Looking at the "big picture" of community health, the Sault Ste. Marie Tribe of Chippewa Indians has put new educational activities in place for people in four Upper Peninsula towns. The program goal is to help prevent illness by encouraging healthy lifestyles across the community, rather than treating individual health problems.

The tribe has reached the one-year point of a five-year, $1.76 million health grant, which is being used to promote healthy communities and encourage healthy lifestyles through a variety of programs and studies. The first year has been mostly devoted to research and, in coming years, more programs will be put in place.

The Strategic Alliance for Health grant, offered through the U.S. Centers for Disease Control and Prevention (CDC), was first received by the tribe October 1, 2008, and has been awarded to seven counties, five urban centers, and two tribal entities across the country.

The idea behind this grant-funded program, said Donna Norkoli, is to look at the big-picture factors that influence people in the community to make healthy or unhealthy lifestyle choices. Mrs. Norkoli is a project coordinator with Sault Tribe Community Health.

"A lot of agencies now, the tribe included, are looking at the bigger picture," Mrs. Norkoli said. This perspective focuses on fostering an environment that encourages happy and healthy residents.

Mrs. Norkoli, who has worked for 30 years in the health service profession and 15 of those years in public health, said the change in focus from treating individual health problems to achieving broader health objectives has been visible in the last few years.

"I have seen a big change since I started," she said. "I think it is a changing focus everywhere, even statewide."

One example of this way of thinking is the walkability audit of St. Ignace completed in early October. This study and the forthcoming report will attempt to advise the city on how to make itself more pedestrianfriendly. The idea is that a community that encourages walking and bicycling will produce healthier, more active citizens.

The project is focusing on four key communities where tribal members live and work, St. Ignace, Manistique, Munising, and Sault Ste. Marie. Tribal members live and work in those communities, Mrs. Norkoli said, but the project will certainly help the community as a whole, not just tribal members.

The first year of the grant has been largely planning and research, Mrs. Norkoli said, although some progress is visible with the soon-to-bereleased report from walkability expert Dan Burden on St. Ignace's pedestrian recommendations and with tobacco-free zone signs, paid for by the grant, which will soon inform visitors to St. Ignace schools of the district's anti-tobacco policy.

"We haven't really implemented a lot of the changes yet," she said. "The first year is mostly assessment."

Marilyn Hillman, Community Health Program manager for the tribe, took the lead on pursuing the strategic alliance for health funding after taking part in the CDC's Steps Communities program, Mrs. Norkoli said.

The tribe takes a team approach to overseeing the project, she said, with a leadership team made up of tribal health board members, tribal board members, and key staff members. These leaders also consult with local health organizations and government officials to help accomplish yearly and long-term goals laid out by each community.

Forming goals and working to accomplish them is up to a coalition in each of the four communities. In St. Ignace, Mrs. Norkoli has teamed with the Mackinac County Wellness Coalition, which meets monthly and helps guide grant administrators toward projects that will best benefit the health and wellness of the community.

"We really want to make it meaningful for the community," she said. "People have been really excited to sink their teeth into it."

Mary Swiderski, Michigan State University Extension educator, said the Wellness Coalition hopes this grant will bring changes in the way St. Ignace residents, businesses, schools, and local governments approach nutrition, tobacco use, and physical activity. Examples would be more smoke-free businesses in town, healthier food choices at restaurants, school lunch nutritional information easily available, a focus on healthier snacks at schools, more physical fitness opportunities for youth, more community bicycle paths, and a downtown more accessible to walkers and cyclists.

Mrs. Norkoli said she feels the effort can inspire positive changes that will make the entire community healthier.

"If you can get an area like downtown St. Ignace more walkable and bike-able," she said, "then it can be a model. I think it will spread."

With tribal members experiencing nearly double the incidence of diabetes seen by the average American, Mrs. Norkoli said there is a definite concern among leadership at the Sault Tribe about the health of the people.

"The tribe wants to improve the health of all tribal members and their families," she said. "We would love to see a reduction in the rate of these diseases."

Each year, the program's leadership board chooses a focus and goals for the upcoming year. The current focus is to create policy and environmental changes to promote physical activity and proper nutrition, and reduce tobacco use and exposure, all contributors to obesity, diabetes, and heart disease.

To accomplish this long-term goal, the group has created several short-term objectives, including increasing the membership of community health coalitions, implementing a "Complete Streets" ordinance that considers pedestrian concerns in St. Ignace, increasing the number of community gardens, increasing participation in a healthy menu labeling program, encouraging smoke-free restaurant policies, and forming a Coordinated School Health Team at St. Ignace Area Schools to encourage physical activity and healthy eating at the schools.

One of the other ideas being tossed around by the Wellness Coalition in St. Ignace is get funding for an education campaign to teach elementary and middle school students about the importance of nutrition and provide a refrigerated vending machine with healthy foods for high school students.

Mrs. Norkoli said people could expect to see new programs and ideas coming out of this grant program through 2013, when the project terminates.

"We do hope that when the funding ends, it doesn't all end there," she said.

Any community members who would like to contribute ideas for how best to enhance the health of area citizens are invited to attend the monthly wellness coalition meetings.

The Mackinac County Wellness Coalition usually meets at 3:30 p.m. on the fourth Tuesday of each month in the reading room next to the St. Ignace Middle School library. The next meeting is scheduled for 3:30 p.m. Tuesday, November 24.