Go Lean Commentary
The forgoing article focuses on an important issue for the Caribbean. Diabetes is a scourge to the region; it is among the leading causes of death. Though death is the final destination of all humans, quality of life is a fitting goal for optimization. Diabetes is a degenerative disease; it grievously affects the quality of life; over time, its sufferers are afflicted with ailments like kidney failures, amputations and blindness. In addition to the personal discomforts, these treatments exact a huge toll on a community’s economics. For this matter, this subject is in scope for the Caribbean Union Trade Federation (CU).
The book, Go Lean … Caribbean, serves as a roadmap for the introduction and implementation of the CU. This technocratic agency will assume oversight to optimize the region’s:
(2) security apparatus, and
(3) governing engines.
The subject of diabetes disease management is in scope for all 3 of these prime directives. The importance and linkage of the topics for diabetes, healthcare and economics are undeniable. But there are security threats as well, as advanced diabetes dispositions increase the need for organ transplantations, inducing many to venture into the illegal organ trade markets. Finally, the strain on governments to service this population and develop mitigation plans is a constant priority – or should be.
By: FELICIA FONSECA
Flagstaff, Arizona — Facing a high prevalence of diabetes, many American Indian tribes are returning to their roots with community and home gardens, cooking classes that incorporate traditional foods, and running programs to encourage healthy lifestyles.
The latest effort on the Navajo Nation, the country’s largest reservation, is to use the tax system to push people to ditch junk food.
Navajo President Ben Shelly earlier this year vetoed measures to enact a 2 percent sales tax on tax on chips, cookies and sodas, and to eliminate the tax on fresh fruit and vegetables. This week, tribal lawmakers have a chance to resurrect the proposals, and supporters are optimistic they’ll be among the first in the country to succeed.
Elected officials across the U.S. have taken aim at sugary drinks with proposed bans, size limits, tax hikes and warning labels, though their efforts have not gained widespread traction. In Mexico, lawmakers approved a junk food tax and a tax on soft drinks last year as part of that government’s campaign to fight obesity.
Shelly said he supports the intent of the proposals on the Navajo Nation but questioned how the higher tax on snacks high in fat, sugar and salt would be enacted and regulated. Supporters of the tax say it is another tool in their fight for the health of the people.
“If we can encourage our people to make healthier choices and work on the prevention side, we increase the life span of our children, we improve their quality of life,” said professional golfer Notah Begay III, who is among supporters.
American Indians and Alaska Natives as a whole have the highest age-adjusted prevalence of diabetes among U.S. racial and ethnic groups, according to the American Diabetes Association. They are more than twice as likely as non-Hispanic whites to have the disease that was the fourth leading cause of death in the Navajo area from 2003 to 2005, according to the Indian Health Service.
Native children ages 10 to 19 are nine times as likely to be diagnosed with Type 2 diabetes, the IHS said.
The proposed Navajo Nation tax wouldn’t add significantly to the price of junk food, but buying food on the reservation presents obstacles that don’t exist in most of urban America. The reservation is a vast 27,000 square miles with few grocery stores and a population with an unemployment rate of around 50 percent. Thousands of people live without electricity and have no way of storing perishable food items for too long.
“They have a tendency to purchase what’s available, and it’s not always the best food,” said Leslie Wheelock, director of tribal relations for the U.S. Department of Agriculture.
Wheelock said the diabetes issue in tribal communities is one that has been overlooked in the past or not taken as seriously as it could be. It has roots in the federal government taking over American Indian lands and introducing food that tribal members weren’t used to, she said.
To help remedy that, the USDA runs a program that distributes nutritional food to 276 tribes. Grants from the agency have gone toward gardening lessons for children within the Seneca Nation of Indians in New York, culturally relevant exercise programs for the Spirit Lake Tribe in North Dakota and food demonstrations using fresh fruit and vegetables on the Zuni reservations in New Mexico.
The Dine Community Advocacy Alliance, which has been pushing for the Navajo Nation junk food tax, estimates it will result in at least $1 million a year in revenue that could go toward wellness centers, community parks, walking trails and picnic grounds in tribal communities in Utah, New Mexico and Arizona. It would expire at the end of 2018.
Tribal lawmakers will vote this week on overturning Shelly’s vetoes. Regardless of whether that legislation passes, “we have to keep stepping up to the plate,” alliance member Gloria Begay said.
No other sales tax on the Navajo Nation specifically targets the spending habits of consumers. Alcohol is sold in a few places on the reservation but isn’t taxed. Retailers and distributors pay a tobacco tax.
Opponents of the junk food tax argue it would burden customers and drive revenue off the reservation. Mike Gardner, executive director of the Arizona Beverage Association, said the lack of specifics in the legislation as to what exactly will be taxed could mean fruit juice and nutritional shakes would be lumped in the same category as sodas.
“I don’t think they mean that, but that’s what will happen,” Gardner said. “It’s a little loose, a little vague. It’s going to create problems for retailers and … it doesn’t solve the problem.”
a. By the numbers:
Total population of Navajo Nation: 250,000
Unemployment rate: 44%
Families living in poverty: 30.5%
People living with diabetes: 55,000
Source: Partners In Health (PIH), a 501(c)(3) nonprofit corporation headquartered in Boston, Massachusetts. (http://www.pih.org/country/navajo-nation/about)
Associated Press (AP) News Wire Service (Retrieved 04/22/2014) –
The roadmap commences with a Declaration of Interdependence. In Verse IX (Page 11) it pronounces:
Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.
The foregoing article highlights diabetes disease management in the controlled population of the Native American Reservation for the Navajo Nation in Arizona [a]. In fact, Go Lean posits that the Caribbean can benefit greatly from a consideration of the examples, samples and lessons from Native American tribes and their experiences. This is included in the book as “10 Lessons from Indian Reservations” (Page 141). As for this issue, Go Lean also recognizes that food choices and the preponderance of junk food could imperil community wellness; (Page 162). We must therefore take heed to these lessons.
The CU mission is to implement the complete eco-system to re-boot health delivery in the region. Applying strategies to win the battles of globalization, the Go Lean roadmap urges the Caribbean region to not only consume; we must create and contribute as well. In that vein, there are many tactics, implementations and advocacies to facilitate the vision for R&D, incubation, entrepreneurship and many other areas related to medical tourism. These are detailed here:
|Community Ethos – Deferred Gratification||Page 21|
|Community Ethos – Intelligence Gathering||Page 23|
|Community Ethos – “Bad Things” Happen||Page 23|
|Community Ethos – Lean Operations||Page 24|
|Community Ethos – Return on Investments||Page 24|
|Community Ethos – Non-Government Org’s.||Page 25|
|Help Entrepreneurship||Page 28|
|Impact Research and Development||Page 30|
|Promote Happiness||Page 36|
|Impact the Greater Good||Page 37|
|Separation of Powers – Health Department||Page 86|
|Steps to Implement Self-Governing Entities||Page 105|
|Ways to Benefit from Globalization||Page 119|
|Improve Healthcare||Page 155|
|Impact Entitlements||Page 158|
|Better Manage Food Consumption||Page 162|
|Better Manage the Social Contract||Page 170|
|Foster Cooperatives||Page 176|
|Ways to Improve Organ Transplantations||Page 214|
|Impact Foundations||Page 219|
|Improve Elder-Care||Page 225|
|Impact Persons with Disabilities||Page 228|
The roadmap addresses the obstacles for full implementation of the CU objectives. Like most communities, there are cost constraints, as the foregoing article reports on a special tax to fund junk food mitigations. How will the CU pay for its strategic and tactical initiatives?
The book addresses this issue in full detail in these advocacies:
|Ways to Pay for Change||Page 101|
|10 Revenue Sources for Administration||Page 172|
Change has come to the Caribbean. Both the people and institutions of the region are urged to “lean-in” for this change. As described in the book Go Lean … Caribbean, the benefits of this roadmap are too important; improving health deliveries is not just economic, more important, it’s about saving lives.
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