The Diabetes Epidemic Amongst Native Americans
Type 2 Diabetes is a significant, pressing and continually worsening public health problem. General research has drawn close connections between this public health problem and certain gender, racial and cultural factors. Additionally, research has recognized that diabetes is today one of the fastest growing public health problems due to the negative health behaviors which have become increasingly culturally prevalent in America. The ‘junk food’ culture that inclines Americans to consume fatty foods with limited nutritional value and to engage relatively sedentary lifestyles is creating a culture of heart-disease, obesity and diabetes. This is a problem which inordinately impacts the Native American and Native Alaskan populations of the United States, which today are struggling to stem the fast rising tide of diabetic Native American children, adolescents and adults.
All attendant research on the subject pinpoints the heightened vulnerability of this group with unequivocal certainty. To this end, “Type 2 diabetes has been recognized as a significant public health problem in American Indian communities for almost 40 years.1,2 The Pima Indians in Arizona have the highest recorded prevalence of diabetes in the world.3 Compared with other US populations, American Indians and Alaska Natives have been disproportionately affected with diabetes since the early 1960s,1 and its increasing prevalence in this population has been documented since 1983.2,4” (Acton et al, 1485) Observations have consistently drawn a connection between Native American ethnicity and a high level of vulnerability to the conditions of diabetes. Particularly, Type 2 Diabetes, which has traditionally been known as an acquired rather than inborn form of Diabetes and which has therefore most commonly been found to be present in adults, is appearing more commonly in adolescents of all ethnicities. However, consistent with the above findings, this impact has also been disproportionately afflictive of Native American ethnicities.
Statistics have tended to reinforce a series of consistent indicators as to the crisis which diabetes represents most especially to Native American populations, who the American Diabetes Association notes are 2.2 times as likely as non-Hispanic Whites to develop Diabetes Type 2, are 3 times as likely to suffer fatality due to these conditions and are markedly more reflective of the sharp increase in reported and suspected cases of Type 2 in adolescents and young adults. (ADA, 1) The reason for this has been attributed to a significant upswing in the proportion of Native Americans or Native Alaskans who suffer from obesity or from other metabolic disorders. Though this does not in and of itself set it apart from other vulnerable groups such as African Americans and Hispanic Americans, the fact that so disproportionate a number of young Native Americans is susceptible to these symptomatic issues suggests a root genetic cause.
More recently, the American Diabetes Association has come to the resolution that certain geographically and historically bound patterns of consumptive survival have had the impact of making the native populations ill-prepared to adapt to those patterns which have emerged with increased industrialization. Namely, there has been a genetic distinction emergent within this group which has predisposed it to the types of harvest patterns bound within its relationship to the earth. Thus, “according to the National Institute for Diabetes and Digestive and Kidney Diseases, the “thrifty gene” theory proposes that African-Americans, Hispanic-Americans, Asian Americans and Native Americans inherited a gene from their ancestors which enabled them to use food more efficiently during “feast and famine” cycles. Today there are fewer such cycles; this causes certain populations to be more susceptible to obesity and to developing type 2 diabetes.” (ADA, 1) This is to say that the increased vulnerability of these populations is directly related to an incapacity to adjust to the terms of modern consumption.
The research conducted here finds that there are yet other conditions which are ethnically distinct to the populations in question and which contribute to their heightened vulnerability. Specifically, the Native American population is distinctly recognized as having a thinner bloodstream when compared to that of white sample subjects. This is, as a tangent, a fact to which is often attributed the heightened susceptibility of these populations also to intoxication and alcoholism. Indeed, the Lee article denotes that there are “significant variables associated with the development of diabetes included triglycerides, obesity, fasting plasma glucose, insulin, and degree of American Indian blood among participants with NGT at baseline. For those with IGT at baseline, significant predictors included fasting plasma glucose, 2-h glucose, BMI, degree of American Indian blood, and albuminuria.” (Lee et al, 49) Collectively, these conditions are indicative of the population’s genetic disadvantage in combating the disease which is commonly described today as epidemic in any event. The epidemic nature of diabetes has drawn a considerable degree of public concern for American society and public health in general. With so many more children, adolescents and young adults showing signs of the illness, there is a marked rise in the public profile of diabetes and the numerous, quite serious repercussions there assocated.
And it is not just because of the group’s heightened vulnerability to contraction of the disease that makes the Native American demographic such a great cause for concern. The level of severity to which it is suffered by these groups is also distinctly high. Accordingly, we are learning today that one outcome of this vulnerability is the group’s increased susceptibility to the most problematic of outcomes related to the condition. As a primary example, this form of diabetes produces a 10 to 21% likelihood for the development of kidney disease and what the American Diabetes Association terms as end stage renal disease or kidney failure. This is a potentially fatal condition. As the ADA reports, Native Americans suffering from diabetes are six times as likely to suffer from kidney failure than are those non-Hispanic whites with the same diabetic condition. (ADA, 1)
Still, the severity and frequency of cases is not cause to conclude that Native American populations cannot be treated. To the contrary, public awareness campaigns have marked our increasing recognition of the outsized threat to this particular group. Public health institutions are increasingly reaching out to Native American groups in a specific effort to ensure that at least individuals who are suffering the condition can be made aware of it before treatment is no longer possible.
But beyond this, there must be the curative goal of preventing the stimulation of new cases, which are constant and always rising in the Native community. According to a 2002 study by Gilliland et al, “lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time.” (78) This is suggestive of the most popularly suggest mode of treatment for the epidemic, as opposed to the larger condition. Indeed, there is a core difficulty in demanding this behavioral outcome considering the genetic challenges against which the population must struggle. In the array of vulnerabilities to which the ethnic group appears to be predisposes is a set of hereditary responses to externalities which have been dramatically altered. Accordingly, the true externalities relating to habits of diet, consumption and activity bear a greater impact on this population than on those around it which have otherwise adopted from transplanted by settled and industrializing cultures.
There is a tendency to denote industrial development as having some progressive inherency. But in the case of nutrition and diet, the struggles facing Native Americans seem to especially disrupt this perception. Reportedly “as we have become “civilized” and developed a large agricultural base to deliver a stable and overly-abundant supply of food, our dietary intake has changed dramatically from our distant ancestral past. It is believed that the genes we now have were acquired only by those who were so genetically equipped to survive with that sparse ancient diet.” (Huber, 1) The result is that for those who emerged from a culturally so many more centuries steeped in this sparseness such as have the Native Americans, the body is ill-prepared to process the pace and content of the modern diet. Historically, the need to yield the highest possible nutritional value from the most modest intake of food has rendered an ethnic group that though deeply advantaged when culturally and geographically linked to the hunting and gathering survival strategy, is today said to possess what—as already referred to here above as a ‘thrifty gene,’ is essentially “an inheritable code that permitted the effective storage of limited food by its ready conversion to fat.” (Huber, 1) For the survival strategy that had sustained Native Americans across many centuries prior to the arrival of the European colonists, this adaptation would be a key to the propagation of the tribal lifestyle. However, the socially and individually sedentary proclivities of the colonizing culture are today increasingly proving to be a dominant and destructive force for Native communities.
The fact that dietary changes have invoked the detrimental effects of the native genetic coding should point in a direction for an effective form of alternative treatment to the individual vulnerabilities threatening the subject. Particularly, we can see that there is a certain genetic preference for the Native American toward diets which do operate with consideration of the so-called ‘thrifty gene.’ Namely, a historically land-bound diet of significant roughage and protein only when opportune seasonal conditions allowed for hunting suggests that Native Americans have become physically suited to the so-called ‘natural diet.’ The impact of preservatives, artificial sugars and saturated facts levies an uncommonly destructive impact on the metabolic system of the Native American, indicating that the most powerful preventative tool could well be the abstention from a long list of comestibles that may be most immediately distinguished by their lack of availability in the periods before Native Americans had fully been evicted from their way of life.
This contributes to a discussion on the distinct cultural conditions and demographic attitudes that have made combating this condition so difficult. With an awareness campaign representing the first line of attack against the condition, it is apparent that changing public health beliefs is an important step in undermining the spread of this condition. However, there yet a greater depth to the cultural aspect of this problem relating to the harsh mistreatment and disruption of opportunity which have faced the Native Americans. Indeed, the native culture is largely molded today by these negative conditions, serving as a breeding ground for so many of the ailments and conditions which have come to be seen as genetic. Though the genetic vulnerability which we see in this group is accurately observed, it would be grossly inappropriate to fail in attributing at least some portion of the blame to the American government which had so abused the natives. Indeed, Huber (2008) reports that “Beginning in the 1930s, government commodity programs and other factors led to very poor eating habits by Native Americans. Bad diseases, like diabetes and hypertension, quickly followed, almost like an epidemic shadow.” (1) Over the course of the 20th century, as agricultural and tribal lifestyles faded almost to non-existence in the United States, the parallel rise in diabetes rates amongst native Americans is a clear fact.
Works Cited
Kelly J Acton, Nilka Rios Burrows, Kelly Moore, Linda Querec, et al. (2002). Trends in diabetes prevalence among American Indian and Alaska Native children, adolescents, and young adults. American Journal of Public Health, 92(9), 1485-90. Retrieved June 22, 2008, from ABI/INFORM Global database.
American Diabetes Association (ADA). (2008). Native American Diabetes Resources. Online at http://vltakaliseji.tripod.com/Vtlakaliseji/id2.html
Susan S Gilliland, Stanley P Azen, Georgia E Perez, Janette S Carter. (2002). Strong in body and spirit: Lifestyle intervention for Native American adults with diabetes in New Mexico. Diabetes Care, 25(1), 78-83. Retrieved June 22, 2008, from Research Library database. (Document ID: 99967358).
Huber, G. (2008). The value of our ancestral diet. Tyler Morning Telegraph. Online at http://www.tylerpaper.com/article/20080625/FOOD/806250305
Elisa T Lee, Thomas K Welty, Linda D Cowan, Wenyu Wang, et al. (2002). Incidence of diabetes in American Indians of three geographic areas: The Strong Heart Study. Diabetes Care, 25(1), 49-54. Retrieved June 22, 2008, from Research Library database.