular diseases (3.9%), COPD (3.1%) and influenza/pneumonia (2.1%).

Premature deaths from 2017-2020 (i.e., deaths before age 65) accounted for 57% of AI/AN deaths in North Dakota. This prevalence of premature deaths among AI/AN is in stark contrast to the rate of premature deaths of all other races in the state (43%). Heart Disease, accidents and cirrhosis were the leading causes of premature deaths among AI/AN, while cancer and heart disease deaths were the leading causes of death for AI/ANs ages 65 and older.

The AI/AN communities have proven their resilience, endurance and tenacity in facing health inequities and barriers. The AI/AN population has built cohesive communities to heal itself and influence future future generations through culture, spirituality, shared values a strong sense of identity, accountability and responsibility.

TRAINING OPPORTUNITIES AND RESOURCES

Indian Health Service   American Indian Public Health Resource Center   Bismarck - Urban Indian Health Institute   Centers for Medicare & Medicaid Services Serving American Indians and Alaska Natives in NorthDakota and South Dakota   Bureau of Indian Affairs (BIA) Financial Assistance and Social Services   Disaster Distress Helpline | U.S. Department of Health & Human Services

BOOK OF THE QUARTER

THE NIGHT WATCHMAN

Louise Erdrich

"Based on the extraordinary life of National Book Award-winning author Louise Erdrich’s grandfather, who worked as a night watchman and carried the fi ght against Native dispossession from rural North Dakota all the way to Washington, D.C., this powerful novel explores themes of love and death with lightness and gravity and unfolds with the elegant prose, sly humor, and depth of feeling of a master craftsman."

Click Here to Read More

QUOTE OF THE QUARTER

"SUCCESS IS NOT FINAL; FAILURE IS NOTFATAL: IT IS THE COURAGE TO CONTINUE THATCOUNTS."

- Winston S. Churchill

CONTRIBUTIONS TO THIS ISSUE

• Ruth Nwatu
• Valentina Asiedu
• Juliana Antwi
• Jorden Laducer-Dix
• Payton Drent
• Agnieszka Mason
• Hannah Anderson
• Krissie Guerard
• Sara Upgren
• Kim N. Mertz

YOUR HEALTH MATTERS IS A NEWSLETTER PRODUCED BY NORTH DAKOTA HEALTH AND HUMAN SERVICES COMMUNITY ENGAGEMENT UNIT.

We welcome your feedback. Email us here (hhs-engagement@nd.gov).

The NDHHS CE Unit works to understand and reduce health disparities among all North Dakotans. The primary goal is to work alongside North Dakota communities in addressing health-related needs to reduce disease rates by providing opportunities for interventions and improving access to health care. This will ensure that all North Dakotans have the ability to reach their optimal health.