Trying to tip the scales toward health for Navajos

A coalition pushes the Navajo council to tax junk food

The largest Native American tribe in the United States could be headed toward extinction if more action isn’t taken to combat the spreading scourge of diabetes.

That’s the opinion of a University of Nevada graduate student majoring in public health who is working with a coalition of other concerned members of the Navajo Nation called the Diné Community Advocacy Alliance.

“One in three Navajo people are diagnosed with diabetes or related diseases,” Denisa Livingston told the Free Press. “At this rate we will be extinct within a few generations if we do not do something to counteract the influence of junk food on this health hazard.”

There are two types of diabetes, one of which occurs in childhood, the other more frequently (but not always) in adulthood. The incidence of the latter, called Type II diabetes, is rising rapidly worldwide, but is a particular problem for Native Americans, who are more than twice as likely as white people to develop Type II diabetes, according to the Centers for Disease Control. A number of factors have been linked with Type II diabetes, including genetics, high blood pressure, high alcohol use, obesity, sedentary lifestyle, and a diet high in fat and carbohydrates, according to webmd.com.

Unlike Type I, Type II can be prevented or delayed with a healthy lifestyle, including maintaining a healthy weight, eating sensibly, and exercising regularly.

But on the Navajo Nation, ready-to-eat meals and other highly processed foods, many made with lots of sugar and white flour, are readily available at convenience stores and fast-food outlets across the vast reservation, while more-nutritious fare, including fresh fruits and vegetables, is hard to come by at local food stores, and can be very pricey.

And while food intake is only one consideration in the control of the disease, diet can be essential in dealing with it effectively it or even warding it off.

So the Diné Community Advocacy Alliance, a grassroots nonprofit, has been working for more than two years to pass legislation that would impose a 2 percent tax on “junk food” on the reservation to discourage unhealthy eating.

At the same time, they are also seeking to eliminate all sales tax on produce and water to make vegetables more affordable and encourage healthier eating habits. (Currently a 5 percent tax is imposed by the Navajo Nation on all food and drinks sold within its boundaries.)

After some initial successes in legislative committees earlier this summer, their proposal ultimately was rejected by the Navajo Nation Council last month.

But the coalition hasn’t given up. The cost of failure is too high, proponents say.

A tremendous toll

According to Robert Ratner, chief scientific and medical officer for the American Diabetes Association, the cost of treating diabetes is rising at a higher rate than overall medical costs, with more than one in 10 health-care dollars in the country being spent directly on diabetes and its complications.

The association recently estimated the total cost of treatment for the disease in the U.S. rose to $245 billion in 2012, up from $174 billion in 2007 – a 41 percent increase over a five-year period.

Twenty-five thousand Navajo people, or about 8.3 percent of the approximately 300,000-member tribe – are currently diagnosed with diabetes and another 75,000 with pre-diabetes, and the disease is taking a tremendous toll.

The annual cost of medical treatment for diabetes itself on the reservation is $325 million, and for treating diabetes-related complications, a staggering $2.5 billion.

Identifying with Spam?

Thus, a “sin tax” on junk food seemed a logical step to take.

Since Livingston joined the all-volunteer alliance earlier this year, she has become a spokesperson at legislative-committee meetings and chapter work sessions on the legislation.

“Our investigations on the Navajo Reservation show that 55 to 80 percent of stock at the Navajo grocery stores, like Basha’s in Kayenta [Ariz.], is processed food,” she said. “For that estimate we used Basha’s own definition of processed or junk food.”

The group has earmarked all of the tax revenue from the proposed junk-food tax for funding wellness projects in local chapters. At this time, she said, 14 chapters have wellness projects. If a chapter doesn’t have a project, the DCAA will help it get started. Volunteers are available to train chapters on how to develop and manage an effective project benefitting the whole community.

On July 18, Livingston presented the DCAA’s proposed legislation for consideration in the Navajo Nation Council. She showed research linking fats, sodium and calories to disease, while citing statistics on the economic impact of junk food on diabetes and related illnesses.

She added national and international statistics to illustrate the global epidemic and how it is not solely a Native disease.

She said The Archives of Internal Medicine predicted an 18 percent tax on pizza and soda would cause Americans to lose 5 pounds a year.

Livingston also pointed out that in an article in the British Medical Journal, economists agreed that “government intervention, including taxation, is justified when the market fails to provide the optimum amount of a good for society’s well-being.

“We would love to be the first Native tribe in the U.S. to take this positive step,” she said.

The legislation, #0086-13, sponsored by Delegate Danny Simpson, was supported by several co-sponsors including Speaker Johnny Naize and delegatess Lorenzo Bates, Jonathon Nez, and Edmund Yazzie.

Prior to the council’s summer session, the legislation was required to go before the scrutiny of the standing committees on Health, Education and Human Services; Law and Order; Budget and Finance and Naa’bik’iyati. When it passed all of them, it was placed on the council’s summer agenda.

At that point, hopes for its passage were on the rise. But after her introduction and explanation of the legislation, “suspicion and apprehension around the Navajo government’s ability to manage the flow of money to the local level became a big concern in the discussion,” said Gloria Begay, another advocate with the group.

Other comments from the floor suggested that the Division of Community Development, possible managers of the new tax dollars, did not have the staff or resources to absorb such a program at this time.

The issue of adding bottled water to the zero-tax group came up as well.

In addition, a few delegates said the tax would impose unfair costs on low-income families who would buy the junk food regardless of the tax.

According to Livingston, one delegate explained “how sad he was about the food tax because Navajos identify with Spam, fry bread and Coke, while another delegate suggested that the tax would cause junk-food bootlegging from the border towns.”

Lobbying for soda

And the unexpected presence of American Beverage Association lobbyists in council chambers was likely a factor in the failure of the junk-food-tax legislation.

According to the ABA website, the nonalcoholic beverage industry plays an important role in the U.S. economy. Direct economic impact of its combined associate members is reportedly $141.2 billion, providing more than 233,000 jobs from beverage sales. The industry also is said to provide more than $14 billion in tax revenues at the state level and $22.7 billion at the federal level, while contributing $765 million to charitable causes.

They are the folks who market hundreds of brands, flavors and packages, including regular and diet soft drinks, bottled water and water beverages, 100-percent juice and more sugary juice “cocktail” drinks, sports drinks, energy drinks and ready-to-drink teas.

Ivan Gamble, of the Navajo Nation’s Lechee Chapter (Page, Ariz.), a lobbyist for economicdevelopment projects and a partner in the Confluence Resort project, said the ABA came to him for lobbying help when the junk-food tax began to gain traction in the Navajo Nation.

Gamble believes that the DCAA legislation was flawed. Fifty percent of the people on the reservation use EBT (food-stamps) cards to buy groceries, and those purchases are not taxed anyway, he said.

In addition, he said, the higher costs of the groceries would cause a run to border towns such as Farmington, N.M., and Flagstaff, Ariz., where there are no taxes on food.

Plus, under the definition of “junk food,” he added, taxes would be assessed on “standard necessities, such as salsa, honey-based ham, orange juice and baby formula.”

His suggestion was to build a peacemaking effort that would set up programs developed from private-sector money.

“Tax-wise,” he said, “it is very complicated to change policy. Delegates are nervous about raising taxes on their constituents, and nobody wants to be the tax collector.

“Peacemaking is a win-win for us all.”

After Gamble had six meetings with the ABA, the beverage representatives agreed to fund wellness projects with funds from bottling companies at all chapters in the nation.

According to Gamble, Coca-Cola, Pepsi, Kalil Bottling Company, Basha’s and the ABA have signed on to his plan. The funds would be put into an interest-bearing trust administered by a not-for-profit foundation, such as the Notah Begay Foundation.

The annual interest paid out from the fund would build one chapter wellness project a year.

“However, we are going after more than a half a million dollars and at this point we have $400,000 in commitments to the fund,” Gamble said. “We will be asking Navajo Gaming, Navajo Hospitality, Shopping Centers and the Navajo Housing Authority for matching funds. We‘ll also be asking the Division of Navajo Health to redirect some funds to the project,” he added.

Gamble explained that the fund is beginning with a match from New Mexico State Rep. Sandra Jeff, who secured $100,000 for diabetes and health-related programs there.

Projections are that $40,000 to $45,000 of interest money will be available each year to fund a chapter wellness project. “Twentytwo thousand dollars will build a basketball court,” Gamble estimated, “so the amount we have available may provide for multiple projects like playgrounds, small parks, gardens and exercise centers at one chapter. However, we could possibly fund two or more chapters per year once matching contributions are found.”

The funding providers do not want to tell the chapters what to do but will ask what they want and then give funding for the projects. However, the chapter-land withdrawal for the wellness-project location is each chapter’s responsibility, according to Gamble. That in itself, and the schedule of one project per year, will take time, and time is of the essence, according to Begay.

She pointed out that under his proposal it would take 110 years before the ABA / Gamble fund has provided for wellness projects at all chapters. Federal funding is drying up due to sequestration. In the meantime, three more generations of people will be diagnosed with diabetes.

Even though the legislation failed on July 18, the vote was close: 10-8. And the discourse put the subject on the table, advocates say.

“We certainly don’t want to fight about the issue,” said Gamble. “I am glad the DCAA legislation has opened the discussion. Now we can work together to solve the problem.”

Fighting food deserts

In a February 2013 New York Times article, “The Extraordinary Science of Addictive Junk Food,” Michael Mann wrote that “this addiction will only deepen as the food industry continues to find new ways to get people hooked on foods that are convenient and inexpensive.”

We are what we eat, said research analyst Dana Eldridge, who works for the Diné Policy Institute at Diné College, where a project called the Diné Food Sovereignty Initiative links nutrition to economic development. Food also creates a link between Navajo Lifeways and economic development.

“We are including everyday people and farmers in our research in order to affect land-use-policy reform in the Navajo government, at IHS [Indian Health Services] and in local communities,” Eldridge said. “It’s a collective effort that will move us toward food sovereignty and help us rebuild our own self-sufficient food system based on the values and guiding principles of the Diné.”

Primary research at DPI focuses on literature and historical review around community members — what they ate when they were children and what food sources were available in the past, what type of food people buy today, where they buy it, the quality of the food and what they would like to buy that is not available.

The U.S. Department of Agriculture has determined that even though the traditional Navajo Lifeway in the past was a farming culture, today the reservation is a “food desert” where access to fresh healthful food is limited by distance, income and transportation. On the reservation the only food resources are convenience stores and a few grocers – all long distances from family homes.

Food deserts are defined as urban neighborhoods and rural towns without ready access to fresh, healthful and affordable food. Instead of supermarkets and grocery stores, these communities may have no food access or are served only by fast-food restaurants and convenience stores that offer few healthy, affordable food options. The lack of access contributes to a poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease.

The USDA’s Economic Research Service estimates that 23.5 million people live in food deserts. More than half of those people (13.5 million) are low-income. Some 2.3 million people live in low-income rural areas that are more than 10 miles from a supermarket.

The Diné Policy Institute is collecting data that addresses the food-desert determination –what roadblocks and barriers define reservation agribusiness and how Navajo people can return to farming.

“To find out how we got here, we are unpacking the historical markers that built the road to this unhealthy diet,” Eldridge said. “Before first contact with colonialism, Navajo people were farmers. Since that contact, extermination campaigns such as the ‘scorched earth’ around the 1860s, when all the Navajo orchards and the crops were burned, leads immediately to the Long Walk campaign that introduced rations [and white flour and shortening] while the people were incarcerated at Ft. Sumner.”

The U.S. Commission on Indian Affairs also developed programs introducing ranching culture, livestock reduction and wholesale slaughter upon the Diné after their return home from Ft. Sumner, which shifted the food culture away from sustainable practices that had worked for centuries.

Boarding schools became a significant influence, too, where students not only began to eat a diet that institutionalized sugar and salt, but also learned to devalue their own Native diets.

Eldridge added, “Removal, relocation and the resulting extinction programs that move Navajo people off of their home reservation land and away from their traditional sheepherding culture opens access to natural-resources acquisition for outside, non-Native companies. It is all linked.”

The formal food-commodity programs created dependency on the U.S. government and the development of a livestock and government- assistance culture.

Controlling people’s food sources controls the people, she added.

“What we lost is the farming culture and therefore access to healthy food. These,” she said, “and the advent of grocers, convenience stores and fast-food outlets on the reservation have impacted the health of our people while at the same time diminishing our sovereignty.”

The DCAA plans to re-introduce the junk-food tax in the fall council session.