University of Montana's Center for Indigenous Innovation and Health - Specific Aims Building an Indigenous Food Pharmacy: A Community-Driven Food as Medicine Model for Urban Indigenous Communities in Missoula, Montana American Indian and Alaska Native (AI/AN) communities experience disproportionately high rates of obesity, type 2 diabetes, cardiovascular disease, hypertension, and food insecurity compared with the general U.S. population. These inequities are not the result of individual behaviors but reflect the enduring impacts of colonization, historical trauma, disruption of Indigenous food systems, structural barriers to accessing healthy foods, and limited availability of culturally responsive prevention and healthcare services. As a result, many Indigenous families face persistent challenges in preventing and managing chronic disease. These challenges are particularly pronounced in urban communities, where more than 70% of Indigenous people now reside and where access to Indigenous-centered nutrition education, traditional food knowledge, and culturally grounded chronic disease prevention programs remains limited. Recognizing the critical role of nutrition in health, the 2023 American Heart Association Presidential Advisory identified Food Is Medicine interventions as an evidence-based strategy for improving diet quality, reducing food insecurity, and preventing and managing chronic disease. Despite this growing body of evidence, relatively few Food Is Medicine initiatives have been developed through equitable partnerships with Urban Indian communities, and even fewer incorporate Indigenous knowledge, culturally relevant food practices, interprofessional education, and longitudinal evaluation to create sustainable, community-driven improvements in health. The proposed Indigenous Food Pharmacy represents a collaborative partnership among the University of Montana Skaggs School of Pharmacy, the Skaggs Institute for Health Innovation (SIHI), the Native American Center of Excellence (NACOE) and local food systems. Together, these organizations provide complementary expertise in Indigenous health, community engagement, healthcare workforce development, chronic disease prevention, pharmacy practice, implementation science, and health disparities research. Guided by a Community Advisory Board composed of Indigenous Elders, community members, healthcare providers, and organizational partners, the project will establish a culturally grounded Food Pharmacy that combines teaching kitchen programming, nutrition education, Indigenous food knowledge, health coaching, and longitudinal health monitoring. The long-term goal of this project is to reduce chronic disease disparities among urban Indigenous populations while building sustainable community capacity to deliver culturally responsive Food as Medicine programming. The overall objective is to develop, implement, evaluate, and sustain an Indigenous Food Pharmacy that improves nutrition behaviors, food security, cardiometabolic health, and community wellness while strengthening partnerships and workforce capacity. Our central hypothesis is that a culturally grounded Food Pharmacy, developed through community partnership and integrating Indigenous food knowledge, evidence-based nutrition education, hands-on culinary instruction, and longitudinal health coaching, will improve health behaviors, reduce chronic disease risk, and establish a sustainable model that can be replicated in Urban Indian Organizations throughout the United States. Aim 1. Establish a culturally grounded Indigenous Food Pharmacy through community partnership. Working collaboratively with SIHI, NACOE, the Skaggs School of Pharmacy, and a Community Advisory Board, we will co-design and implement a weekly Indigenous Food Pharmacy utilizing the teaching kitchen at Garden City Harvest, a local food grower and distributor. Programming will integrate evidence-based nutrition education, Indigenous food traditions, healthy meal preparation, chronic disease prevention, grocery budgeting, food
