It is no secret that the instance of diabetes is significantly higher in Eeyou Istchee than in non-Aboriginal communities just miles away from Cree territory, but with the suffering so prevalent, why does this trend persist?
This was something that the Nation discussed with Sol Awashish, the Chronic Disease Prevention Program Officer for the Cree Board of Health and Social Services of James Bay (CBHSSJB), since November is Diabetes Awareness Month.
“We went from being nomadic hunters and fishermen for centuries and then in a timeframe of just 30 years we have settled into these communities. Many of us have jobs that don’t require much physical activity or no physical activity at all.
“Instead of learning what healthy eating is, we tend to buy what is convenient and what is fast. From what I see, a lot of us just don’t know how to cook healthy or know what to cook. And some of us just don’t want to cook,” said Awashish
Unfortunately, it is inactivity combined with a poor diet that has paved the way for so many Crees to become obese and in turn develop diabetes since many already have two genetic factors against them. According to Awashish, many Crees have family histories of diabetes, leaving them predisposed to the disease and then there is the fact that all Indigenous peoples in North America hang on to calories more rigorously. This has come as a result of thousands of years of Native people subsisting on hunter/gatherer diets, which was either feast or famine.
Whereas having historically “thrifty metabolisms” (an ability to conserve more energy than the average person) is what has been essential to the survival of Indigenous peoples, a mere 30 years of transition time to adapt to a typical western diet simply has not been enough.
Diabetes is a major issue for Indigenous peoples living in developed nations worldwide as the rates are exploding amongst those who have seen rapid development.
The Cree are unfortunately typical of international statistics on Indigenous peoples and diabetes in that more than one in five Crees over the age of 20 has diabetes. According to information released by the CBHSSJB in 2009, the diabetes rate amongst the Crees in Eeyou Istchee is 21.4% – almost four times the rate of the general population of Quebec.
What Awashish says he sees going on in the communities in terms of family life is symptomatic of the problems Crees are facing, particularly amongst the women.
“The majority of the moms in our communities work and so they don’t really have time to cook meals at dinnertime when the kids come home. It is much easier for them to hand their kids some money or go out and pick up something to eat,” said Awashish.
And so, it is not unusual to see Cree kids heading off to the local restaurants with their friends or siblings to get something to eat for lunch or dinner or sometimes both. The problem however is that the judgment of this child or youth isn’t always the best when it comes to meal selection and the choice is often high-fat, high-sodium poutine, washed down with a sweet beverage, like a soda or iced tea – both of which are very high in calories.
While Awashish admits that in moderation this kind of meal is innocuous, but having it more than once a week or once every two weeks is simply unhealthy. He said it’s one thing to go to a restaurant with a child and show them what on the menu is healthy to eat but without adult guidance, kids are most likely going to pick what tastes good.
“So much of what we eat right now is processed and this is really the worst thing that we can eat. This is what people tend to buy as you don’t need to be able to cook to eat processed foods. You just heat and serve,” said Awashish.
As a result, families – even those with the best of intentions – may end up serving meals that they do not realize are unhealthy and the impact on their bodies is evident. When you compare the game stews that Gookum made 30 years ago to a frozen pizza or frozen chicken wings, the meals are worlds apart nutritionally. As a result, Crees are remarkably heavier and, in turn, sicker.
“What we are starting to see are third-generation diabetics. These are people whose grandparents have it, whose parents have it and now they have it and they are still young. We even have some in their 20s, who are on dialysis already and are going blind,” said Awashish.
Because of the persistent obesity rates in the communities, Crees are continuing to get sick. Complications, such as kidney dysfunction, are common amongst diabetics because high blood sugar can overwork the kidneys, causing them to stop functioning properly.
When diagnosed early, kidney disease can be slowed with treatment but later diagnoses can often result in kidney failure. Once the kidneys fail, frequent dialysis treatment or a kidney transplant are the patient’s two major options when it comes to kidney replacement therapy.
“What we have seen in the past is more kidney dysfunction over other complications. In the general population, from the date of diagnosis until they start showing signs of complications, it usually takes about 20 years. However, in the Cree world, this usually takes about five years,” said Awashish.
Because of the high rates of kidney related complications, Awashish stressed that those being diagnosed with the disease take it seriously and listen to the advice of their diabetes educators.
From what he sees, it is not a matter of people needing to go on dialysis right away but just learning how to manage their disease so that they can avoid the eventuality.
Whereas he acknowledges that people can’t do anything about the fact that they may be predisposed or have inherited metabolisms that make them more susceptible, Awashish said people need to tackle the factors they can change, such as their diets, activity rates and stress levels.
“A lot of us are living in denial as we think that this just isn’t going to happen to us, even though we have seen it happen to our own parents. People will say, hey, that isn’t going to happen to me,” said Awashish.
Whether people are in denial or not, Awashish and his team have worked hard at trying to change the environment that Crees live in to make being healthier easier.
In 2010, the CHBSSJB launched a new diabetes campaign called Maamuu Nakahehtaau to get the communities together to create healthy environments that will promote physical activities.
“In the communities, there are not enough biking trails, walking paths and other things that bodies like the Chief and Council should be able to come up with,” said Awashish.
At the same time, every community has its own recreation department that provides for local sports and recreation for its residents. While Awashish said he believes these departments are doing an excellent job, a large portion of their budgets often get spent on hockey, which he feels is too much.
With so much emphasis on hockey, other sports and activities have fallen by the wayside as the sport does not appeal to everyone on a physical level.
This wouldn’t be such an issue if it weren’t for the fact that the rates of diabetes amongst women are significantly higher than in men – 25.2% vs. 17.5%.
According to the CBHSSJB, this could be because women are more likely than men to be obese, become overweight at a younger age, and are less physically active.
While Awashish said some of the communities are starting to offer hockey programs for girls as well as broomball, he admits that it may not be enough to engage the female population. This is why he was so happy to see the Lemon Cree fitness programs take off.
In 2010, the Cree Women of Eeyou Istchee Association launched a physical fitness program through professional trainer Theresa Ducharme to start up fitness programs for women throughout the Cree communities.
Eighteen months later and in many communities the programs are still going strong while Lemon Cree has begun its own endeavour to teach Crees to become trainers.
“The first thing we have to do as Cree people is we have to take these matters into our own hands and stop depending on others to do it for us. That’s the good thing about the Lemon Cree program, they are now training trainers and these people can go into the communities and work.
“This is really a good thing and we need more of it. There are a lot of other people out there who need encouragement to do things for the community,” said Awashish.
And it is this kind of change in the communities that Awashish is most hopeful for, to get Crees moving and healthier once more.