Partnerships to address the diabetes epidemic in Aboriginal Communities in Alberta
1. “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
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. Healthy Eating and Active LivingHealthy Eating and Active Living
was a way of lifewas a way of life
4. 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
5. 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+
Rateper1,000
0
5
10
15
20
25
30
No Subsidy
First Nations
7. 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)
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. The Burden of Diabetes
• Increase rates of CVD
• HTN
• PVD
• Renal Disease
*All contributes to premature death
10. 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
11. 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)
12. 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
13. 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
14. Aboriginal Diabetes Wellness ProgramAboriginal Diabetes Wellness Program
Capital Health, Edmonton, AlbertaCapital Health, Edmonton, Alberta
Present TeamPresent Team::
Frank Daniels, ElderFrank Daniels, Elder
Isabel Auger, ElderIsabel Auger, Elder
Francis Alexis, Cultural FacilitatorFrancis Alexis, Cultural Facilitator
Douglas Klein MD, CCFPDouglas Klein MD, CCFP
Paul W. Humpheries BSc. B.Ed, MD, FCFPPaul W. Humpheries BSc. B.Ed, MD, FCFP
KimKim McBeathMcBeath MD, CCFPMD, CCFP
TamiTami ShandroShandro MD, CCFPMD, CCFP
Corrine Cull MD, CCFPCorrine Cull MD, CCFP
Kathleen Cardinal RN, BScN, CDEKathleen Cardinal RN, BScN, CDE
MartyMarty LandrieLandrie RPNRPN
VanessaVanessa NardelliNardelli BScBSc,, BEdBEd, RD, RD
CandanceCandance Frank, Admin AssistantFrank, Admin Assistant
15. Program Components:Program Components:
OnsiteOnsite
•• PrePre--assessment/assessment/
FollowFollow--up clinicsup clinics
•• 1 or 31 or 3--day Basicday Basic
Diabetes EducationDiabetes Education
& Management& Management
•• 33--day Refresherday Refresher
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. P.R.I.A.D.EP.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 EducationAdult Education
19. Aboriginal Diabetes WellnessAboriginal Diabetes Wellness
Program: PhilosophyProgram: Philosophy
•• Partnership ModelPartnership Model
•• Guided by EldersGuided by Elders
and Culturaland Cultural
FacilitatorsFacilitators
•• NewoyawNewoyaw: Life: Life
map for living withmap for living with
diabetesdiabetes
•• Culturally relevantCulturally relevant
21. Aboriginal DiabetesAboriginal Diabetes
Wellness ProgramWellness Program
•• IncorporatesIncorporates
both Westernboth Western
Medicine andMedicine and
AboriginalAboriginal
TraditionalTraditional
TeachingTeaching
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 ratio
valuesvalues
•• Significant improvement in ophthalmologySignificant improvement in ophthalmology
assessmentsassessments
•• Further research needed!!!!Further research needed!!!!
27. 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
28. 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
