Editor’s note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change. Interested communities are encouraged to apply for the 2015 RWJF Culture of Health Prize. Applications are due September 17, 2014.

The Taos Pueblo in New Mexico is a National Historic Landmark and one of a handful of places around the world designated a World Heritage Site by the United Nations. Native Americans have continuously lived in this ancient tribal community, with its remarkable multi-story adobe buildings, for more than 1,000 years. Today, the Taos Pueblo tribe has about 1,350 people living on some more than 100,000 acres, just outside the artist community of Taos.

The pueblo has its share of poverty and unemployment, along with troubling rates of diabetes, obesity, and alcoholism. Data from the Indian Health Service clinic at the pueblo show that about 47 percent of pueblo youth under age 20 are overweight or obese. And 21 percent of the adults have diabetes. Many pueblo residents live below the poverty level, which is not surprising as their economy is based on tourism, crafts, and a small casino.

Taos Pueblo has kept its ancient oral language, culture, and traditions alive despite the onslaught of history. Members of the tribe draw strength from their community and their past. The people of the pueblo, determined to preserve their tribe, are working hard to improve the health and prospects of the next generation. Their own unique traditions have become a key part of their response to modern problems.

A small, incredibly close-knit community, the pueblo struggled with huge state and federal bureaucracies for years. At one point residents on pueblo land had to navigate 36 different programs, from diabetes prevention to early childhood education—each run by a different manager, some from the pueblo, many from outside. It was a fractured and uncoordinated system.

Self-Governance

Then, in 2007, the tribe made a daring decision. Taos Pueblo, which is a sovereign nation, took over many of those programs through self-governance, giving the tribe more independent control in setting its own goals. Taos Pueblo receives government funding and operates within certain parameters, but the community has the freedom to manage and direct the programs. Tribal leaders take this stewardship very seriously because they know other tribal nations are looking to Taos Pueblo as a model.

After self-governance, the tribe reorganized these services and streamlined efforts. Community meetings are now held regularly to discuss what people want in programs, and the Tribal Council weighs the community input in establishing priorities. Although progress has been made with these programs, they are relatively new and collecting data can be a challenge.

From a public health perspective, Taos Pueblo is making systems and organizational changes, such as sending a public health nurse, who is from the Taos Pueblo community, door to door to visit the most vulnerable and ill pueblo residents. The community is seeing positive results. For example, the pueblo was named an “outstanding grantee” by the Department of Labor, and in 2012 the Department of Interior recognized it for its “innovation, creativity, and exemplary program management.”

New Partnerships

  • Red Willow Community Growers Cooperative and the Red Willow Farmers Market are reviving the tribe’s agricultural heritage to improve health and incomes. The co-op has its own fields, gardens, raised beds and greenhouses, with passive solar design and drip irrigation. The weekly market open year-round sells organic fruits and vegetables to pueblo families, tourists, and locals as well as the tribe’s Head Start and Senior Center. High school students, working at the market and the co-op, learn about greenhouse production and organic farming. The co-op and market have seen demand rise, and the co-op now contracts to provide local ingredients to several area restaurants.
  • Taos Pueblo Head Start and My First School serves children ages one to five and is located in a newly renovated building designed to welcome children and their families. The school serves organic food, including food grown in the school’s indoor garden, tended by students, teachers, and parents. New Mexico’s Healthy Kids Healthy Childcare Initiative recently recognized the Taos Head Start as a model program for the way it incorporates healthy eating into its daily lessons. Teachers connect the food and the cycle of planting to pueblo traditions. The garden is one aspect of this type of connection, the instruction of Tiwa is another example. The community’s native language of Tiwa is taught to the young children as part of the school curriculum to help instill a stronger sense of community.
  • The Public Health Nursing Department was created three years ago on the pueblo. Before the tribe took control, tribal members had to go to the clinic to receive medical attention. Now, a Native American nurse from the pueblo and two trained Community Health Workers go door to door and provide case management services for those with chronic diseases as well as assist with the other health needs of the community. The department also runs a diabetes prevention program, which helps residents learn about screening, preventing, and managing Type II diabetes. The health team worked with the free fitness program, stressing the link between exercise and diabetes. Three-quarters of the people in the prevention program now regularly use the pueblo’s fitness facilities at the recently renovated community center, where group sports and even Zumba and yoga are offered.

What Have We Learned?

Take control of your programs. That control has galvanized the tribe. Tribal leaders and members of the community are interested, involved and willing to work hard.

Listen to the community. Regular meetings, surveys, and focus groups allow Taos Pueblo to tailor its services to the community’s needs, expanding involvement in programs ultimately making them more successful.

In the future, Taos Pueblo will work to see that its four streamlined departments— Education, Health and Community Services, Natural Resources and Municipal Services— are closely linked to build a culture of health.