Emphasizing Tradition to Reduce Diabetes in American Indians/Alaska Natives

by U.S. Medicine

November 6, 2013

By Annette M. Boyle

Judy Goforth Parker, PhD, RN

TAHLEQUAH, OK – Fifty years ago, the Cherokee had no word for diabetes. Today, American Indians and Alaska Native (AI/AN) adults have 2.3 times the risk of developing diabetes, and AI/AN youth age 10 to 19 are nine times more likely to receive a diabetes diagnosis as non-Hispanic whites. In some AI/AN communities, as many as 60% of adults have diabetes.

As a result, many in AI/AN communities consider diabetes an inevitable health problem.

“I had a gentleman say, ‘We are a diabetic people.’ We’re really not, but we do seem to have genetic predisposition,” said Judy Goforth Parker, PhD, RN, administrator of the Chickasaw Nation Division of Health.

To combat diabetes and provide hope, the Centers for Disease Control and Prevention (CDC) recently released a series of public service announcements (PSAs) and an eight-minute video to raise awareness of the problem of diabetes in these communities and to promote a return to traditional foods and activities. Filmed at the Cherokee Nation in Tahlequah, OK, “Our Cultures Are the Source of Health,” features Cherokee actor Wes Studi and representatives from tribal partners who have joined with the CDC to address the growing toll of diabetes on their communities.

“The message is that, even in the 21st century with the problems we face today, traditional ways have health benefits for now and for future generations,” said Aubrey Skye, Standing Rock Sioux Tribe’s Native Gardens Coordinator and an actor in the PSAs.

The video spots support a five-year grant made to 17 tribal programs focused on increasing the cultivation and consumption of traditional foods and restoring traditional games and activities. Each program emphasizes the wisdom of the associated indigenous culture and seeks to transmit, through tribal elders, historical methods of raising and preparing food and staying physically active to prevent and treat type 2 diabetes.

Native youth paddle the Chickasaw Nation Riversport “dragon” boat around an Oklahoma lake. The boat is fashioned to look like a traditional Chickasaw dugout and scales painted on the side resemble gar fish, which has special meaning to the Chickasaw People. Photo from the Oklahoma City RiverSport website.

Traditional Foods, Sports

“We’ve gotten away from eating closer to the ground, where the nutrition of our food is greatest,” said Sarah Miracle, program manager with the Chickasaw Nation of Oklahoma. Tribal youth can improve their health by “learning about the foods that their grandparents ate when they were young,” she adds.

The grants and PSAs supplement the long-standing efforts of the Special Diabetes Program for Indians and other efforts overseen by the Indian Health Service. More than 90% of grant programs funded under the SDPI incorporate culturally appropriate diabetes education activities. Demonstration programs conducted under the grant validated the use of traditional practices in the preventing and treating diabetes.

Research supports the cultural focus on diabetes prevention in AI/AN communities. A study in The Diabetes Educator found that engaging youth on two Northern Plains Indian reservations in Montana in a diabetes prevention program “was contingent on the lessons incorporating cultural strategies for healthy behaviors in youth such as berry picking, gardening, horseback riding, and dancing.” 1

Other significant factors in success were using tribal members to lead classes and taking an intergenerational approach that involved young people and their parents as well as featuring tribal elders talking to them about the importance of adopting healthy behaviors when they are young.

In testimony this year, Kelly Moore, MD, of the American Academy of Pediatrics and the Friends of Indian Health told the House Appropriations Subcommittee on Interior, Environment, and Related Agencies specifically about the growth of culturally appropriate healthy weight programs for youth. Included in her testimony was information about the Zuni Youth Enrichment Program, the Hopi running program and the “Be Hopi, Be Healthy” Camps.

By engaging children and adolescents in activities that are fun and resonate with them culturally, researchers and health educators hope to stem the growth of diabetes in AI/AN communities. As one example, the Chickasaw Nation sponsors a canoe-kayak team that competes at regional and national levels, providing both a connection to the participants’ heritage and a challenging activity that improves physical health.

Technology Plays a Role

While technology, at least video games and labor-saving devices, are often cited as contributors to increases in obesity and diabetes, at least one researcher maintains that technology can help American Indians prevent or manage diabetes.

Mugur Geana, director of the Center for Excellence in Health Communication to Underserved Populations (CEHCUP) at the University of Kansas in Lawrence, plans to integrate the wisdom of tribes and theory-based approaches into health messaging to help combat diabetes through a community-specific website.

Geana is working with the Prairie Band Potawatomi Nation in Kansas and the Iowa Tribe of Kansas and Nebraska to gain understanding of the cultural aspects of each nation that can be harnessed to fight diabetes. Each tribe will have its own version of Geana’s Web app that can be used by all community members. The project will include culturally specific information on diabetes management and health and a community forum to facilitate discussions about the disease.

“We hope to empower everyone to better manage their diabetes by being able to learn from us and from the collective wisdom,” Geana said.

1 Brown BD, Harris KJ, Harris JL, Parker M, Ricci C, Noonan C. “Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods.” The Diabetes Educator. November/December 2010. 36(6):924-35.

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