Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes

The prevalence of diabetes among Pima (Akimel O’odham) Indians involves three important domains: political-economic, genetic, and cultural. Programs in diabetes education have made noteworthy improvements in the last two decades in addressing cultural information and attitudes. It is less common to see political-economic factors addressed, particularly the structural barriers to care that include poverty and unemployment. The genetic contributions to modern rates of diabetes have, perhaps, been overemphasized in the past, contributing to a sense that this disease is inevitable in American Indian populations. I review six lessons drawn from these domains and from diabetes prevention and treatment programs in Indian country: 1) the basic importance of cultural sensitivity; 2) the strengths of community participation; 3) the influential but not dominant significance of genetics; 4) some relevant structural changes in forms of health care; 5) the need for political-economic change within tribes to sustain com...