“Partnerships to Addressing the Diabetes Epidemic in Aboriginal Communities”

CDA/CSEM Professional Conference & Annual Meeting

October 28, 2004, Quebec City, Quebec

Kathleen Cardinal RN, BScN, CDE

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 Indians 80,700 Register Indians •• 46 First Nation Community 46 First Nation Community •• 66,000 66,000 Metis Metis --5000 on 8 Settlements5000 on 8 Settlements

(Alberta Aboriginal Affairs)

Healthy Eating and Active LivingHealthy Eating and Active Livingwas a way of lifewas a way of life

Aboriginal People and Diabetes

• First Nations 3-5 times higher• Metis -occurs more twice than often• Inuit - not as high• Children being diagnosed as young as 6

years old

Diabetes Incidence in Alberta, 2000Diabetes Incidence in Alberta, 2000

Age

<10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+

Rat

e pe

r 1,0

00

0

5

10

15

20

25

30

No Subsidy First Nations

Age-Specific Prevalence

Age

<10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+

Perc

ent

0

5

10

15

20

25

30

35

No Subsidy Subsidy First Nations Social Services

Perceptions

Many Aboriginal people consider diabetes an example of “white man’s illness,” a new, introduced disease similar to smallpox and tuberculosis in the past. The adoption of modern foods and the decline of hunting and fishing are widely believed to be the underlying causes of the epidemic”(Young et al, 2000)

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)

The Burden of Diabetes

• Increase rates of CVD • HTN• PVD• Renal Disease

*All contributes to premature death

Barriers and Challenges• Poverty• Delivery of services to isolated

communities• Poor socio-economic conditions• Competing community priorities i.e.

addictions, housing, sanitation etc…• Inappropriate health services (top down)• Conflicting belief systems

Barriers and Challenges

“Individuals Health and Well-being is linked lack of control and dependency. Communities lack of access to basic necessities to good health- clean water, education and employment opportunities engender feelings of hopelessness, depression and despair” (Warry, unfinished Dreams, 2000)

Cultural Concepts

• Aboriginal– Ecological-we are part

of the land all things are connected

– Cultural values -Humanistic based, wellness focused and Preventive approach

– Primarily Maternalistic

• Western– consumerism- land is a

commodity

– Modern Values -scientifically based, disease focused and treatment oriented

– Primarily Paternalistic

Cultural Concepts

Aboriginal• Collectivity- community

interest• Interconnectedness to all

things• Spiritual-sacredness of

being respected• Consensual-decision

based on for the good of all

Western• Individualism• Secular - things are

separated

• Conflict decision making-political structures, free market

Aboriginal Diabetes Wellness Program Aboriginal Diabetes Wellness Program Capital Health, Edmonton, AlbertaCapital Health, Edmonton, Alberta

Present TeamPresent Team::Frank Daniels, Elder Frank Daniels, Elder Isabel 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, FCFPKim Kim McBeathMcBeath MD, CCFPMD, CCFPTami Tami ShandroShandro MD, CCFPMD, CCFPCorrine Cull MD, CCFPCorrine Cull MD, CCFPKathleen Cardinal RN, BScN, CDEKathleen Cardinal RN, BScN, CDEMarty Marty LandrieLandrie RPNRPNVanessa Vanessa NardelliNardelli BScBSc, , BEdBEd, RD , RD CandanceCandance Frank, Admin AssistantFrank, Admin Assistant

Program Components: Program Components: OnsiteOnsite

•• PrePre--assessment/ assessment/ FollowFollow--up clinicsup clinics

•• 1 or 31 or 3--day Basic day Basic Diabetes Education Diabetes Education & Management & Management

•• 33--day Refresher day Refresher

Program Components: Program Components: OutreachOutreach

•• Diabetes Awareness and Prevention Diabetes Awareness and Prevention •• Urban and RuralUrban and Rural•• Individualized based on community needsIndividualized based on community needs

P.R.I.A.D.E P.R.I.A.D.E (Professional Relationships in (Professional Relationships in Aboriginal Diabetes Education)Aboriginal Diabetes Education)

•• Train the TrainerTrain the Trainer•• Capacity BuildingCapacity Building•• ExperientialExperiential•• Cultural AwarenessCultural Awareness•• Teaching StrategiesTeaching Strategies•• Adult Education Adult Education

WOLF ProgramWOLF Program(A Way Of Life for Families)(A Way Of Life for Families)

Aboriginal Diabetes Wellness Aboriginal Diabetes Wellness Program: PhilosophyProgram: Philosophy

•• Partnership ModelPartnership Model•• Guided by Elders Guided by Elders

and Cultural and Cultural FacilitatorsFacilitators

•• NewoyawNewoyaw: Life : Life map for living with map for living with diabetesdiabetes

•• Culturally relevantCulturally relevant

Elders & Cultural FacilitatorsElders & Cultural Facilitators

Aboriginal Diabetes Aboriginal Diabetes Wellness ProgramWellness Program

•• Incorporates Incorporates both Western both Western Medicine and Medicine and Aboriginal Aboriginal Traditional Traditional TeachingTeaching

Spiritual Mental

Physical

Emotional

Newoyaw encourages one to balance the four bodies encourages one to balance the four bodies

Cultural Relevance

• Beliefs and Values• Terminology• Analogies• Daily life• Historical Experiences

Program ComponentsProgram Components

•• Individualized Care and ManagementIndividualized Care and Management

Health Promotion ActivitiesHealth Promotion Activities

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 ratio Decreasing trends in Albumin/creatinine ratio

valuesvalues•• Significant improvement in ophthalmology Significant improvement in ophthalmology

assessmentsassessments•• Further research needed!!!!Further research needed!!!!

Approaches to consider

•Acknowledge the cultural and historical context•Acknowledge cultural “expertise” and integrate into present service delivery or reorient•Must take on an Ecological perspective “We are all related”•Consolidate resources form partnerships•Address socio-cultural issues

Approaches• Spirituality is first and foremost• Holistic approach: Newoyaw• Developed by and with Aboriginal

people in Partnership with other Stakeholders

• Variety programs to address accessibility

Thank you!