The Pima and Tohono O’odham Indians of southern Arizona have arguably the highest diabetes rates in the world – half of all adults are afflicted. But a century ago, diabetes was virtually unknown here. What happened to the health of the Pima?

The Pima and Tohono O’odham Indians of southern Arizona have arguably the highest diabetes rates in the world – half of all adults are afflicted. But a century ago, diabetes was virtually unknown here. What happened to the health of the Pima?

Unhealthy neighborhoods and lack of health care contribute to poor health, and they are unequally distributed. People of color are exposed to greater threats and have less access to quality care. This report outlines causes of inequities as well as promising initiatves around the country to combat them. One chapter focuses on Tohono O'odham Community Action (www.tocaonline.org) an organization co-founded by Terrol Dew Johnson, who appears in the episode "Bad Sugar."

Dr. Donald Warne talks about how cultural loss impacts the health of Native American tribes in Arizona. The damming of rivers plunged local tribes into poverty, dependence and ultimately poor health. Deprived of their language, land, livelihood and traditions, many Native Americans have developed a fatalistic view about  diseases like diabetes.

In some Native American communities, diabetes is so common that people grow up feeling that it is in some ways, inevitable. "I don't have diabetes yet," is what Dr. Warne often hears from his patients. Yet hope for the future is an important factor in preventing and controlling diabetes - something health care practitioners need to take into account when treating patients.

The U.S. government has spent hundreds of millions of dollars over the past 40 years trying to uncover a biological explanation for why the Pima Indians of southern Arizona have one of the highest rates of diabetes in the world. But as Dr. Donald Warne tells us, diabetes was extremely rare here 100 years ago. What's changed? Not biology but environment.

Type 2 diabetes and its principal risk factor, obesity, have emerged as twin epidemics in communities of color. This book investigates the epidemiology of diabetes in these minority communities, arguing that the determinants of diabetes include not only personal choices, but also broader social and contextual factors, such as community racism, residential segregation, and cultural patterns.

This book includes in-depth analyses of many community-based interventions which serve African-American, Hispanic/Latino American, Asian American, and Native American populations. The author also provides suggestions for community-based initiatives to reduce the "obesogenic" environment many minorities live in.

Competing agendas drive the distribution of resources when it comes to diabetes care and prevention. We spend most of our dollars on late-stage care, which not coincidentally is highly profitable to companies that provide those services. To reduce diabetes rates among Native Americans and other populations, we have to advocate for policies that will invest more resources in primary prevention and underlying social conditions.

A full list of publications about diabetes, including diabetes in Native Americans and other minority communities.

This book argues that, contrary to popular opinion, Type 2 diabetes is not a medical problem so much as it is a social pandemic caused by toxic environments - high in stress and sugar, low in opportunities to exercise or feel good about yourself - and a lack of power. Spero describes the social sources of the toxic environment, including the stress and inequality built into our modern culture and the traumas and loss of community that make people vulnerable to illness. It reveals the medical mistreatment of diabetes - from kicking diabetics off medical insurance to underfunding diabetes education, from over-emphasizing drugs to giving corporate-influenced dietary advice.

This report looks at the effects of "food deserts" (areas with minimal access to grocery stores) on the health of residents in Chicago's neighborhoods. The study develops an empirical score to quantify the balance of food choice (groceries vs. fast food outlets) available to residents, and compares food access and food balance directly to health outcomes, holding constant education, income, and race. They find that African American communities are especially likely to have poor balance of food choice, and that residents of these "food deserts" suffer noticable health effects.

Pember looks at efforts in the Ho-Chunk (or Winnebago) tribe of North Dakota to use traditions to counteract fatalism and fight diabetes.

The Gila Crossing Elementary School in southern Arizona was once operated by the Bureau of Indian Affairs. When the local tribe took it over, community members created a gardening program to teach children about their cultural heritage as farmers, to encourage healthy eating, and to foster their development and future interest in agriculture.

An excellent article about Tohono O'odham photographer and artist Terrol Dew Johnson and the organization he co-founded, Tohono O'odham Community Action, which seeks to improve health by helping people re-establish their ties to traditional culture.

An interview with Dr. Donald Warne, one of the experts featured in Bad Sugar, Episode 3 of UNNATURAL CAUSES.
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As Dr. Donald Warne explains, there is a direct biochemical connection between living in poverty and blood sugar levels. The stress of being poor and of having family members die young creates a complicated web of cultural values and beliefs that make controlling diabetes more difficult. Add to that the lack of availability of healthy food and it's no wonder diabetes rates are high.

The third in a series of in-depth articles about New Yorkers living with diabetes, this article explores the booming business of diabetes treatment and the profit incentive that hospitals, dialysis centers, medical device manufacturers and others have to exploit the growing epidemic. Programs to prevent diabetes from occurring have shown promise but many have closed due to lack of funding.

At the Gila River Indian Community, there are hopes that planned irrigation will help combat an obesity epidemic and soaring rates of diabetes. This article discusses the water settlement and the challenges the tribe faces in translating their restored water rights into real health gains for the community.

This report documents what we know about the health of Indigenous children (from birth to age twelve) and evaluates the quality of Indigenous child health data collection in Canada, Australia, New Zealand, and the United States. Similar exclusionary social policies active in all four countries are at the root of these profound and unjust differences in child health.

The second in a series of in-depth articles about New Yorkers living with diabetes, this article describes the epidemic of diabetes in low-income neighborhoods like East Harlem.

A positive look at how some young people living on reservations are becoming involved in cross country running. Wings of America, a team of Native American athletes from around the country that has won 20 national titles since 1988, is also an NGO that works to counter the high rates of diabetes, obesity, alcoholism, and suicidal depression on reservations.

With the return of their water in a landmark settlement, the Pima Indians of southern Arizona are returning to their agricultural roots. Upscale eateries like Kai Restaurant on the edge of the Gila River Indian Community reservation are working with tribal farmers to obtain local, seasonable produce - a win-win situation for chefs and growers alike.

This article describes the history and implications of the historic Arizona Water Rights Settlement Act of 2004, guaranteeing river water to the impoverished Pima and Maricopa Indian communities.

In this excerpt from his new book, Closing the Food Gap: Resetting the Table in the Land of Plenty, Mark Winne explains a growing split in the diets of the haves and have-nots; at the same time that the wealthy are coming to prefer organic and locally-grown foods, the poor have been losing geographical and economic access to healthy options. He also reports on a survey by the non-profit group Hartford Food System, which found that low-income consumers in the area would prefer to purchase organics and fresh foods, but simply couldn't access or afford them.

Terrol Dew Johnson, featured in the "Bad Sugar" segment of UNNATURAL CAUSES, is co-founder of TOCA, a community-based organization focused on cultural renewal as key to empowerment and better health. TOCA has four primary program areas: basketweaving, traditional foods, youth/elder outreach and traditional arts and culture.