The Pima and Tohono O’odham Indians of southern Arizona have arguably the highest diabetes rates in the world – half of all adults are afflicted. But a century ago, diabetes was virtually unknown here. What happened to the health of the Pima?

The Pima and Tohono O’odham Indians of southern Arizona have arguably the highest diabetes rates in the world – half of all adults are afflicted. But a century ago, diabetes was virtually unknown here. What happened to the health of the Pima?

Unhealthy neighborhoods and lack of health care contribute to poor health, and they are unequally distributed. People of color are exposed to greater threats and have less access to quality care. This report outlines causes of inequities as well as promising initiatves around the country to combat them. One chapter focuses on Tohono O'odham Community Action (www.tocaonline.org) an organization co-founded by Terrol Dew Johnson, who appears in the episode "Bad Sugar."

Daniel Goldberg teaches a course at the Brody School of Medicine that aims to answer such questions as: What causes disease across the globe? What causes people in some parts of the world to have much higher rates of certain diseases than others? And what are the implications for global health policy and ethics?

Dr. Donald Warne talks about how cultural loss impacts the health of Native American tribes in Arizona. The damming of rivers plunged local tribes into poverty, dependence and ultimately poor health. Deprived of their language, land, livelihood and traditions, many Native Americans have developed a fatalistic view about  diseases like diabetes.

In some Native American communities, diabetes is so common that people grow up feeling that it is in some ways, inevitable. "I don't have diabetes yet," is what Dr. Warne often hears from his patients. Yet hope for the future is an important factor in preventing and controlling diabetes - something health care practitioners need to take into account when treating patients.

The U.S. government has spent hundreds of millions of dollars over the past 40 years trying to uncover a biological explanation for why the Pima Indians of southern Arizona have one of the highest rates of diabetes in the world. But as Dr. Donald Warne tells us, diabetes was extremely rare here 100 years ago. What's changed? Not biology but environment.

Type 2 diabetes and its principal risk factor, obesity, have emerged as twin epidemics in communities of color. This book investigates the epidemiology of diabetes in these minority communities, arguing that the determinants of diabetes include not only personal choices, but also broader social and contextual factors, such as community racism, residential segregation, and cultural patterns.

This book includes in-depth analyses of many community-based interventions which serve African-American, Hispanic/Latino American, Asian American, and Native American populations. The author also provides suggestions for community-based initiatives to reduce the "obesogenic" environment many minorities live in.

Competing agendas drive the distribution of resources when it comes to diabetes care and prevention. We spend most of our dollars on late-stage care, which not coincidentally is highly profitable to companies that provide those services. To reduce diabetes rates among Native Americans and other populations, we have to advocate for policies that will invest more resources in primary prevention and underlying social conditions.

A full list of publications about diabetes, including diabetes in Native Americans and other minority communities.

This book argues that, contrary to popular opinion, Type 2 diabetes is not a medical problem so much as it is a social pandemic caused by toxic environments - high in stress and sugar, low in opportunities to exercise or feel good about yourself - and a lack of power. Spero describes the social sources of the toxic environment, including the stress and inequality built into our modern culture and the traumas and loss of community that make people vulnerable to illness. It reveals the medical mistreatment of diabetes - from kicking diabetics off medical insurance to underfunding diabetes education, from over-emphasizing drugs to giving corporate-influenced dietary advice.

This lesson plan uses the series and the examination of primary source documents to guide students in understanding the social, economic, and political contexts of two epidemics in American history: pellagra and Type II diabetes. In six activities, students reflect on their own conceptions about the factors that influence health and longevity, learn about the socioeconomic conditions in the post-bellum South that led to the pellagra epidemic of the early 1900's, propose legislative solutions to the crisis, and finally use what have learned about pellagra to inform their understanding of the Type II diabetes epidemic among the Pima and Tohono O’odham Indians of southern Arizona today.

The lesson plan includes worksheets, links to primary sources, evaluation rubrics, and references to relevant standards.

In Word (doc) format

The much lower prevalence of type 2 diabetes and obesity in the Pima Indians in Mexico than in the U.S. indicates that even in populations that may be genetically prone to these conditions, their development is determined mostly by environmental circumstances, thereby suggesting that type 2 diabetes is largely preventable. This study provides compelling evidence that changes in lifestyle associated with Westernization play a major role in the global epidemic of type 2 diabetes.

This report looks at the effects of "food deserts" (areas with minimal access to grocery stores) on the health of residents in Chicago's neighborhoods. The study develops an empirical score to quantify the balance of food choice (groceries vs. fast food outlets) available to residents, and compares food access and food balance directly to health outcomes, holding constant education, income, and race. They find that African American communities are especially likely to have poor balance of food choice, and that residents of these "food deserts" suffer noticable health effects.

Historically, federal Indian policies have been destructive to Native American communities - ranging from removal to assimilation and termination. These policies have had a negative impact on health and health-related behaviors. More recent trends towards self-determination and tribal control provide reason to hope.

O’odham Indians, living on reservations in southern Arizona, have perhaps the highest rates of Type 2 diabetes in the world. Forty years of poking and prodding by medical researchers have yielded few improvements, as disease rates continue to rise. But the O’odham and other Native communities are taking matters into their own hands – finding hope for their health by strengthening ties to traditional culture, fighting for their rights, and trying to regain control over their destinies.

Pember looks at efforts in the Ho-Chunk (or Winnebago) tribe of North Dakota to use traditions to counteract fatalism and fight diabetes.

The Gila Crossing Elementary School in southern Arizona was once operated by the Bureau of Indian Affairs. When the local tribe took it over, community members created a gardening program to teach children about their cultural heritage as farmers, to encourage healthy eating, and to foster their development and future interest in agriculture.

An excellent article about Tohono O'odham photographer and artist Terrol Dew Johnson and the organization he co-founded, Tohono O'odham Community Action, which seeks to improve health by helping people re-establish their ties to traditional culture.

An interview with Dr. Donald Warne, one of the experts featured in Bad Sugar, Episode 3 of UNNATURAL CAUSES.
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Lesson plans and other materials about the Pima's struggle to regain their water rights, and the landmark settlement in 2004.

Jennifer Poudrier, an associate professor of sociology at the University of Saskatchewan, is one of many scholars to argue that the "thrifty gene" theory allows society to curl up with the notion that biology shoulders most of the blame for the ill health of native people. She dismisses it as “a colonial lens put on aboriginal history,” promoting the myth that indigenous people all have the same genes that make their diabetes “a special problem” beyond the reach of public-health initiatives.

As Dr. Donald Warne explains, there is a direct biochemical connection between living in poverty and blood sugar levels. The stress of being poor and of having family members die young creates a complicated web of cultural values and beliefs that make controlling diabetes more difficult. Add to that the lack of availability of healthy food and it's no wonder diabetes rates are high.