Communities take a holistic stance on diabetes prevention: A new CDC grant supports gardens, cooking, horse programs, and more

Published in Indian Country Today in June 2010.

Preventing and treating diabetes encompasses more than physical cures in 17 innovative tribal efforts funded by the Native Diabetes Wellness Program of the U.S. Centers for Disease Control. The most effective approaches take spiritual, emotional, and cultural aspects into account as well, said Aubrey Skye, Hunkpapa Lakota, gardens coordinator of one recipient of CDC funds, the Standing Rock Sioux Tribe Diabetes Program. “You have to consider the whole person.”

At the end of November, the grantees will meet in Albuquerque to compare notes, said Lemyra DeBruyn, the CDC’s field director for the program. “We’re awestruck at what the communities are doing. Grantees like the Tohono O’odham, in Arizona, have been leaders in this field for so long.”

The wisdom comes from the communities, agreed her colleague Larry Alonso. “The CDC wants to support the idea that traditional lifeways make wellness part of life, not something you do for an hour at the gym.” Alonso had just returned from the Santee Sioux Nation, in Nebraska, which offers kids’ activities under its grant, including a horse program that is as much about establishing a relationship with the animals as it is about riding them.

Called “Using Traditional Foods and Sustainable Ecological Approaches for Health Promotion and Diabetes Prevention in American Indian/Alaska Native Communities,” the CDC project runs through 2013.

Ramah Navajo School Board
Alternately speaking in Navajo then translating into English, garden project coordinator Randy Chatto, Ramah Band of Navajo, shown right, recounted a conversation he’d had with an elder. She asked him whether some children Chatto had put to work in a garden understood why Navajos must cultivate the land.

Not really, he told her. “Nowadays with stores and fast food, gardening is not a priority for their families, and young people don’t see the need. They say they don’t want to wait for something to grow.”

“Let me talk to them,” the elder responded.

She gathered the youngsters around her and explained what being a part of their community means, Chatto recalled. “She addressed them as her own children. Afterward, one young lady said no one had ever told her those things. She had always thought being Navajo was like being anything else.”

Soon Chatto noticed that that the kids were giving up sodas and playing video games less. “Now I understand,” the youngsters told him.

To emphasize the gift of culture and combat rising rates of diabetes and other diet-related chronic diseases that result from poor food and lack of exercise, Chatto has built raised-bed gardens for more than 50 families in his New Mexico community.

Future plans include putting in school gardens, updating a cooking handbook, and developing an advisory council with members of all ages, said Louise Ingraham of Pine Hill Health Center, a nutritionist with the project. “The kids on the council will help us appeal to even more youngsters.”

Indian Health Care Resource Center of Tulsa
The Indian Health Care Resource Center of Tulsa serves Native and non-Native clients living in a large Oklahoma urban area that’s effectively a so-called food desert, said Nancy O’Banion, the center’s health education and wellness director. “There can be 10 miles between supermarkets here — an impossible distance for people without transportation. Their only food sources are convenience stores with mainly processed foods.”

These products are not just less healthy than fresh, whole ones, they create yet another problem, according to O’Banion. “Because processed items are eaten as is or just reheated, the younger generation is losing cooking skills. They don’t know what to do with real food.”

Chronic diseases, including diabetes, have resulted, said O’Banion. Under the CDC grant, the health care center is returning good food and physical activity to the lives of its clients with school and community gardens, a walking trail with fitness stations, distribution of wholesome snacks for schoolchildren to take home for the weekend, and kids’ camps during school vacations.

Gardening doesn’t just provide fresh food, according to O’Banion, it expands the variety of options, and thus the nutrients, that people consume. “We were delighted to discover that if kids have grown something themselves, they’ll eat it — including items like okra or green beans that they wouldn’t touch in the school cafeteria.”

To introduce culturally relevant foods, the health care center collaborated with the Mvskoke Food Sovereignty Initiative, based on the nearby Muscogee (Creek) Nation, whose members prepared traditional dishes for children at a summer camp.

The health care center also wants to attack the problem at its root. With several partners, it is exploring the creation of a food distributorship that would carry fresh products and accept smaller clients than the major wholesalers, said O’Banion. “A store has to guarantee the big warehouses that it’ll buy 20 thousand dollars’ worth of food weekly. A small grocery can’t do that, which is why they’ve gone out of business and the giant supermarkets are what remain. If we can start our own warehouse, we can get neighborhood stores going and ‘green’ our food desert.”

Aleutian Pribilof Islands Association, Inc.
Loss of cooking skills is also an issue in Alaska tribal communities, according to Cara Bethe, Aleut, an assistant in the association’s community services department. “We surveyed our people and found traditional food use is declining. About half reported that because of their jobs, they don’t have time to harvest or prepare them. That, in turn, means they’re losing that knowledge.” Simultaneously, diabetes and other diet-related illnesses are increasing, she added.

            The association, which is the federally recognized tribal organization of the Aleut people in Alaska, recruited expert elder cooks and set up demonstrations in Anchorage and in communities around Alaska.

            The ladies prepared items like seal, octopus, and salted-salmon soup, reported Bethe. “They also showed us how to extend Alaska’s short growing season by pickling wild celery, making mossberry jam, and seasoning with wild parsley. We all said, ‘wow, cool!’ when we learned that fruits and vegetables were traditionally eaten year-round.”

            Association staffers contributed nutritional analysis, said Sue Unger, environmental health research coordinator. “We also talked about issues like cooking with healthy fats.” In coming years, a cookbook and K-12 lesson plans will be created, according to Unger.

Kids take to the old-time dishes readily, said Bethe. “When children tried traditional foods during a culture camp, they all came back for more.”

Catawba Cultural Preservation Project
The Catawbas, in South Carolina, are experiencing skyrocketing rates of type-2 diabetes. Nearly 20 percent of community members are affected — more than both the national average for Native people and the rate for all people in the Nashville area. Even worse, increasingly younger people are developing the illness, once considered an adult-onset disease.

The solution is in Catawba culture, tribal members realized. The community’s time-honored foodways are optimal in ways that science shows are essential to good health: high in plant foods, low in saturated fat, and involving plenty of physical activity. Under the CDC grant — headed up by the preservation project’s director, Wenonah Haire, Catawba — elders are teaching youngsters traditional skills such as gardening, gathering of wild foods, and preparation of heritage dishes.

The center chose this learning model because it already had success with it in maintaining knowledge of crafts such as pottery, said Lisa Martin, an Indian Health Service nutritionist with the project. The expectation is that the children will inspire their families to make better food and lifestyle choices, causing the healthy lifeways to ripple out into the community.

 “Our biggest discovery was that prevention is the key,” said Kristine Carpenter, Catawba, the preservation project’s programs director. “Our goal is to have fewer people with diabetes, period.”

For more on CDC diabetes programs, go to www.cdc.gov/diabetes/projects/diabetes-wellness.htm. These include a new K-12 curriculum  — Diabetes Education in Tribal Schools: Health Is Life in Balance — created with eight tribal colleges, the National Institutes of Health, and the Indian Health Service. c. Stephanie Woodard.

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