According to this study, healthier foods are not as readily available in Navajo convenience stores as they are in Navajo supermarkets. Improving access to and affordability of healthier foods in reservation stores of all sizes may support healthy eating among Navajo residents.

The purpose of this study was to examine the relationship of health risk level to charged medical costs and determine the excess cost of higher risk individuals compared to low risk. Two years of medical claims from six corporations1 National health expenditures in 1999 were more than 1.2 trillion dollars, which includes private expenditures of $662 billion, of which $401 billion was paid by private insurance.2 Of this, $252 billion was spent by private insurance to pay for hospital care and physicians' services. It has been shown that corporate health benefits are close to 60% of after-tax profit.3 Obviously, any percent decrease in these outlays would equal substantial cost savings to employers and/or employees.The literature indicates that only a small segment of the population is responsible for the majority of health care expenditures. From 15% to 30% of the total annual medical cost has been attributed to the top 1% to 2% of the total population with the highest medical expenditures and 70% to 90% of the annual total cost has been attributed to the top 10% to 15% of the population, although it is not necessarily the same people each year. 4 -7 The association between health behavior and medical claims costs has been well established in the literature. -12Using a high-cost analysis technique, research conducted at Texas A&M University demonstrated that more than 43% of the costs of medical claims were associated with elevated risk.13 A study of Procter & Gamble employees showed similar results, where on average, potential lifestyle-related medical costs accounted for approximately 35% of their 3-year total medical costs.14 Their results were also consistent on

Between 1990 and 1999, cumulative participation in a health risk appraisal (HRA) reached 79%, and participation in any health promotion program reached 94% of employees employed continuously by the Progressive Corporation during that time period. Participation rates in the HRA per year ranged from 14% to 36%. First time participants reached no higher than 2.6% after the sixth year. Non-participants tended to have higher mean but lower median costs.

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