Diabetes is the leading cause of death among American Indians and Alaska Natives, and they are twice as likely to have diabetes as non-Hispanic whites.

Social determinants of health, such as poverty, lack of access to healthcare, unhealthy diet, and physical inactivity, all contribute to chronic diseases in tribal populations.

Culturally competent care for tribal populations involves respecting traditional beliefs and practices, using culturally appropriate language, and involving tribal elders and leaders in healthcare planning.

The Indian Health Service (IHS) is a federal agency within the U.S. Department of Health and Human Services that provides healthcare to American Indians and Alaska Natives.

The Tribal Self-Governance Program allows tribes to contract with the IHS to provide healthcare services to their members, provides funding to tribes for healthcare infrastructure and personnel, and provides technical assistance to tribes in developing and implementing healthcare programs.

Challenges to addressing chronic diseases in tribal populations include poverty, lack of access to healthcare, unhealthy diet, physical inactivity, and cultural barriers.

Promising approaches to addressing chronic diseases in tribal populations include community-based interventions, culturally tailored interventions, school-based interventions, and worksite interventions.

Traditional healers can provide spiritual support to patients, provide traditional remedies for chronic diseases, and help patients connect with their cultural heritage.

Involving tribal communities in the development and implementation of chronic disease prevention and control programs ensures that programs are culturally appropriate, increases the likelihood that programs will be successful, and builds trust between tribal communities and healthcare providers.

Metrics that can be used to track progress in addressing chronic diseases in tribal populations include incidence of chronic diseases, prevalence of chronic diseases, mortality from chronic diseases, and years of potential life lost due to chronic diseases.