Abstract: The purpose of this article is to present a review of the literature on diabetes type 2 prevention interventions for Native American populations. The interrelation of the cultural role of food in Native American diets, educational policies related to food, outcomes of federal policies, and the historical background of diabetes are addressed. In addition, published studies of diabetes prevention interventions with Native American populations are examined. Lastly, exemplars of programs that represent best practices in the prevention of diabetes are described.
Key Words: Native America, Type 2 Diabetes, Prevention Programs, Cultural
Much has been written about American Indians and Type 2 diabetes. Search engines bring up hundreds of articles and internet sites on this topic. How do these published reports really impact diabetes prevention for Native Americans? Has what is known gone from awareness to intervention to success in preventing diabetes? The purpose of this article is to present a review of the périment published literature about the prevention of Type 2 diabetes (hereafter called diabetes) among Native Americans and to highlight exemplar programs and empirically tested interventions in the literature that could make a difference. The impetus for this process is the authors' work as Co-Directors for the nursing research training core of the American Indian Diabetes Prevention Center. The mission of the American Indian Diabetes Prevention Center is to prevent or delay the onset of diabetes in American Indians and Alaska Natives. The goal of this project is to teach tribal nurses, who work with Native Americans, about research methods, the process of implementing evidence-based practice, and the ethical conduct of research in the practice setting. In learning about any issue, it is important to review its historical background.
HISTORY OF AMERICAN INDIAN HEALTH IN AMERICA
Native Americans have a rich history of healthy food systems and prosperous agricultural economies. By 800 A.D., North American Indian farmers from Florida to Ontario, Canada were cultivating several crops and developing varieties that were appropriate for the growing season where they lived (Keoke & Porterfield, 2002). Explorers landing in the so called "new world" marveled at the abundance of agricultural crops and the advanced agricultural technology. As a result, many explorers and settlers were aided by Indian farmers' "bounty (Keoke & Porterfield, 2002).
This changed as colonization was established and the Indigenous people were pushed out of their traditional nomelands, subject to war and disease and finally, containment on reservations or city slums. Surveys of Native American diets from the 1920s into the 1950s found staples of canned meat and fish, bread, beans, sugar, and coffee or tea (Prucha, 1986). On many reservations, malnutrition and nutritional deficiencies were endemic. Despite recommendations to improve Native American diets, food aid provided to the tribes was usually insufficient and of low quality. Also, the food aid did not include traditional roods, leading to further deterioration in health. The history of food insecurity for Native Americans that began with the establishment of reservations continues today. Until the 1950s, malnutrition and hunger were the primary food issues facing tribes (Prucha, 1986). After the 1950s, Native American dietary patterns were increasingly dictated by "the arrival of welfare checks and the distribution of government commodities" (Bass, 1974 p.37). To the contrary, despite the increase in federal rood aid, Native American diets remained inadequate to their needs.
By the 1960s most Native Americans had diets similar to those of the non-Indian population. This trend continues. For example, documented reports indicate that as recently as the late 1990s, almost one-fourth of Native American households were food insecure, meaning that they did not have access to enough food to meet their basic needs and one out of twelve experienced food insecurity coupled with hunger (Henchy, Cheung, & Weill, 2002"). …