The diabetes epidemic in Canada has had a throttling grip on Indigenous populations nationwide but where you live might really impact the severity of the situation.
According to the Cree Health Board, there is a 19% diabetes rate among Quebec Crees 20 years older compared to a rate of 4.9% to 5.8% of the population aged 12 and over for the overall Canadian population.
Though the rates for Eeyou Istchee might be high, according to Dr. Murray Trusler, the recently retired former chief-of-staff at Moose Factory’s Weeneebayko Hospital, no actual numbers exist for the Ontario Cree. Without their own health board and because of a lack of digital records, Trusler said that though he has seen a high rate of patients with diabetes, he cannot even speculate as to what the rate is for Ontario’s James Bay Cree.
Trusler first visited Moose Factory in 1972 after working in Norway House, Manitoba in 1967. In Norway House, he and a colleague were responsible for 10,000 Cree people and covered an area of 30,000 square miles, and ran a 40-bed hospital and supervised a number of nursing stations.
“There was some diabetes but in most cases the disease was relatively mild and controlled on oral hypoglycemics. The people were in general very physically active, eating a traditional diet and had few luxuries, except for some motor boats and skidoos,” said Trusler.
Medically he said that the two communities were easily comparable. A colleague of his, who had begun working in Moose Factory in the 1950s, had reported to him that at the time there were virtually no instances of diabetes.
That same colleague passed along old home movies to Trusler, who said the most remarkable thing about them was how slim the Natives were in them.
During his 1972 visit, Trusler stopped by the Hudson’s Bay Company store where he said the store sold basic staples, a small selection of fruit and vegetables and almost no junk food.
Almost 40 years later the story is dramatically different. According to Trusler, diabetes is rampant amongst the communities.
“It is particularly the women, we see a lot of them coming in who have gestational diabetes and after about two or three pregnancies they are diabetic,” said Trusler.
That is not to say that men and children are not suffering as he has noticed particularly high rates amongst them both.
According to his discussions with Moose Factory residents, the scales really began to tip with the advent of welfare because it changed how those in the community acquired their food and how much physical exertion they needed to obtain it.
Add to this the availability of vehicles and the means to purchase them, and suddenly a population that was once very active no longer has to be and weight gain ensued.
At the same time, how the Ontario Cree communities have evolved over the last 30 years with Indian and Northern Affairs having a strong hold on the amount of money going into the communities for infrastructure has also had a large impact on the population and their health.
“In First Nations communities, the appalling social conditions compound the problem of diabetes. If you are impoverished, how can you eat a proper diet? If you are a diabetic Elder living with your family of 15 people in a house with one refrigerator, how can you separate your food from the rest of the family’s?” said Trusler.
An intense lack of employment along with a lack of access to educational training programs or even sufficient schools for children to attend have all contributed to the dire poverty cycle in these communities.
Not only is poverty widespread amongst the Cree in Ontario’s north, but in Trusler’s opinion, the situation becomes even more dire since welfare cheques have not caught up to the cost of living in the north.
Trusler said it was not uncommon to have Elders coming to the clinic where he worked who had no food left in their fridges by the third week of the month. This was because their welfare cheques wouldn’t last until the end of the month or because they lived with growing teens who would eat everything in the fridge.
Trusler went as far as saying that these communities should consider a “tax” on junk foods to discourage the local Northern Stores from selling the high carbohydrate/ high sugar-laden foods as that is mainly what is available on the store shelves.
“When your primary food source is a lot of processed foods and other elements that are not particularly healthy, you end up with kids who gain a lot of weight and a lot of them who have impaired glucose tolerance go on to have diabetes in their early 20s,” said Trusler.
The other problem is the lack of access to healthy foods because of their prices. In some of these communities, such as the remote Peawanuck reserve, a litre of milk can cost as much as $11. Most of the stores do not even stock dietetic foods as they are simply too costly.
Though the Crees of the Ontario communities once subsisted on traditional foods that they fished and hunted, in remote communities whose populations have exploded over the years, this has become much more challenging. In some instances these communities have grown five times larger over the last 30 years.
Trusler said that he has heard many stories of hunters from Moose Factory taking the train to nearby Cochrane to hunt because there is much more to hunt down there.
The bottom line for Trusler is how much poverty has compounded the diabetes epidemic for the Ontario Crees and though there are other factors, one of the largest is Ottawa’s treatment of the Aboriginals in these communities.
“Why is it that our society isn’t better structured to say that these are fundamental rights that everybody has: a decent education, decent healthcare and a decent water supply, these are basics,” said Trusler.
In his mind however, the tides will not be turned until adequate education becomes accessible to these communities to break the poverty cycle and without proper investment into infrastructure it’s not going to happen.
On the other side of the Bay….
Over on the Quebec side of the border, the Cree Board of Health and Social Services of James Bay was proud to announce the launch of their new diabetes teaching tool, a DVD entitled Sweet Blood.
Solomon Awashish, from the CHB’s Chronic Disease Prevention team, was proud to have had the opportunity to present the DVD to an international audience at the 20th International Diabetes Federation Congress held in Montreal Oct. 18-22.
“Everybody was very happy that the DVD came out and they wanted a copy,” said Awashish.
The film was produced for the CBHSSJB to be given to those already living with the disease and also as a teaching tool for those who are newly diagnosed.
Sweet Blood chronicles a group of Crees from different parts of Eeyou Istchee who are living with diabetes, how they cope with it and how they have changed their lives to survive. The film is one of the very first that is entirely culturally relative, featuring traditional living, traditional food preparation and a great deal of dialogue about the Crees ancestrally and how things have changed.
Awashish said that the film was very necessary not just because the Crees have such a high diabetes rate, but amongst the Quebec Crees there is also an incredibly high rate of complications stemming from diabetes.
“For those amongst the general population in Quebec, when an individual is diagnosed with diabetes, they will usually see a complication within 20 years. What we find with the Cree is that from the date they are diagnosed they will show complications within five years,” said Awashish.
Much like the Ontario Crees, Awashish said that the surge in diabetes and its complications have resulted from a rapid lifestyle change and that many Crees have not adapted.
It is not just that Crees are more sedentary, have genetic factors against them, such as metabolisms that tend to hang onto calories more rigorously and have changed what they have eaten, Crees have also not adapted in terms of attitude.
“Once people are diagnosed with diabetes it is extremely hard for people to change their lifestyles, to get them to be physically active again. Part of this is the attitude that people have. In the old days people tended to think that if they were doing something physical, it needed to have a purpose, like checking their traps or getting wood. But, if you are not engaged in those activities, it is strange to see somebody walking for an hour a day just to do that. There seems to be no point to that,” said Awashish.
Though the problems in both Quebec and Ontario are widespread when it comes to Crees and diabetes, the fact that the James Bay and Northern Quebec Agreement has fueled more money into Eeyou Istchee to allow for wider economic prosperity and control over their own health board has made a significant difference.
Not only can the Quebec Crees produce culturally specific DVDs, there is also an effort within the region to target younger portions of the population when it comes to educating the youth to prevent further outbreak of the epidemic.
Awashish said that amongst the youth there is a significant trend where youth refuse to cook for themselves and tend to eat out much more often.
One of the more recent strides the CBHSSJB has made over the last two years is starting to work with better nutrition for children in daycare.
Nutritionists have been working with the daycares to ensure that the children are eating more appropriate foods and that they are learning about them too.
“What we have noticed within the Crees is that if a child is given either traditional foods or other healthy foods at an early age they will be more adept to healthy eating patterns as they get older. When you are trying to teach an older kid or an adolescent to eat the same kinds of things it is almost impossible,” said Awashish.
Though Awashish said that the CHB wanted to hold another Cree Regional Conference on Diabetes like the one they had in 2006, the H1N1 influenza outbreak has prevented them from doing so. In their efforts to work with the Crees to reduce both the instance of diabetes and complications from it, they hope to get another off the ground in 2010.
This however is a luxury that the Ontario Cree communities might never see.
