- Diabetes as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples
Why has diabetes become so prevalent among many tribes of North American Indians? The non-insulin-dependent or adult-onset form of diabetes mellitus, which affects about 2–5 percent of all people in North America, was exceedingly rare among native Americans at the turn of this century; now, more than 50 percent of certain tribes struggle with the disease. And not only are a greater percentage of Indians afflicted, but those who have diabetes are far more likely to suffer the disease’s consequences—kidney failure, blindness, amputations, and ultimately death. Furthermore, this phenomenal rising tide of diabetes and its mortal sequelae appears to be a worldwide event, striking a variety of indigenous peoples who are adopting aspects of Western civilization. Why did this epidemic of a chronic disease descend upon these people? And, as important, what has it meant to them?
This collection of nineteen essays addresses these questions with both overviews and specific case studies, ranging from the Navajo to the Kiowa to the Inuit. The approaches vary, drawing on medical, historical, epidemiologic, and ethnographic reasoning, as reflected in the titles of the articles: “Diabetes and Indians: A Clinician’s Perspective,” “Food Habit and Cultural Changes among the Pima Indians,” “Explanations of Diabetes: Anishinaabe and Dakota Deliberate upon a New Illness.” Although many of the essays are written in a style that is needlessly formal and stiff, and they often repeat the same background information, these flaws are redeemed by the wealth of information that the authors collectively present, the importance of their central subject, and—for the historically minded readers of the Bulletin—their attempts to understand disease and health change in a broadly synthetic manner.
Two major theses run through the essays. The first argues for a complex causal chain: Political and military conflict between Native Americans and encroaching United States settlers ended with the former group interned on reservations. This relocation and subjugation disrupted the social and cultural equilibrium of the tribes, and eventually increased the caloric density of their diets and fostered [End Page 747] sedentary habits. For members of these tribes, endowed with a genetic constitution adapted for prolonged periods of fasting and an arduous lifestyle, such changes led to an increasing prevalence of obesity and diabetes.
Rich and varied data support this thesis. For example, whereas the indigenous diet consisted of a wide variety of wild plants, nuts, and game, as well as native crops such as corn, beans, and squash, the monthly rations distributed by the Department of Indian Affairs in 1890 for every one hundred reservation inhabitants comprised, at most, “150 pounds beef (or bacon in lieu), 3 pounds beans, 3 pounds coffee, 50 pounds flour, 7 pounds sugar” (p. 387). In the years since 1890, the fat content of the diet has continued to rise. Even more recently, in the period between 1968 and 1988, the percentage of Pima women who are sedentary more than doubled, to 38 percent. And finally, in the Many Farms-Rough Rock community in Arizona, the prevalence of obesity likewise rose twofold between the 1950s and the 1980s, to 44 percent.
The second major thesis focuses on how Native Americans have come to understand the “white man’s sickness,” arguing that a culturally perceptive understanding is needed in order to provide better health care to individuals and communities. For instance, when Navajo adults first present to the physician with complaints that eventually are diagnosed as diabetes, they often do not offer the classic triad of polyuria, polydipsia, and polyphagia, or the red flag of genital itching, instead speaking vaguely of “body ache” or “waist pain”—and in so doing, they are operating within their culture, stoically and demurely. Or when Indian adolescents talk about the shame or powerlessness of those who have diabetes, another culturally resonant aspect of this illness...