Both historical and present-day factors contribute to high rates of food insecurity innavajo nation

Long-standing historical policies, including military destruction of local nativefood sources and diversion of water sources, have undermined traditional agricultural practices.1VAST geography (27,000 square miles) and limited infrastructure (78% of public roads areunpaved) pose formidable barriers to food access. With only 13 grocery stores on thereservation, IT is common for navajo residents to drive 400 miles round trip to buy food.finally, opportunities for economic development are few: 43.6% live below the federal povertyline 3 and 64%-70% of income generated within navajo nation is spent off-reservation, with asignificant portion spent on food.community outreach and patient engagement (cope) works with community partners tounderstand how food insecurity affects local community members and implement solutions.from 2012 to 2014, cope partnered with navajo community health representatives (chrs) todesign and conduct 250+ surveys, 30 in-depth interviews, and a dozen stakeholder meetings; findings revealed that most families travel more than one hour to buy groceries, and a quarter offamilies (26%) only shop once a month. A majority of households (57%) indicated they wereunable to access enough fruits and vegetables, with reasons for lack of access reported as highcost (66% of respondents) and difficulty keeping produce fresh (61%). These findings alignwith published data indicating that 75% of navajo households may face food insecurity. As aresult, many navajo residents rely instead on low-cost, shelf-stable, high-calorie foods.unreliable access to healthy foods is driving up rates of obesity, diabetes, and cardiovasculardisease across navajo nation. The united states department of agriculture (USDA) classifiesnavajo nation as a food desert. Compared to 9.3% of the overall US adult population, one infive navajo adults (approximately 25,000 total) has diabetes, anda further 75,000 are prediabetic.9,10 consistent access to affordable healthy food is critical to addressing these publichealth problems, particularly for navajo youth who are facing some of the highest rates oftype 2 diabetes in the country. This is of particular salience as 50% of the population ofnavajo nation is under 29 years of age, and 20% are between the ages of 10-19 years, representing the largest age group.13IN response to these public health threats, there has been growing momentum among leaders and community advocates to strengthen food systems and promote health and wellness in navajo nation. Since 2014, cope has partnered with 14 healthcare facilities, two community-based health programs and 26 stores to implement the navajo fvrx program. This is the first fvrx program in a rural native community. Wholesome wave (founded by GUS schumacher)has provided and continues to provide technical assistance to cope for program implementation.building on existing formal agreements with navajo area indian health services, we approachedclinical sites to explore their interest in offering fvrx at their sites. All sites agreed to participate, forming provider teams and implementing fvrx. Cope has also been approached by tribal health programs and home visitation programs. In total, we have trained 17 teams that offer fvrx programs to navajo families. The program requires that provider teams must:include maternal/child healthcare providers and health promotion specialists; andhave leadership approval (e.g. department supervisor) to deliver fvrx.to continue fvrx, teams must meet program standards including: successful participantenrollment and retention; monthly health promotion sessions and voucher disbursements; activeteam participation in regional fvrx meetings; and timely collection of evaluation data.a key factor for fvrx success has been embracing local stores as valuable assets in thenavajo food system. Because they are often the only food source for miles, local stores can beprofound drivers of positive change. Among 22 managers surveyed in an EPI-aid reportauthored by the navajo nation and CDC, 91% were interested in offering more healthy foods, but described barriers of limited suppliers and low consumer demand. Cope works withretailers (e.g. grocery stores, chain and independently-owned convenience stores, trading posts)to make store improvements by researching distributors, making layout changes, training staff onproduce handling and fvrx systems and providing marketing materials. USDA gusnip funds would allow US to continue to fund the fvrx program for navajo families residing in new mexico with the goal of increasing the purchase of fruits and vegetables and providing the educational support to change consumption behaviors that have directly contributed to the high rate of diabetes on the reservation.