Academic journal article Human Organization

Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes

Academic journal article Human Organization

Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes

Article excerpt

The prevalence of diabetes among Pima (Akimel O'odham) Indians involves three important domains: political-economic, genetic, and cultural. Programs in diabetes education have made noteworthy improvements in the last two decades in addressing cultural information and attitudes. It is less common to see political-economic factors addressed, particularly the structural barriers to care that include poverty and unemployment. The genetic contributions to modern rates of diabetes have, perhaps, been overemphasized in the past, contributing to a sense that this disease is inevitable in American Indian populations. I review six lessons drawn from these domains and from diabetes prevention and treatment programs in Indian country: 1) the basic importance of cultural sensitivity; 2) the strengths of community participation; 3) the influential but not dominant significance of genetics; 4) some relevant structural changes in forms of health care; 5) the need for political-economic change within tribes to sustain communitywide change; and 6) the significance of a stable financial foundation for diabetes programs.

Key words: diabetes, political economy, community participation, Pima Indians

Pima Indians are better known around the world for their diabetes than for their culture and history. More than half of all Pima Indians over age 35 have diabetes, a condition arising from a body's decreased ability to metabolize glucose (Knowler et al. 1990). Adult onset, noninsulin-dependent diabetes, now called type 2 diabetes, is the most common form of diabetes among Pima Indians. Data from research conducted by the National Institutes of Health since 1965 reveal the incidence of Pima diabetes to have increased for three successive decades in both men and women (Bennett, Burch, and Miller 1971; Narayan 1997:173). Among the Pima, it is a leading cause of extremity amputation and acquired renal disease, is associated with an increased risk for ischemic heart disease and infections (Narayan 1997:178), contributes to higher risk for depression, and is, in turn, made worse by depression and alcoholism (Harwood 1981; Lang 1990; Scheder 1988). Diabetes-related conditions account for 19.5 percent of all (age-adjusted) Pima deaths-four times that of whites and two times that of blacks in the United States (Newman et al. 1993).

Three domains of influence contribute to Pima diabetes: political-economic, genetic, and cultural. Stemming in part from attention paid to diabetes by anthropologists, but also from increasing involvement of native people in program development, diabetes programs are improving their cultural relevance. Genetic contributions to modern rates of diabetes have been overemphasized in the past, contributing to a sense that this disease is inevitable in Native American populations (e.g., Kozak 1997). It is rarer to see political-economic factors addressed, although it is possible for programs to deal with structural issues even if they cannot resolve them. In this discussion, I review how each of these three domains influences diabetes rates at Gila River, then apply this knowledge in calling for holistic planning and programs that might best be able to reduce rates of this disease. First, I provide a brief profile of the Gila River Indian Community, where I conducted an ethnographic study on diabetes between 1997 and 2001. Foci of that study included the political-economic and historic factors in Pima diabetes, with an ethnographic focus on the health and health care experiences of pregnant women and mothers. Methods for that research included: an outcome study of women enrolled in the Diabetes Education Center's prenatal classes; lengthy interviews with 90 community members including 27 pregnant women who spoke with me several times over the course of their pregnancy; behavioral (and diet) observations of Pima women; extensive participation observation, including attendance with women of prenatal appointments; and a written survey of health providers on the reservation. …

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