Preventing Diabetes in Preventing Diabetes in Aboriginal Communities:Aboriginal Communities:

To Screen or Not To ScreenTo Screen or Not To Screen

Adrian Jacobs Adrian Jacobs ––

Community LiaisonCommunity LiaisonMDSi Field Team, BRAID Research GroupMDSi Field Team, BRAID Research Group

University of AlbertaUniversity of Alberta

Preventing Diabetes in Preventing Diabetes in Aboriginal Communities:Aboriginal Communities:

To Screen or Not To ScreenTo Screen or Not To Screen

To Screen or Not To ScreenTo Screen or Not To Screen

Yes, as long as it is an act of empowerment Yes, as long as it is an act of empowerment that resources the Aboriginal community to that resources the Aboriginal community to

make Health Agenda decisions.make Health Agenda decisions.

James Lamouche Dr. Daniele Behn Smith Dr. Dawn Martin-Hill

The Screening DebateThe Screening Debate

2003 CDA guidelines recommend community2003 CDA guidelines recommend community--

based screeningbased screening

2008 CDA guideline do not recommended 2008 CDA guideline do not recommended communitycommunity--based screeningbased screening

ADA discourages communityADA discourages community--based screeningbased screening

Why not?Why not?

Potential poor patient followPotential poor patient follow--upup

Uncertain health impactUncertain health impact

Fear of Fear of

LabelingLabeling

StigmatizationStigmatization

Feelings of loss of controlFeelings of loss of control

Cultural barriersCultural barriers

Reasons to screenReasons to screen

Cost effectiveness of preventionCost effectiveness of prevention

Current and projected costs of extant diabetesCurrent and projected costs of extant diabetes

SocioSocio--cultural benefitcultural benefit

EmpowermentEmpowerment

Capacity buildingCapacity building

CollaborationCollaboration

Cultural renewalCultural renewal

My Own DiagnosisMy Own Diagnosis

““Your mother has it. You have it. Your mother has it. You have it. You are Aboriginal. You are You are Aboriginal. You are genetically pregenetically pre--disposed.disposed.””

““The White Man did this to you.The White Man did this to you.””

Lifestyle change.Lifestyle change.

Active lifestyleActive lifestyle

HuntingHunting

FishingFishing

Nomadic lifeNomadic life

HorticultureHorticulture

Natural harvestingNatural harvesting

Change of DietChange of Diet

FROMFROM

Lean wild meatsLean wild meats

FishFish

Fruits and vegetablesFruits and vegetables

TOTO

White fatWhite fat

White flourWhite flour

White sugarWhite sugar

White saltWhite salt

CaffeineCaffeine

DisempowermentDisempowerment

ColonialismColonialism

Treaty breakingTreaty breaking

Indian ActIndian Act

Residential SchoolsResidential Schools

RacismRacism

PovertyPoverty

““We did this to you.We did this to you.””

ColonialismColonialism

Another peopleAnother people’’s agendas agenda

Another peopleAnother people’’s valuess values

Another peopleAnother people’’s norms norm

Creation of a norm makes all others deviantCreation of a norm makes all others deviant

This leads to marginalizationThis leads to marginalization

The end result is stigmatization The end result is stigmatization ––

the ultimate the ultimate disempowermentdisempowerment

““I take responsibility for this.I take responsibility for this.””

BlameBlame--deflectingdeflecting

I was not there.I was not there.

We did not make these decisions.We did not make these decisions.

That happened so long ago, you just need to get That happened so long ago, you just need to get over it.over it.

Healthy immigrant effectHealthy immigrant effect

Immigrants to Canada are healthier than Immigrants to Canada are healthier than Canadians when they arriveCanadians when they arrive

After being here a number of years they are less After being here a number of years they are less healthy than Canadianshealthy than Canadians

European immigrants decline lessEuropean immigrants decline less

People of colour of nonPeople of colour of non--European origin decline the European origin decline the mostmost

Who is making them sick?Who is making them sick?

Western culture?Western culture?

European immigrants suffer lessEuropean immigrants suffer less

NonNon--European immigrants suffer moreEuropean immigrants suffer more

As an Aboriginal I can say, As an Aboriginal I can say, ““Perhaps it is making Perhaps it is making you sick like it made us sick.you sick like it made us sick.””

What is making them sick?What is making them sick?

Western medicineWestern medicine’’s s ““norm making?norm making?””

What happens if you use a northern European as What happens if you use a northern European as ““the norm?the norm?””

What about a southern European?What about a southern European?

What about an English Canadian or French What about an English Canadian or French Canadian?Canadian?

As an Aboriginal I can say, As an Aboriginal I can say, ““It doesnIt doesn’’t matter, t matter, they are all Western, we will never correspond.they are all Western, we will never correspond.””

Aboriginal Diabetes PreAboriginal Diabetes Pre--DispositionDisposition

I lamentedI lamented

My grandmotherMy grandmother’’s diabetess diabetes

My motherMy mother’’s diabetess diabetes

My diabetesMy diabetes

My Aboriginal heritageMy Aboriginal heritage

I hoped my children would not be cursed by my I hoped my children would not be cursed by my Aboriginal geneticsAboriginal genetics

““No (not bad genetics)! Good No (not bad genetics)! Good genetics genetics ––

bad diet and lifestyle!bad diet and lifestyle!””

This turned everything completely around in meThis turned everything completely around in me

My heritage is not the problemMy heritage is not the problem

My genetics is not the problemMy genetics is not the problem

I have a great heritageI have a great heritage

I have great geneticsI have great genetics

Decolonized ThinkingDecolonized Thinking

I am Ongwehohweh and I am not a deviation!I am Ongwehohweh and I am not a deviation!

Our Aboriginal heritage is our asset.Our Aboriginal heritage is our asset.

We are how the Creator made US.We are how the Creator made US.

We donWe don’’t have to change to become t have to change to become ““normal.normal.””

We are the We are the ““normnorm””

for US.for US.

Give us the tools and we will find our way Give us the tools and we will find our way through to health for US.through to health for US.

DecolonizationDecolonization

Prime Minister Harper apologized for the Prime Minister Harper apologized for the ““policy of assimilationpolicy of assimilation””

as expressed in the as expressed in the

Residential School systemResidential School system

What does What does ““not assimilatingnot assimilating””

Aboriginal people Aboriginal people

look like?look like?

RCAP (Royal Commission RCAP (Royal Commission on Aboriginal Peoples)on Aboriginal Peoples)

A return to the treaty relationshipA return to the treaty relationship

Nation to NationNation to Nation

RespectRespect

Dealing honestly with the pastDealing honestly with the past

Treaty violationsTreaty violations

Residential SchoolsResidential Schools

ReconciliationReconciliation

Ruppert RossRuppert Ross

““while western psychologywhile western psychology’’s discussions about things s discussions about things like like Complex PTSD might help nonComplex PTSD might help non--aboriginal people aboriginal people understand the impact of residential schools, they understand the impact of residential schools, they remain remain westernwestern

discussions, coming out of a western discussions, coming out of a western

worldworld--view. A different worldview. A different world--view, however, would view, however, would result in a different vision of what a result in a different vision of what a healthyhealthy

person is, person is,

a different description of a different description of illill--health, and different health, and different prescriptions for returning to prescriptions for returning to goodgood--health.health.””

Heartsong: Heartsong:

Exploring Exploring Emotional Suppression and Disconnection in Emotional Suppression and Disconnection in Aboriginal Canada, Nov. 2009Aboriginal Canada, Nov. 2009

EmpowermentEmpowerment

The locus of control for Aboriginal Health The locus of control for Aboriginal Health needs to be needs to be inin the Aboriginal community not the Aboriginal community not outsideoutside..

Health PolicyHealth Policy

Health BudgetHealth Budget

Health ProgrammingHealth Programming

Health AccountabilityHealth Accountability

Colonialism in HealthColonialism in Health

Aboriginal ControlAboriginal Control

To Screen or Not To ScreenTo Screen or Not To Screen

MDSi produces a data resource for Aboriginal controlMDSi produces a data resource for Aboriginal control

Community Based Research and Education Community Based Research and Education

NAHONAHO’’s OCAP (Ownership Control Access s OCAP (Ownership Control Access Possession)Possession)

Decolonizing Aboriginal Health requires it.Decolonizing Aboriginal Health requires it.

““YES, as long as it is an act of YES, as long as it is an act of empowerment, resourcing the empowerment, resourcing the

Aboriginal community to make Aboriginal community to make health agenda decisions.health agenda decisions.””

Adrian Jacobs Adrian Jacobs ––

ajacobs@ualberta.caajacobs@ualberta.ca

www.braiddm.cawww.braiddm.ca

““Restoring Aboriginal culture through communityRestoring Aboriginal culture through community--based type 2 diabetes screeningbased type 2 diabetes screening”” by Richard by Richard OsterOster, Ellen , Ellen TothToth

International Journal of Circumpolar Health 2010 httphttp://www.braiddm.ca/69_3_oster.pdf://www.braiddm.ca/69_3_oster.pdf

Nia:wenNia:wen GowaGowa