Neqpiaput Iinruugut (Our Food is Medicine): Testing a tribally-driven intervention to prevent heart disease among Alaska Native communities

Project Summary/ Abstract
There is an urgency to address disparities in coronary heart disease (CHD) among Yup’ik Alaska
Native People living remote, frontier communities in the Yukon Kuskokwim Delta Region (YKD).
Well-intentioned mainstream interventions in Native communities have fallen short of their intended
goals, largely because they focus too narrowly on changing dietary behaviors without addressing the
deeper root cause of CHD, i.e., the lasting harms of colonization and historical trauma and disruption
of traditional food systems. Consistent with a robust body of research, Yup’ik tribal leaders and Elders
recognize that this limited perspective is ineffective and potentially harmful, as it perpetuates
stereotypes that poor health is their own fault. Most interventions continue to reflect individualistic
causes and solutions, despite broad acknowledgment that colonization was, and continues to be,
harmful to Native Peoples. In response to direct calls for action by Yup’ik Elders and community
leaders we propose to confront disparities in CHD through a tribally driven, Indigenous food
sovereignty (IFS) intervention, called Neqpiaput Iinruugut (Our Food is Medicine). Neqpiaput Iinruugut
reconnects Yup’ik People with their cultural strengths by blending an established and thriving Yup’ik
Elder-designed behavioral health program rooted in ancestral wisdom (Calricaraq) with a carefully
selected set of Yup’ik Elder-designed teaching/learning workshops on traditional foodways. This
12-month, strengths-based and tribally led intervention will be delivered by community interventionists
in three complementary layers: (a) monthly in-person community gatherings; (b) quarterly in-person,
hands-on workshops; and (c) a Facebook group for participants to access knowledge resources and
engage with other community members between monthly sessions. This intervention is designed to
address health factors beyond the individual, catalyzing systems that synergize reduction of CHD risk
and progress toward IFS. The cornerstone of this study is the longstanding and trusting CBPR
relationship between The Center for Alaska Native Health Research, the Yukon Kuskokwim Health
Corporation (the tribal healthcare organization in the YKD), and the Calricaraq Elders Council,
comprised of approximately 40 Elders from across the region. Our specific aims are to 1) Determine
the effectiveness of Neqpiaput Iinruugut on CHD risk, 2) Determine if cultural buffers (growth in
cultural identity, Yup’ik wellness, community connectedness, social support, and family cohesion)
mediate the effect of the intervention on CHD risk, and 3) Examine the impact of Neqpiaput Iinruugut
on IFS indicators. Findings have the potential to reduce the burden of CHD in Alaska Native
communities while advancing the field of tribally driven diet-related disease interventions.

Grant Number: 1R01HL181633-01
NIH Institute/Center: NIH
Principal Investigator: Andrea Bersamin