American Indians and Alaska Natives have higher rates of chronic disease than other racial and ethnic groups in the United States.

They have highest prevalence of diabetes, have higher heart disease and stroke death rates, are more likely to be obese and smoke cigarettes.

Despite these

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health challenges, American Indians and Alaska Natives have a number of inherent strengths developed as a result of time, history, and adversity, including unique tribal languages and cultures, and use of these resources to foster community and cultural connections.

Connection to place, history, culture, and spiritual strength all create opportunities for wellness that can be drawn upon to overcome these challenges.

Culture is the root of American Indian and Alaska Native identities – culture incorporates aspects of living, interpersonal and communal relationships, communication, worldviews, traditional customs, and spirituality.

Tribal leaders have discussed the importance of investing in tribal practices and cultural traditions as they have supported good health and wellness in tribal populations for generations.

This NOFO supports tribal practices that connect individuals and community to culture with the long-term goals of building resiliency; reducing morbidity and mortality due to heart disease, stroke, cancer, and diabetes; and reducing risk factors for all chronic disease among American Indians and Alaska Natives.

These practices were identified by tribal health leaders during 3 convenings, undertaken in 2016 at the request by the Tribal Advisory Committee, to help CDC better understand what tribal health leaders believe will keep their people healthy and well.

Studies have also demonstrated that culture and language have a positive impact on health and well-being; American Indian youth that speak their language and have non-parental role models may have lower rates of suicide, be less likely to engage in risky behaviors like alcohol and commercial tobacco use and lifestyle interventions that incorporate native history and culture may be more effective in addressing risk factors for diabetes.

The uniqueness of tribal cultures and their commonalities is a source of strength, and although each tribe is unique, there are commonalities that tribes share, including valuing traditional practices, honoring elders, respecting nature, and emphasizing clan/community importance.

The strategies tribes and urban Indian health centers will implement as part of this NOFO will draw upon the common value of honoring traditional practices.

The NOFO will support evaluation of this approach in tribal communities to build the evidence-base.

This NOFO will build upon the Good Health and Wellness in Indian Country (DP14-1421PPHF14) program, which has demonstrated that a coordinated, holistic, and tribally-driven approach can strengthen the ability of tribes to improve the health of American Indians and Alaska Natives.