preventing diabetes in aboriginal communities: to screen or not to screen
DESCRIPTION
2010 (Oct) Canadian Diabetes Association Annual Conference, Aboriginal health Symposium facilitated by BRAID Research, presentation by BRAID ResearchTRANSCRIPT
Preventing Diabetes in Preventing Diabetes in Aboriginal Communities:Aboriginal Communities:
To Screen or Not To ScreenTo Screen or Not To Screen
Adrian Jacobs Adrian Jacobs ––
Community LiaisonCommunity LiaisonMDSi Field Team, BRAID Research GroupMDSi Field Team, BRAID Research Group
University of AlbertaUniversity of Alberta
Preventing Diabetes in Preventing Diabetes in Aboriginal Communities:Aboriginal Communities:
To Screen or Not To ScreenTo Screen or Not To Screen
To Screen or Not To ScreenTo Screen or Not To Screen
Yes, as long as it is an act of empowerment Yes, as long as it is an act of empowerment that resources the Aboriginal community to that resources the Aboriginal community to
make Health Agenda decisions.make Health Agenda decisions.
James Lamouche Dr. Daniele Behn Smith Dr. Dawn Martin-Hill
The Screening DebateThe Screening Debate
2003 CDA guidelines recommend community2003 CDA guidelines recommend community--
based screeningbased screening
2008 CDA guideline do not recommended 2008 CDA guideline do not recommended communitycommunity--based screeningbased screening
ADA discourages communityADA discourages community--based screeningbased screening
Why not?Why not?
Potential poor patient followPotential poor patient follow--upup
Uncertain health impactUncertain health impact
Fear of Fear of
LabelingLabeling
StigmatizationStigmatization
Feelings of loss of controlFeelings of loss of control
Cultural barriersCultural barriers
Reasons to screenReasons to screen
Cost effectiveness of preventionCost effectiveness of prevention
Current and projected costs of extant diabetesCurrent and projected costs of extant diabetes
SocioSocio--cultural benefitcultural benefit
EmpowermentEmpowerment
Capacity buildingCapacity building
CollaborationCollaboration
Cultural renewalCultural renewal
My Own DiagnosisMy Own Diagnosis
““Your mother has it. You have it. Your mother has it. You have it. You are Aboriginal. You are You are Aboriginal. You are genetically pregenetically pre--disposed.disposed.””
““The White Man did this to you.The White Man did this to you.””
Lifestyle change.Lifestyle change.
Active lifestyleActive lifestyle
HuntingHunting
FishingFishing
Nomadic lifeNomadic life
HorticultureHorticulture
Natural harvestingNatural harvesting
Change of DietChange of Diet
FROMFROM
Lean wild meatsLean wild meats
FishFish
Fruits and vegetablesFruits and vegetables
TOTO
White fatWhite fat
White flourWhite flour
White sugarWhite sugar
White saltWhite salt
CaffeineCaffeine
DisempowermentDisempowerment
ColonialismColonialism
Treaty breakingTreaty breaking
Indian ActIndian Act
Residential SchoolsResidential Schools
RacismRacism
PovertyPoverty
““We did this to you.We did this to you.””
ColonialismColonialism
Another peopleAnother people’’s agendas agenda
Another peopleAnother people’’s valuess values
Another peopleAnother people’’s norms norm
Creation of a norm makes all others deviantCreation of a norm makes all others deviant
This leads to marginalizationThis leads to marginalization
The end result is stigmatization The end result is stigmatization ––
the ultimate the ultimate disempowermentdisempowerment
““I take responsibility for this.I take responsibility for this.””
BlameBlame--deflectingdeflecting
I was not there.I was not there.
We did not make these decisions.We did not make these decisions.
That happened so long ago, you just need to get That happened so long ago, you just need to get over it.over it.
Healthy immigrant effectHealthy immigrant effect
Immigrants to Canada are healthier than Immigrants to Canada are healthier than Canadians when they arriveCanadians when they arrive
After being here a number of years they are less After being here a number of years they are less healthy than Canadianshealthy than Canadians
European immigrants decline lessEuropean immigrants decline less
People of colour of nonPeople of colour of non--European origin decline the European origin decline the mostmost
Who is making them sick?Who is making them sick?
Western culture?Western culture?
European immigrants suffer lessEuropean immigrants suffer less
NonNon--European immigrants suffer moreEuropean immigrants suffer more
As an Aboriginal I can say, As an Aboriginal I can say, ““Perhaps it is making Perhaps it is making you sick like it made us sick.you sick like it made us sick.””
What is making them sick?What is making them sick?
Western medicineWestern medicine’’s s ““norm making?norm making?””
What happens if you use a northern European as What happens if you use a northern European as ““the norm?the norm?””
What about a southern European?What about a southern European?
What about an English Canadian or French What about an English Canadian or French Canadian?Canadian?
As an Aboriginal I can say, As an Aboriginal I can say, ““It doesnIt doesn’’t matter, t matter, they are all Western, we will never correspond.they are all Western, we will never correspond.””
Aboriginal Diabetes PreAboriginal Diabetes Pre--DispositionDisposition
I lamentedI lamented
My grandmotherMy grandmother’’s diabetess diabetes
My motherMy mother’’s diabetess diabetes
My diabetesMy diabetes
My Aboriginal heritageMy Aboriginal heritage
I hoped my children would not be cursed by my I hoped my children would not be cursed by my Aboriginal geneticsAboriginal genetics
““No (not bad genetics)! Good No (not bad genetics)! Good genetics genetics ––
bad diet and lifestyle!bad diet and lifestyle!””
This turned everything completely around in meThis turned everything completely around in me
My heritage is not the problemMy heritage is not the problem
My genetics is not the problemMy genetics is not the problem
I have a great heritageI have a great heritage
I have great geneticsI have great genetics
Decolonized ThinkingDecolonized Thinking
I am Ongwehohweh and I am not a deviation!I am Ongwehohweh and I am not a deviation!
Our Aboriginal heritage is our asset.Our Aboriginal heritage is our asset.
We are how the Creator made US.We are how the Creator made US.
We donWe don’’t have to change to become t have to change to become ““normal.normal.””
We are the We are the ““normnorm””
for US.for US.
Give us the tools and we will find our way Give us the tools and we will find our way through to health for US.through to health for US.
DecolonizationDecolonization
Prime Minister Harper apologized for the Prime Minister Harper apologized for the ““policy of assimilationpolicy of assimilation””
as expressed in the as expressed in the
Residential School systemResidential School system
What does What does ““not assimilatingnot assimilating””
Aboriginal people Aboriginal people
look like?look like?
RCAP (Royal Commission RCAP (Royal Commission on Aboriginal Peoples)on Aboriginal Peoples)
A return to the treaty relationshipA return to the treaty relationship
Nation to NationNation to Nation
RespectRespect
Dealing honestly with the pastDealing honestly with the past
Treaty violationsTreaty violations
Residential SchoolsResidential Schools
ReconciliationReconciliation
Ruppert RossRuppert Ross
““while western psychologywhile western psychology’’s discussions about things s discussions about things like like Complex PTSD might help nonComplex PTSD might help non--aboriginal people aboriginal people understand the impact of residential schools, they understand the impact of residential schools, they remain remain westernwestern
discussions, coming out of a western discussions, coming out of a western
worldworld--view. A different worldview. A different world--view, however, would view, however, would result in a different vision of what a result in a different vision of what a healthyhealthy
person is, person is,
a different description of a different description of illill--health, and different health, and different prescriptions for returning to prescriptions for returning to goodgood--health.health.””
Heartsong: Heartsong:
Exploring Exploring Emotional Suppression and Disconnection in Emotional Suppression and Disconnection in Aboriginal Canada, Nov. 2009Aboriginal Canada, Nov. 2009
EmpowermentEmpowerment
The locus of control for Aboriginal Health The locus of control for Aboriginal Health needs to be needs to be inin the Aboriginal community not the Aboriginal community not outsideoutside..
Health PolicyHealth Policy
Health BudgetHealth Budget
Health ProgrammingHealth Programming
Health AccountabilityHealth Accountability
Colonialism in HealthColonialism in Health
Aboriginal ControlAboriginal Control
To Screen or Not To ScreenTo Screen or Not To Screen
MDSi produces a data resource for Aboriginal controlMDSi produces a data resource for Aboriginal control
Community Based Research and Education Community Based Research and Education
NAHONAHO’’s OCAP (Ownership Control Access s OCAP (Ownership Control Access Possession)Possession)
Decolonizing Aboriginal Health requires it.Decolonizing Aboriginal Health requires it.
““YES, as long as it is an act of YES, as long as it is an act of empowerment, resourcing the empowerment, resourcing the
Aboriginal community to make Aboriginal community to make health agenda decisions.health agenda decisions.””
Adrian Jacobs Adrian Jacobs ––
[email protected]@ualberta.ca
www.braiddm.cawww.braiddm.ca
““Restoring Aboriginal culture through communityRestoring Aboriginal culture through community--based type 2 diabetes screeningbased type 2 diabetes screening”” by Richard by Richard OsterOster, Ellen , Ellen TothToth
International Journal of Circumpolar Health 2010 httphttp://www.braiddm.ca/69_3_oster.pdf://www.braiddm.ca/69_3_oster.pdf
Nia:wenNia:wen GowaGowa