By Edy Rodewald

On February 2, 2016, SEARHC presented at the 33^rd annual Alaska Health Summit in Anchorage, entitled “Health Across the Generations.”  Sessions focused on ways the public health community can support and promote optimal health and wellness across the life span, including health policy and systems change, the social and economic determinants of health, interdisciplinary partnerships, research, and evaluation.  A session on tobacco-related illnesses and cancer disparities among the American Indian and Alaska Native (AI/AN) populations seemed more than appropriate.   Why is this issue important? Nationally, adult smoking rates dropped from 21% in 2005 to about 18% in 2013.  AI/AN people have the highest rates of smoking, smokeless tobacco, cigar use, and use of more than one tobacco product, of any major U.S. racial or ethnic group.  Overall, 38.5% AI/AN continue to smoke commercial tobacco, more than double the national average. Smoking is a public health crisis in many American Indian and Alaska Native communities and it is a health equity issue.  Many Americans’ lives and health have improved but some groups (like AI/AN) have not.  This unequal health burden on the AI/AN people has been largely ignored.

In Alaska we are seeing diseases that were not historically common among Alaska Natives. Lung cancers, which are 90% attributable to cigarette smoking, are the leading cause of death for Alaska Natives.  Smoking is linked to 6 of the top 8 causes of death among AI/AN.  While every other race has seen decreases in cancer mortality over the last two decades, some AI/AN cancer mortality rates have increased.  Other diseases caused by tobacco include higher rates of heart disease and strokes (1 in 5), respiratory disease (8 in 10), higher infant mortality, diabetes, and asthma.  We need policy, systems, and environmental change to end this tobacco epidemic.

In Alaska more than half of all 229 Tribes have passed Tribal Resolutions to protect their members from secondhand smoke, encourage smokers to quit, and discourage youth from starting tobacco use.  But health care systems, including health insurance and good surveillance systems are also needed to intervene with this epidemic.  Alaska recently approved Medicaid Expansion.  The Affordable Care Act and Medicaid now cover proven effective medications and counseling to help people quit tobacco.  Environmental change is needed.  Things like removing gratuitous smoking from movies; limiting tobacco advertising (sponsorships, promotions and giveaways especially using electronic media; banning tobacco sales in pharmacies; ensuring implementation of tobacco-free campuses in schools and universities, health care campuses, and public outdoor places can all be part of the solution.