A Perspective on Diabetes from Indigenous Views

Six elders, representing six different indigenous cultures, three of whom have academic appointments, were asked to provide their perspectives on diabetes addressing etiology, risk factors, increasing prevalence and co-morbidities. The rapid increase of this chronic disease has impacted the systems of care and financial management within Indian Health Service, the United States healthcare system established for federally-recognized American Indians and Alaska Natives. Indigenous people of North America not only have the highest incidence of diabetes in the world but also are experiencing early disease onset with rates increasing in those < 18 years of age. Giving voice to the very people affected by this disease is critical to develop a culturally relevant solution. Using a storytelling method and qualitative analysis, four themes emerged from the elders’ perspectives: a) before contact with Europeans, diabetes was not found among the indigenous peoples; b) outside influence on food choices and activity patterns have been major factors in the rise of diabetes; c) disconnection from cultural roots yielding a state of imbalance or loss of harmony is manifest in negative health outcomes, such as wide-spread diabetes; and d) hope that a solution lies in the core values and knowledge of indigenous cultures. These narratives and themes can be used to guide the practice of non-indigenous health care providers working with indigenous people.