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Navajos Leading the Way in the Fight Against Obesity

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The rest of the country should pay attention to what happens on the Navajo Nation following the institution of the junk food tax, which recently passed. They may lead the way for the rest of America in the fight against obesity and related chronic disease.

Across the country, the call for taxation of junk foods has mostly come from politicians and public health authorities, but on the Navajo reservation a grassroots group called the Diné Community Advocacy Alliance (DCAA), has been working for over two years to establish such a tax to improve the health of the Diné, or Navajo people.

The DCAA is made up of mostly women, including many grandmothers and great-grandmothers. They drive and hitch rides across the dirt roads of the 27,000-square-mile Navajo reservation in Arizona, New Mexico, and Utah to gather support. The largest reservation in the country, Navajo is divided up into 110 local governances, called chapters, and the DCAA members have been methodically showing up at chapter meetings to present their message.

The DCAA has accomplished something that others with more money, power, and influence have repeatedly failed to do: establish a tax on junk food.

The stakes are high for the Navajo: Over the past 20 years the obesity rate in the United States has soared, along with associated medical conditions like diabetes, high blood pressure, cardiovascular disease, renal failure, and depression. Native American communities bear a disproportionate burden of this epidemic. They suffer from diabetes at twice the rate of the rest of the U.S. population. These rates are particularly high among tribes in the Southwest, including the Navajo. Between 2003 and 2008, the incidence of diabetes in pregnancy among the Navajo doubled, to 13.6 percent, and new diagnoses of "adult-onset" diabetes among Navajo adolescents are twice as frequent as among whites.

There are many reasons why this is happening, but there is a well-established link between poverty and obesity, and the convenience and low price of high calorie foods certainly contribute. About 40 percent of people on the reservation live in poverty, and half of working-age adults are unemployed. The Navajo often point out that diabetes is a disease, akin to smallpox, that the white man brought, in this case by way of modern food production and agricultural subsidies.

Two bills came up before the council the last week of January, and both passed with a wide margin. The first, "The Healthy Diné Nation Act of 2013," passed 12-7, and will impose an additional 2 percent sales tax on junk food items in addition to the current sales tax of 5 percent. Junk food is defined as "sweetened beverages and ... snacks low in essential nutrients and high in salt, fat, and sugar, including snack chips, candy, cookies, and pastries." The proceeds will be divided up by chapter and earmarked for wellness-related projects.

The second legislation, "The Elimination Of The Sales Tax On Fresh Fruits, Fresh Vegetables, Water Nuts, Seeds And Nut Butters," passed 17-1, and will eliminate the sales tax completely on these products.

Assuming that the president signs both of these laws, they will soon become law, and a law that the rest of the country should follow.

Most studies assume that a tax rate of 10-50 percent, many times higher than what DCAA is proposing, is needed to decrease consumption of targeted foods. A 2012 Health Affairs article estimates that a nationwide penny per ounce tax would reduce consumption of sugary drinks by 15 percent and reduce obesity and diabetes rates. The DCAA realizes it is starting small, concerned that a bigger tax would incite more opposition and might send people off the reservation to buy their food. They are hoping that even a low tax might make a small impact and increase awareness.

Not surprisingly, the proposed legislation has faced push back. As in other parts of the country, the beverage industry has hired locals as lobbyists to come out against this tax, labeling it as paternalistic and regressive, while offering money to fund wellness projects. In some ways this fight has been the same as the many others across the county with the beverage industry using local messengers to curry favor by offering money to appealing and worthwhile causes. But in other ways, this fight is different.

The prime sponsor of the legislation, Council Delegate Danny Simpson, sees it as an issue of self-determination. He says, "My dad was diabetic. And my mom always told us, 'Later on, you're not going to get these free services from the government, especially [health care from] the Indian Health Service [IHS].' They always said that you had to take care of yourself. And to this day it's happening; the funding for IHS is going down."

He has seen the IHS do intensive education and exercise campaigns to promote a healthy lifestyle, "But it's not working. So how do we get the government involved now? ... Every single day we see our Navajo people at these dialysis centers, we see our Navajo people with limbs amputated. We see that every day. What more do we need to see as a council to address this issue?"

Let's watch what happens as the Navajo Nation leads the rest of the United States towards a healthier path forward.

Originally published in the Albuquerque Journal.

Authors:

Heather Kovich, M.D. is a family physician with the Indian Health Service in Shiprock, NM. The views expressed are her own and do not reflect the position of the IHS.

Christina Palmer, M.D. is a third year resident at the University of California San Francisco Family & Community Medicine program recently returning from a rotation on the Navajo Reservation.

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