Established in 1979, and taken under Winnebago tribal management in 1995, the Whirling Thunder Wellness Program combats diabetes and substance abuse by raising community awareness, administering primary and secondary prevention services, and encouraging healthy lifestyles that are consistent with traditional practices. With its focus on prevention, this field-based program is changing individual and community behavior on the reservation and helping to ensure a healthy citizenry for generations to come.
Community health has long been a priority for tribal leaders at the Winnebago Tribe of Nebraska. Having suffered through epidemics of small pox and measles in the 1600s that reduced the population from about 25,000 to 150, the Winnebago have a deep historical understanding of the importance of good physical health. Even as the Winnebago lost almost of their lands to the United States in treaties signed in the 1820s and 1830s, tribal leaders insisted that health care be among the services guaranteed by the federal government for their people. Among them was Chief Whirling Thunder, a champion of community health and wellness who sponsored foot races in the early 1800s.
Despite their belief that tribal strength is directly linked to community health, the Winnebago have struggled with serious health problems over the last half-century. Like many American Indian populations, diabetes has been a destructive force among the Winnebago Reservation's 2,600 residents. Currently, one third of Winnebago adults have Type 2 diabetes, and incidence and prevalence of diabetes are 7.7 percent and 8.8 percent higher in this population than in the US population at large. Diabetes does not just plague Winnebago adults, however: 48 percent of Winnebago youth have hyperinsulinemia, a predictor of future diabetes.
There has been a concerted effort to treat diabetes on the Winnebago Reservation for more than two decades. In 1979, the Indian Health Service (IHS) established one of its five model diabetes programs on the reservation. The Winnebago/Omaha Diabetes Project operated out of the local IHS hospital and was administered by three community health nurses who served both the Winnebago and its neighboring tribe, the Omaha. Although the Project provided much-needed data collection and improved clinical treatment for tribal citizens with diabetes, by the mid-1990s tribal leaders became attracted to the idea of the Tribe running its own diabetes program - one that would focus on diabetes prevention, be field based (rather than operated out of the IHS hospital), and incorporate community values into its services. As one tribal leader proclaimed, "The Indian Health Service is good at counting up the new cases of diabetes and the bad problems of diabetes like amputations and kidney dialysis. My question is how do we get in front of this problem, to stop it for future generations?"
Convinced that the Winnebago Tribal Health Department could self-manage an exemplary diabetes program, in 1994 the Tribe initiated the process of contracting its share of the Diabetes Project from the IHS under the Indian Self-Determination and Education Assistance Act of 1975 (P.L. 93-638). In 1995, the contract was approved and the Tribe launched the Whirling Thunder Wellness Program.
Housed within the Winnebago Tribal Health Department, the Whirling Thunder Wellness Program's mission is to "elevate the health and wellness status of Winnebago community members." With a twelve-person staff comprised of four health professionals and eight para-professionals in the fields of fitness, nutrition, public health, and substance abuse prevention, the Program addresses both diabetes and substance abuse - a dual focus that has been in place since 1998 following a review that found that almost half of the diabetes sufferers have a dual diagnosis of substance abuse. The Program possesses three core objectives: first, to increase and maintain community awareness and focus on the diseases of diabetes and substance abuse; second, to provide culturally appropriate primary and secondary prevention programs and services; and third, to provide programs to encourage healthy lifestyles consistent with traditional practices. These objectives, along with the services and programs that advance them, are reviewed annually by Whirling Thunder Wellness Program staff, the Winnebago Wellness Coalition (a group of health care professionals, representatives of institutional partners, and concerned community members), and the Winnebago Tribal Health Directors.
Because of the strong ties between diabetes, substance abuse, and lifestyle behaviors, the Whirling Thunder Wellness Program works closely with Winnebago youth to establish healthy lifestyle habits that will carry over into adulthood. For example, during peak "risk hours," the Program administers a robust set of healthy options. From 3:00 to 5:00 p.m. Monday through Thursday, Program staff immerse children from kindergarten to eighth grade in exercise, athletic events, dance classes, nutrition courses, and culture and language education. Recognizing that Winnebago youth may fall into unhealthy habits during the summer months, the Program organizes a number of cultural programs - such as teaching youth how to grow and harvest Indian corn - and administers the Whirling Thunder Youth Sports Program. The Sports Program, which involves parents and other adults as coaches, includes swimming, basketball, soccer, bowling, golf, baseball, softball, boxing, martial arts, cross-country, and track and field.
In addition to these after-school and summer programs, the Whirling Thunder Wellness Program administers several other critical services for Winnebago youth. For one, the Program screens for diabetes, diabetes risk factors, and substance abuse related risk behaviors. With parental consent, the Program measures children's height, weight, blood pressure, waist/hip ratio, body composition, blood sugar levels, and undertakes Acanthosis Nigricans grading and fitness testing. Also, since 1998 the Program has operated the Kidz Caf