Partnerships to address the diabetes epidemic in Aboriginal Communities in Alberta


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2004 (Oct) Canadian Diabetes Association Conference

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Partnerships to address the diabetes epidemic in Aboriginal Communities in Alberta

  1. 1. “Partnerships to Addressing the DiabetesEpidemic in Aboriginal Communities”CDA/CSEM Professional Conference & Annual MeetingOctober 28, 2004, Quebec City, QuebecKathleen Cardinal RN, BScN, CDE
  2. 2. Aboriginal People in Alberta, 2001•• ApproxApprox. 156,000 Aboriginal People. 156,000 Aboriginal People•• 44,000 in Edmonton: 22,000 Calgary44,000 in Edmonton: 22,000 Calgary•• 58% under age 2458% under age 24•• 80,700 Register Indians80,700 Register Indians•• 46 First Nation Community46 First Nation Community•• 66,00066,000 MetisMetis --5000 on 8 Settlements5000 on 8 Settlements(Alberta Aboriginal Affairs)
  3. 3. Healthy Eating and Active LivingHealthy Eating and Active Livingwas a way of lifewas a way of life
  4. 4. Aboriginal People andDiabetes• First Nations 3-5 times higher• Metis -occurs more twice than often• Inuit - not as high• Children being diagnosed as young as 6years old
  5. 5. Diabetes Incidence in Alberta, 2000Diabetes Incidence in Alberta, 2000Age<10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+Rateper1,000051015202530No SubsidyFirst Nations
  6. 6. Age-Specific PrevalenceAge<10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+Percent05101520253035No SubsidySubsidyFirst NationsSocial Services
  7. 7. PerceptionsMany Aboriginal people consider diabetes anexample of “white man’s illness,” a new,introduced disease similar to smallpox andtuberculosis in the past. The adoption ofmodern foods and the decline of hunting andfishing are widely believed to be theunderlying causes of the epidemic”(Young et al, 2000)
  8. 8. The Burden of Diabetes• Mortality & Morbidity rates higher then ave.- Die 10 years earlier- Higher rates of chronic disease, infections (CMAJ, 1996)• Manitoba between 1996-2016, there will be;- 10 fold increase in CVD- 10-fold increase in low limb amputation- 5-fold increase in blindness (CMAJ, 2003)
  9. 9. The Burden of Diabetes• Increase rates of CVD• HTN• PVD• Renal Disease*All contributes to premature death
  10. 10. Barriers and Challenges• Poverty• Delivery of services to isolatedcommunities• Poor socio-economic conditions• Competing community priorities i.e.addictions, housing, sanitation etc…• Inappropriate health services (top down)• Conflicting belief systems
  11. 11. Barriers and Challenges“Individuals Health and Well-being islinked lack of control and dependency.Communities lack of access to basicnecessities to good health- clean water,education and employment opportunitiesengender feelings of hopelessness,depression and despair” (Warry, unfinished Dreams,2000)
  12. 12. Cultural Concepts• Aboriginal– Ecological-we are partof the land all thingsare connected– Cultural values -Humanistic based,wellness focused andPreventive approach– Primarily Maternalistic• Western– consumerism- land is acommodity– Modern Values -scientifically based,disease focused andtreatment oriented– Primarily Paternalistic
  13. 13. Cultural ConceptsAboriginal• Collectivity- communityinterest• Interconnectedness to allthings• Spiritual-sacredness ofbeing respected• Consensual-decisionbased on for the good ofallWestern• Individualism• Secular - things areseparated• Conflict decisionmaking-politicalstructures, free market
  14. 14. Aboriginal Diabetes Wellness ProgramAboriginal Diabetes Wellness ProgramCapital Health, Edmonton, AlbertaCapital Health, Edmonton, AlbertaPresent TeamPresent Team::Frank Daniels, ElderFrank Daniels, ElderIsabel Auger, ElderIsabel Auger, ElderFrancis Alexis, Cultural FacilitatorFrancis Alexis, Cultural FacilitatorDouglas Klein MD, CCFPDouglas Klein MD, CCFPPaul W. Humpheries BSc. B.Ed, MD, FCFPPaul W. Humpheries BSc. B.Ed, MD, FCFPKimKim McBeathMcBeath MD, CCFPMD, CCFPTamiTami ShandroShandro MD, CCFPMD, CCFPCorrine Cull MD, CCFPCorrine Cull MD, CCFPKathleen Cardinal RN, BScN, CDEKathleen Cardinal RN, BScN, CDEMartyMarty LandrieLandrie RPNRPNVanessaVanessa NardelliNardelli BScBSc,, BEdBEd, RD, RDCandanceCandance Frank, Admin AssistantFrank, Admin Assistant
  15. 15. Program Components:Program Components:OnsiteOnsite•• PrePre--assessment/assessment/FollowFollow--up clinicsup clinics•• 1 or 31 or 3--day Basicday BasicDiabetes EducationDiabetes Education& Management& Management•• 33--day Refresherday Refresher
  16. 16. Program Components:Program Components:OutreachOutreach•• Diabetes Awareness and PreventionDiabetes Awareness and Prevention•• Urban and RuralUrban and Rural•• Individualized based on community needsIndividualized based on community needs
  17. 17. P.R.I.A.D.EP.R.I.A.D.E(Professional Relationships in(Professional Relationships inAboriginal Diabetes Education)Aboriginal Diabetes Education)•• Train the TrainerTrain the Trainer•• Capacity BuildingCapacity Building•• ExperientialExperiential•• Cultural AwarenessCultural Awareness•• Teaching StrategiesTeaching Strategies•• Adult EducationAdult Education
  18. 18. WOLF ProgramWOLF Program(A Way Of Life for Families)(A Way Of Life for Families)
  19. 19. Aboriginal Diabetes WellnessAboriginal Diabetes WellnessProgram: PhilosophyProgram: Philosophy•• Partnership ModelPartnership Model•• Guided by EldersGuided by Eldersand Culturaland CulturalFacilitatorsFacilitators•• NewoyawNewoyaw: Life: Lifemap for living withmap for living withdiabetesdiabetes•• Culturally relevantCulturally relevant
  20. 20. Elders & Cultural FacilitatorsElders & Cultural Facilitators
  21. 21. Aboriginal DiabetesAboriginal DiabetesWellness ProgramWellness Program•• IncorporatesIncorporatesboth Westernboth WesternMedicine andMedicine andAboriginalAboriginalTraditionalTraditionalTeachingTeaching
  22. 22. Spiritual MentalPhysicalEmotionalNewoyaw encourages one to balance the four bodiesencourages one to balance the four bodies
  23. 23. Cultural Relevance• Beliefs and Values• Terminology• Analogies• Daily life• Historical Experiences
  24. 24. Program ComponentsProgram Components•• Individualized Care and ManagementIndividualized Care and Management
  25. 25. Health Promotion ActivitiesHealth Promotion Activities
  26. 26. Research•• Shifting from Inadequate control to the SubShifting from Inadequate control to the Sub--optimal categoryoptimal category•• Decrease Fasting Glucose levelsDecrease Fasting Glucose levels•• Decreasing trends in cholesterol and TGsDecreasing trends in cholesterol and TGs•• Decreasing trends in Albumin/creatinine ratioDecreasing trends in Albumin/creatinine ratiovaluesvalues•• Significant improvement in ophthalmologySignificant improvement in ophthalmologyassessmentsassessments•• Further research needed!!!!Further research needed!!!!
  27. 27. Approaches to consider•Acknowledge the cultural and historical context•Acknowledge cultural “expertise” and integrateinto present service delivery or reorient•Must take on an Ecological perspective“We are all related”•Consolidate resources form partnerships•Address socio-cultural issues
  28. 28. Approaches• Spirituality is first and foremost• Holistic approach: Newoyaw• Developed by and with Aboriginalpeople in Partnership with otherStakeholders• Variety programs to address accessibility
  29. 29. Thank you!