2010 (Oct) Canadian Diabetes Association Annual Conference, Aboriginal health Symposium facilitated by BRAID Research, presentation by BRAID Research

1. Preventing Diabetes in
Aboriginal Communities:
To Screen or Not To Screen
Adrian Jacobs – Community Liaison
MDSi Field Team, BRAID Research Group
University of Alberta

2. Preventing Diabetes in
Aboriginal Communities:
To Screen or Not To Screen

3. To Screen or Not To Screen
Yes, as long as it is an act of empowerment
that resources the Aboriginal community to
make Health Agenda decisions.
James Lamouche Dr. Daniele Behn Smith Dr. Dawn Martin-Hill

4. The Screening Debate
 2003 CDA guidelines recommend community-
based screening
 2008 CDA guideline do not recommended
community-based screening
 ADA discourages community-based screening

5. Why not?
 Potential poor patient follow-up
 Uncertain health impact
 Fear of
 Labeling
 Stigmatization
 Feelings of loss of control
 Cultural barriers

6. Reasons to screen
 Cost effectiveness of prevention
 Current and projected costs of extant diabetes
 Socio-cultural benefit
 Empowerment
 Capacity building
 Collaboration
 Cultural renewal

7. My Own Diagnosis

8. “Your mother has it. You have it.
You are Aboriginal. You are
genetically pre-disposed.”

9. “The White Man did this to you.”

10. Lifestyle change.
 Active lifestyle
 Hunting
 Fishing
 Nomadic life
 Horticulture
 Natural harvesting

11. Change of Diet
FROM TO
 Lean wild meats  White fat
 Fish  White flour
 Fruits and vegetables  White sugar
 White salt
 Caffeine

12. Disempowerment
 Colonialism
 Treaty breaking
 Indian Act
 Residential Schools
 Racism
 Poverty

13. “We did this to you.”

14. Colonialism
 Another people’s agenda
 Another people’s values
 Another people’s norm
 Creation of a norm makes all others deviant
 This leads to marginalization
 The end result is stigmatization – the ultimate
disempowerment

15. “I take responsibility for this.”

16. Blame-deflecting
 I was not there.
 We did not make these decisions.
 That happened so long ago, you just need to get
over it.

17. Healthy immigrant effect
 Immigrants to Canada are healthier than
Canadians when they arrive
 After being here a number of years they are less
healthy than Canadians
 European immigrants decline less
 People of colour of non-European origin decline the
most

18. Who is making them sick?
 Western culture?
 European immigrants suffer less
 Non-European immigrants suffer more
 As an Aboriginal I can say, “Perhaps it is making
you sick like it made us sick.”

19. What is making them sick?
 Western medicine’s “norm making?”
 What happens if you use a northern European as
“the norm?”
 What about a southern European?
 What about an English Canadian or French
Canadian?
 As an Aboriginal I can say, “It doesn’t matter,
they are all Western, we will never correspond.”

20. Aboriginal Diabetes Pre-Disposition
 I lamented
 My grandmother’s diabetes
 My mother’s diabetes
 My diabetes
 My Aboriginal heritage
 I hoped my children would not be cursed by my
Aboriginal genetics

21. “No (not bad genetics)! Good
genetics – bad diet and lifestyle!”
 This turned everything completely around in me
 My heritage is not the problem
 My genetics is not the problem
 I have a great heritage
 I have great genetics

22. Decolonized Thinking
 I am Ongwehohweh and I am not a deviation!
 Our Aboriginal heritage is our asset.
 We are how the Creator made US.
 We don’t have to change to become “normal.”
 We are the “norm” for US.
 Give us the tools and we will find our way
through to health for US.

23. Decolonization
 Prime Minister Harper apologized for the
“policy of assimilation” as expressed in the
Residential School system
 What does “not assimilating” Aboriginal people
look like?

24. RCAP (Royal Commission
on Aboriginal Peoples)
 A return to the treaty relationship
 Nation to Nation
 Respect
 Dealing honestly with the past
 Treaty violations
 Residential Schools
 Reconciliation

25. Ruppert Ross
“while western psychology’s discussions about things
like Complex PTSD might help non-aboriginal people
understand the impact of residential schools, they
remain western discussions, coming out of a western
world-view. A different world-view, however, would
result in a different vision of what a healthy person is,
a different description of ill-health, and different
prescriptions for returning to good-health.” Heartsong:
Exploring Emotional Suppression and Disconnection in
Aboriginal Canada, Nov. 2009

26. Empowerment
 The locus of control for Aboriginal Health
needs to be in the Aboriginal community not
outside.
 Health Policy
 Health Budget
 Health Programming
 Health Accountability

27. Colonialism in Health

28. Aboriginal Control

29. To Screen or Not To Screen
 MDSi produces a data resource for Aboriginal control
 Community Based Research and Education
 NAHO’s OCAP (Ownership Control Access
Possession)
 Decolonizing Aboriginal Health requires it.
“YES, as long as it is an act of
empowerment, resourcing the
Aboriginal community to make
health agenda decisions.”

30. Adrian Jacobs – ajacobs@ualberta.ca
www.braiddm.ca
“Restoring Aboriginal culture through community-based type 2 diabetes screening”
by Richard Oster, Ellen Toth
International Journal of Circumpolar Health 2010
http://www.braiddm.ca/69_3_oster.pdf

31. Nia:wen Gowa