The Navajo, like many other American Indians and Alaska Natives, struggle with some of the worst health outcomes in the United States. Forty percent of Navajo Nation residents are unemployed. Roughly 20 percent live with diabetes. Even more struggle to control chronic diseases such as hypertension and cardiovascular disease.

The Community Outreach and Patient Empowerment (COPE) Project launched in 2009 to help improve the health of people living within Navajo Nation. Comprised of a partnership between the Navajo Nation Community Health Representative Program, Indian Health Service (IHS), Brigham and Women’s Hospital, and Partners In Health, COPE provides training and resources to teams of community health workers, known as Community Health Representatives (CHRs), who have been working in Navajo Nation since the 1960s.Their goal is to improve the overall health of high-risk patients with poorly controlled chronic diseases and those at risk of developing chronic diseases living within Navajo Nation.

Providing access to health care services

COPE was inspired by PIH’s Boston-based Prevention and Access to Care and Treatment (PACT) Project, which uses community health workers to provide care to marginalized patients in inner-city Boston. The Navajo Nation Community Health Representatives serve as a critical link between the Indian Health Service health care system and the Navajo community. The Navajo CHRs connect patients suffering from chronic diseases—such as diabetes, hypertension, and cardiovascular disease—with the IHS hospitals and clinics.

Improving health through training and education

A main focus of COPE is providing the CHR teams with training, resources, and materials to improve the health of their communities. The CHRs receive monthly health education trainings and quarterly skill-building trainings from the COPE team and local health care providers and educators. COPE has developed structured teaching modules, including interactive materials designed for people with low levels of literacy who do not speak English as a first language. These resources help CHRs educate their patients about how to care for and improve their chronic conditions.

By the numbers:

Total population of Navajo Nation: 176,604
Unemployment rate: 42%
Poverty: 44% of people over age 25 live below the federal poverty line
People living with diabetes: 26,000—22% of the adult population