A Focused Look at Native American Diabetes

The world is facing a new epidemic; type II diabetes. It is vital that smaller groups that have already faced an epidemic of type II diabetes be researched to learn what can be done to help reduce the treatment and to identify what is not worth repeating. Type II diabetes is also know as adult-onset diabetes and it often comes later in life. Native American populations have long faced a greatly increased percentage of type II diabetes. In fact the Pima natives of Arizona have the highest rate of type II diabetes in the world (Wheelwright). They know well that it is a deadly disease. By looking both at the history that has led up to the current diabetes epidemic in native populations and the preventative methods and their relative success rate, world health organizations could better prepare to help reduce the severity of the inevitable diabetes epidemic. National health care associations should begin a world wide prevention program for type II diabetes based on the experience of a population (Native Americans) that has already undergone such an epidemic like this before.

With estimates of the number of people worldwide with type II diabetes exceeding 300 million by 2025 it is vital that health organizations understand the devastating costs both monetarily and personally of this illness (Polikandrioti 217). Diabetes is a life changing and expensive illness. It is estimated that the treatment of diabetes in the United States now costs over $132 billion annually. Diabetes is the sixth leading cause of death in the United States (Type 2). The $132 billion is only the United States’ cost but proportionally higher costs hit other economies. China will lose “$558 billion in foregone national income due to heart disease, stroke and diabetes alone” over the period from 2006-2015 (Diabetes). It is not only the monetary cost that makes diabetes such a challenging illness. According to the World Health Organization, diabetes increases the risk of heart attack, stroke, limb amputation, blindness, kidney failure, nerve damage, and at least doubles the risk of death (Diabetes). This cost of diabetes was echoed by a study done by O’Connor, Crabtree and Nakamura that found that the mortality rate of Navajos increased from 17% to 39% with diabetes (216). The cost both monetarily in humanitarian loss that is caused by type II diabetes makes the illness one worth trying to prevent.

The good news about this impending epidemic is that type II diabetes is in many cases a preventable illness. This is important because illnesses that can be prevented are far easier and less expensive to prevent than to treat after onset has occurred. It is often referred to as an illness of lifestyle (Miller). Although there can be genetic factors at play, much can be done with a person’s lifestyle to prevent or delay the onset of the illness. The World Health Organization states that maintaining a healthy body weight, staying physically fit and eating a healthy diet can all help to reduce the risk of type II diabetes (Diabetes). Prevention for most cases of type II diabetes can be done through the seemingly simple act of getting people to live healthy lives, with regular frequent exercise and consistently a healthy diet. People who live healthier live are also less likely to get other chronic health problems like heart attack and stroke. A focus on prevention would not only help to reduce the prevalence of type II diabetes but also help in the overall wellbeing and general health of the people who were already being treated, thus world health organization should focus prevention on confronting this epidemic.

Prevention is possible. Treatment is very expensive and often cannot fix the problem. Therefore, prevention becomes the logical, practical and effective focus. If world health organizations are able to implement a successful prevention program that is able to convince its members to live a healthier life style then the overall health care need of that group will be reduced. The United States paying a staggering $132 billion annually makes it vital for the survival of aid organizations to do what they can to reduce the cost of treating major illnesses (Type II). A successful prevention program will not only reduce the number of people with type II diabetes within the community but it will also help to improve the general health of community thus reducing the cost of health care to the community further. Preventative medicine is almost always less expensive and often more effective than treatment, because it allows for the problem to be corrected before it becomes a full blown illness. This is not to say that treatment will not be important, but just that the money of health organizations can and will go further if they put their focus in to the prevention, while still preparing for treatments as necessary.

With the type II diabetes epidemic at the world’s door step, it is a challenge that all the world health organizations use that knowledge which has been gained by the group (Native Americans) that has already suffered from this epidemic. Native American tribes have had to face their own diabetic crises and have done a large amount of work to find what is most successful in the reduction of type II diabetes within their own tribes. Type II diabetes is a relatively new problem to the Native American populations, but the number of type II diabetes cases has risen very quickly (Edwards 33). With the quick rise of type II diabetes with in the Native community and the history of studies that have been done in the treatment and prevention of the illness for this community; Native Americans are a very good focus group for health organizations to consider. The studies that have been done on prevention programs for Native Americans could be very easily applied, and expanded on to help world organizations to reduce this epidemic before it comes.

Native Americans’ have the highest rate of type II diabetes in the world; the Pima in particular are the highest or any subgroup worldwide (Wheelwright). The reasons that type II diabetes is so high in this population are not known, but it is thought that here might be a genetic element. With such alarming numbers of type II diabetes it is important to understand how the Native American population got to this point and see if there are any trends in common with the world situation today. Prior to the 1940’s diabetes was virtually unheard of, but ever since the 1960’s the prevalence has been on the rise (Edwards 33-4). This rise is thought to be in part due to their food history and culture. Native Americans had a diverse food history prior to colonization, but after colonization the natives were forced to live on non-traditional lands and eat government hand-outs for food. Much of this food was of low quality, meaning that here is not much nutritional content for the caloric intake and led to many Natives being malnourished. Even as recently as the late 1990’s one in four Native household had elements of malnutrition (Edwards 32). Today most native diets more closely resemble the western diet than their traditional diet. The combination of the loss of their traditional diet with the replacement of that diet with low quality government food, especially highly processed grain like flour seems to have been a big part of, if not the cause of the increase of diabetes in the Native population. Let us hope that there is time before the world mimics the history of the Native American populations, but that will require action now.

The story around that world today looks much like that of the history books telling of the treatment on Native Americans in the 1940’s. There are many groups of people world-wide in developing nations who are starving to death or are severely malnourished. Many governments throughout the world are now providing food aid of a similar kind to world populations that are facing starvation or famine. Famine is a sociological issue, starvation is a physiological change within an individual. Both can result from unintended consequences of the political and economic patterns of western nations like the United States. Food aid tends to come in the form of inexpensive food products, mostly heavily processed grains. Heavily processed grains are very cheap because wheat, corn and rice are relativity easy to grow and subsidized by our government. Once processed such grains can last for a long time. The problem with such grains is that the human body breaks them down to sugar very easily, thus making its consumers more likely to get type II diabetes (Miller). This type of food aid sets up a structure similar to that which was created in the 1950’s and 1960’s with the Native Americans. The groups that are being given the aid become reliant on that food and lose their native food culture. As well as losing their native food culture, the groups are also staying malnourished, because they are not getting everything that they need from the food aid. Although this type of aid may be offered with the best of intentions, it also has hidden consequences, like type II diabetes. It is in places where aid like this is going that world health organizations need to focus on prevention.

There is another sleeping dragon in the room when it comes to the cause of the world epidemic of type II diabetes; westernization. Companies like McDonalds are now all over the world serving western fast food. This food is well known in America for causing chronic health problems like diabetes. Another western adaptation that is contributing to the diabetes epidemic is soda. Coke -A-Cola is sold in every country around the world and it is full of sugar. A diet that it very high is sugar will increase a person’s risk for getting type II diabetes (Miller). Government food aids along with the strong westernization of the rest of the world are placing the world at an enhanced risk of diabetes. The result of western aid programs and diet are being seen in the dramatic increase of type II diabetes world wide that is going on now. It is the role of western culture, in particular western food culture, that we are witnessing as the cause of the drastic spike in the number of type II diabetes cases world wide. It is western culture that has gotten us in to this mess, it should be the western health organizations that help to get us out.

For prevention programs of any kind to work it must instill the drive to change, and make those changes not only preferable but also achievable. Many people will want to change if they know that it will be better for them, but if that change is very hard or expensive they simply will not do it. For example, if you want a dietary change part of your program to work, you must not only tell people that their way of eating is bad for their health but also make them not desire to eat such foods. A study on the effectiveness of prevention programs in Native American populations found that:
“The major identifiable barriers were not lack of knowledge of healthy dietary practices and the value of exercise but preferences for high fat foods and large servings and less physically active lifestyles. Perhaps more important were a lack of personal confidence, a lack of skills and a lack of social support for bringing about desired changes” (Hood)

For a program to be successful it must not only present the information to the individual, but must also give that person the tools to make the desired changes, and make those changes more desirable. Cultural involvement, personal empowerment, social support and skills training, as well as a focus on preventative health measures all need to be involved in any successful prevention program.

In order to successfully create prevention programs worldwide it is vital that world health organizations look to see what makes programs that are now in use successful. Because of the Native Americans’ abnormally high level of diabetes and the large number of prevention programs in place within the community, they are particularly a good focal group. Successful diabetes prevention programs in Native American populations all have a combination of traditional methods and personal/community empowerment. In 2009 a group of researchers did a review of the literature on diabetes prevention in Native American communities, and found five programs that were exceptionally effective (Edwards 32). All the successful programs incorporated a large amount of personal and/or community support in addition to a focus on healthy living (Edwards 35). Having a strong support system, both individual and community, helps to make this prevention program far more effective. For world health organizations to make a program successful they should look at success of these five programs and mimic their value of a strong support structure. The individual culture of the target group must be taken into account in order to create a successful prevention program with an appropriate support network.