The Cree Board of Health and Social Services of James Bay (CBHSSJB) once again crunched the numbers on how many Crees have succumbed to diabetes in the past decade and, like in all previous studies, the numbers have increased.
“It wasn’t very different from the last one. The message hasn’t really changed in the last 10 years. Diabetes continues to be a big problem with young people. Nothing has changed except that the numbers are higher,” said David Dannenbaum, a medical doctor who worked on the study.
According to Dannenbaum, the incidence rate is roughly 19 per thousand so there are roughly two cases per 100 people for the total Cree population. This works out to about 150 new cases of diabetes per year that are diagnosed by the CBHSSJB.
While the numbers aren’t surprising, Dannenbaum said what is surprising is that as each of these reports on diabetes is published, people seem to anticipate a major change but that never happens as diabetes is a secondary effect to an even greater problem.
“More and more people are getting type two diabetes because of obesity and lack of exercise,” said Dannenbaum.
The Crees are not the only population in the world that has this problem. The diabetes rate is literally exploding amongst Indigenous peoples all over the world who have started to adopt western diets and become less active.
This is because Indigenous peoples have what Dannenbaum describes as the hunter-gatherer hemotype, where their bodies are inclined hang on to every calorie and store it in the waist rather than the legs.
“If you look at Aboriginal populations in New Zealand, Australia and South Africa, you see this. India is being devastated by diabetes right now, it is a huge problem and China is seeing it too,” said Dannenbaum.
But, it isn’t just the size of people’s waistbands that is at the heart of the issue, the perception of obesity becoming the norm is just as dangerous.
While being overweight used to be a sign of prosperity amongst Crees since it was a sign that the family had a good hunter, Dannenbaum believes that this train of thought is still prevalent. That being slim is the sign of having a bad hunter in the family and is therefore frowned upon.
“A lot of people today see individuals who have a healthy body weight as being sick and this is a Cree myth that needs to be dealt with. When people lose weight and become healthier, everybody in their community tells them that they look ill. Then they will feel bad about it and try to gain the weight back,” said Dannenbaum.
Despite this, Dannenbaum still believes that there is hope for the Cree people and that through a changing of attitude the problem can be reversed.
He recalled working with the Cree a decade ago when diabetes was still a hush-hush topic because it was shameful. A decade later, and the subject is so far out of the closet that it’s become comfortable dinner conversation.
Hope at the CBHSSJB is that within time the same will happen with obesity because they believe it to be a taboo issue amongst Crees. But, that taboo needs to be stripped of its status.
This is urgent because diabetes is just a symptom of a greater problem, that if someone develops the disease it is simply a symptom of unhealthy living for far too long.
“If you can deal with the obesity, then there are many studies which show that you can prevent diabetes by dealing with obesity and that this will work better than any pill,” said Dannenbaum.
The biggest part of tackling the issue outside of just raising awareness is getting people to make the right decisions when it comes to making food choices and getting active.
While Dannenbaum acknowledged that fresh fruits, vegetables and lean meats are much more expensive than what the average consumer wants to pay, people will have to accept it. If they want to eat healthy, they will have to pay for it.
“People are gaining weight from what they are putting in their carts in the stores. If you look you will see chips, pop, pizza pockets and all sorts of things that you just pop into the microwave and then eat. You also see that the packages containing three servings are being eaten by one person in one sitting. This is the area where people need to think about what they are doing,” said Dannenbaum.
At the same time he sympathizes with the people in this situation since part of it he believes stems from the effects of residential schools because people never had the chance to learn how to cook and were also force fed vegetables. Unfortunately that effect has been passed down through generations.
Couple that with the fact that some families are now having to adapt to both mom and dad working outside of the home and the end result is some Cree children are going to the local restaurant twice a day to eat poutine instead of nutritious meals.
On the Public Health side of the CBHSSJB, Solomon Awashish, chronic disease program officer, is looking at how Crees can best prevent the disease and the impact it is having on the Cree population. Through the Maamuu Nakaahehtaau project, the CBHSSJB’s latest endeavour to prevent diabetes, Awashish and other members of his team have been educating and listening to the Cree people to see what the public wants in order to fight the disease.
When looking at the new study, Awashish said what concerns him most is that Crees are being diagnosed in their early 40s as opposed to in their 60s like the rest of the general population. This means that Crees are enjoying significantly less of their lifetime living healthy and more of their years from middle age onward trying to avoid complications from the disease or treating them by enduring amputations.
Like Dannenbaum, Awashish recognizes that it’s an attitude or philosophy of thought adjustment that needs to be made throughout Cree society.
“Walking is the best exercise you could choose, but in Cree society we have this thing where you don’t just want to exercise for no reason. Crees don’t want to walk just for the sake of walking. If you go for a walk, it’s to check a snare or a bear’s den that they discovered 10 years ago,” said Awashish.
The same goes for dispelling certain myths that have gripped the Cree population. Right now Public Health is trying to promote drinking water instead of juice or pop because of the extra calories these beverages have.
Many Crees don’t trust their drinking water since there have been problems in the past. According to the CBHSSJB, the drinking water in all of the Cree communities is routinely tested and is safe unless that community is under a water advisory. Studies have even shown that tap water is usually safer than drinking water as it is tested more frequently.
Instead, many Crees flock to the stores to buy their beverage of choice, which usually isn’t water. Some will get iced tea in a bottle thinking it is a healthier option, but it isn’t.
“People have to learn that iced tea has the same amount sugar as regular pop. When you look at the numbers it is really the same thing and we discourage it,” said Awashish.
Other myths in Eeyou Istchee aren’t much different from those in the south, that the wonder diets advertised in the media – like South Beach, Atkins, or eating for your blood type – are the keys to ending obesity and diabetes. While some of these programs may work short term, they often have a pendulum effect where the dieter will lose weight, but then quickly gain it back. It all works under the premise that there’s a “magic pill” that will solve the problem instead of doing the hard work – eating healthy and exercising.
“Eating healthy, exercising regularly and taking the medication that your doctor prescribes is what is good. People who really take care of themselves actually know their sugar levels better than anyone else and how they react with their medication. It is up to the individual to work with the doctors to get the right medication or dose. This comes with experience, taking care of yourself more regularly and using the gluco-meter to check your blood sugars. It’s all a matter of balancing your lifestyle,” said Awashish.
Through the Maamuu Nakaahehtaau project, Awashish said the CBHSSJB is looking to the people to see what can be offered to help them change their lifestyles and end diabetes for good.
If there’s a demand for it, the CBHSSJB will work on providing what is needed and this includes help from nutritionists, exercise programs, support groups and psychological assistance.
“With the way things were in the past, we had come up with some of the ideas that we wanted to try out on the communities, but we have now reversed our thinking as this should come from the people instead of the top down,” said Awashish.