partnerships to address the diabetes epidemic in aboriginal communities in alberta
DESCRIPTION
2004 (Oct) Canadian Diabetes Association ConferenceTRANSCRIPT
“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!