Preventing Diabetes in Aboriginal Communities: To Screen or Not To Screen
Preventing Diabetes inAboriginal Communities:To Screen or Not To Screen Adrian Jacobs – Community LiaisonMDSi Field Team, BRAID Research Group University of Alberta
Preventing Diabetes inAboriginal Communities: To Screen or Not To Screen
To Screen or Not To ScreenYes, 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
The Screening Debate 2003 CDA guidelines recommend community- based screening 2008 CDA guideline do not recommended community-based screening ADA discourages community-based screening
Why not? Potential poor patient follow-up Uncertain health impact Fear of Labeling Stigmatization Feelings of loss of control Cultural barriers
Reasons to screen Cost effectiveness of prevention Current and projected costs of extant diabetes Socio-cultural benefit Empowerment Capacity building Collaboration Cultural renewal
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
Blame-deflecting I was not there. We did not make these decisions. That happened so long ago, you just need to get over it.
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
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.”
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.”
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
“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
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.
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?
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
Ruppert Ross“while western psychology’s discussions about thingslike Complex PTSD might help non-aboriginal peopleunderstand the impact of residential schools, theyremain western discussions, coming out of a westernworld-view. A different world-view, however, wouldresult in a different vision of what a healthy person is,a different description of ill-health, and differentprescriptions for returning to good-health.” Heartsong:Exploring Emotional Suppression and Disconnection inAboriginal Canada, Nov. 2009
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
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.”
Adrian Jacobs – email@example.com 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