Health outcomes of Aboriginal individuals with early onset diabetes
Preventing Diabetes in Aboriginal Communities: To Screen or Not To Screen
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
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
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
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
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