The Cree Diabetes Network was formed in 1997 to address diabetes in Eeyou Istchee. In line with the National Aboriginal Diabetes Association, we want to create networks and opportunities for individuals and communities within our culture, traditions and values. Anyone is welcome to join.
Today, many people are aware of the diabetes epidemic affecting our communities. This is an epidemic that is affecting the Indigenous Peoples of many countries, including Canada, the USA, New Zealand, Australia, the South Pacific Islands and others. In our communities of the Eastern James Bay Cree Nation, Eeyou Istchee, 10.3% of persons 15 years of age and older had been diagnosed with diabetes type 2 by May, 1999. This compares to 2.5% for the rest of Canada. These figures only include people who know they have diabetes. In most studies, when you check everybody in a community for diabetes, you find that the number of people diagnosed with diabetes doubles. So, in Eeyou Istchee, the true number of people diagnosed with diabetes could be as high as 20%, one of the highest in the world.
I constantly think of what may be bringing this epidemic to our communities and what the solution may be.
My experience as a physician living in Chisasibi has led me through different stages in what I think are the main factors related to the prevention and control of diabetes.
-In medical training, the emphasis was on medications: pills to lower sugar and insulin injections.
-As I started my clinical practice in Chisasibi, I observed that full doses of pills and insulin alone only worked well on some people. I started thinking that the solution must lay in adequate nutrition and physical activity. In fact, these were shown to be effective in a large study in the United Kingdom; however the intervention only lasted for 3 months, so after a year, the participants’ blood tests were back to what they were before the intervention; the pharmaceutical industry then claimed that physical activity and nutrition interventions did not work, but this is like saying that a pill doesn’t work after a year, when you have only taken it for 3 months.
-For lack of resources, we have not been able to provide the best conditions for people to have optimal nutritional intake and physical activity to prevent and control diabetes. However, as I started to talk more in depth to people with extremely high blood sugar levels that they felt unable to control, they all had one thing in common: severe stress in their lives. So my focus then turned to the role of stress in diabetes type 2, an area that is under-recognized in the medical world and for which there is little research done. -Why would there be such high levels of stress? I participated in the World Health Organization’s International Consultation on the Health of Indigenous Peoples in November of 1999. There, Indigenous Peoples and health experts from around the world declared that the issues of oppression, lack of self-determination and loss of control over one’s life are very important causes of chronic stress and chronic disease. It is interesting to note that there is only one place in the world where the rate of diabetes is decreasing.
In Nauru, an island in the South Pacific, diabetes rates started to decrease 20 years ago. They also gained independence from the USA 20 years ago. I do not believe that this is a coincidence.
Of course, the genetic component is a factor, and a gene has been identified in the Cree-Ojibway community of Sandy Lake, Ontario that is associated with a larger incidence of diabetes. But to blame it all on genes is to ignore that in our territory, before the construction of the James Bay Hydroelectric projects in the late 1970’s, there were only 3 people diagnosed with type 2 diabetes. By May of 1999, there were 821. People had the same genes in 1975 and in 1999. What may have changed is how much control people feel they have over their own lives. Granted, the diet and physical activity also changed, but I wonder if the changes in the levels of chronic stress weren’t a lot greater? This is an area that requires more participatory, community-based research, because the people know what the problem is and are more likely to find the right solution themselves. If the link between Oppression, Chronic Stress and Diabetes Type 2 is better documented, it will be more difficult for governments and large resource-extracting corporations to continue to deny the terrible health impacts of their policies and projects. My personal belief is that we will only see decreasing rates of diabetes in Eeyou Istchee when the people of Eeyou Istchee will have increased control over their land, resources and lives in general.
All Community Members are invited to join us for Sadie’s Walk on June 19, to support those of us who live with diabetes.
By Robert Harris, MD MPH CCFP