When I first walked into Winnipeg’s Health Sciences Centre cafeteria some 20 years ago, I was shocked to see many patients with lower-leg amputations.
My medical colleagues told me this “epidemic of lower-limb loss” was mostly related to diabetes, primarily among Indigenous people.
The epidemic persists.
About one in 10 Canadians are diabetic and the trends are on the upswing. In addition to losing limbs, people with diabetes are at increased risk of heart, kidney and eye disease. Diabetes, primarily Type 2, used to be rare in Indigenous adults but is now three to five times more common than in the general population. Type 2 diabetes generally develops in adulthood and accounts for about 90 per cent of all diabetes cases. Type 1 diabetes generally develops in childhood and is the result of the body’s immune system attacking insulin-producing cells in the pancreas.
The main reasons for the diabetes epidemic in Indigenous people are thought to be a combination of forced adoption of European diets and lifestyles, and a genetic predilection for the disease. Historic restrictions on traditional hunting and gathering, forced removal of children from their communities during the Sixties Scoop to residential schools where they were fed western diets, and the price of food in northern communities are among the reasons for the rise of diabetes among Indigenous populations.
Scientific debate continues about biological versus environmental risk factors for diabetes. The “thrifty gene effect,” developed in the 1960s, is a prevailing theory that suggests that genetic protective mechanisms developed by Indigenous people during periods of fasting during traditional hunting and gathering activities actually predispose individuals to diabetes when a western diet is introduced.
In line with Health Canada’s Framework for Diabetes in Canada, the federal government has pledged $35 million toward diabetes education, monitoring, data collection and research. The framework report acknowledges the negative impacts of colonial practices and ongoing systemic racism, noting that Indigenous people are not only at increased risk of being diabetic but also have more severe outcomes and face additional barriers to accessing care.
But “frameworks” are, by nature, very general and do not offer specific solutions, which need to be tailored to the community in which they will be rolled out. Indigenous groups have put forward community-specific solutions to address some of the key contributors to diabetes – diet and lifestyle.
Among them are Canada North Environmental Services (CanNorth). The Indigenous-run company owned and operated by the Lac La Ronge Indian Band conducts environmental monitoring programs, in partnership with mine operators and the Canadian Nuclear Safety Commission, around Northern Saskatchewan mines. CanNorth also assesses the safety of traditional harvested foods and relays the results back to the local community through reports and presentations tailored to the community.
“Gathering and eating traditional country foods can help reduce the risk of diabetes, heart disease, and obesity, especially when the foods are cooked in traditional ways.”
In its Eastern Athabasca Regional Monitoring Program summary report for 2011-22, CanNorth concludes that locally harvested traditional foods such as wild blueberries, lake trout, moose and caribou are safe to eat.
This is in keeping with the Canada Food Guide – First Nations, Inuit and Métis edition, whose recommendations highlight the benefits of traditional food such as wild game and bannock and recommends against foods high in sugar, salt and fat.
This message is also echoed by a Saskatchewan public health official James Irvine of the Northern Saskatchewan Population Health Unit, who has said: “Gathering and eating traditional country foods can help reduce the risk of diabetes, heart disease, and obesity, especially when the foods are cooked in traditional ways.”
Another strategy is to offer healthy food at reasonable prices. This is what the Athabasca Chipewyan First Nation (ACFN) had in mind when, in 2018, it opened K’ai Taile Market in Fort Chipewyan, a community of just under 1,000 people on the eastern shore of Lake Athabasca. The community is located more than 250 kilometres north of Fort McMurray, Alta., reachable by plane or by a four-hour drive, on ice road during winter. The market, which gets its foods from commercial suppliers, is open to both Indigenous and non-Indigenous community members.
“Our main emphasis, and goal, is healthy foods,” says Cathwyn Philpotts, executive director of operations of K’ai Taile Market. “So, we really focus on a broad assortment within fresh produce, dairy as well as meat.”
Groceries are less expensive than at corporate-owned northern grocery stores, according to Philpotts, and shoppers do not have to trek to Fort McMurray to buy them. The store is independent and locally owned, with ACFN community members as the stakeholders. The Nutrition North Subsidy Program helps reduce grocery costs. For example, Philpotts says a four-litre jug of milk costs less than $10 at K’ai Taile Market and more than $15 at a regular northern grocery store.
In addition, representatives of a Fort McMurray food bank visit Fort Chipewyan monthly to provide hampers and food vouchers. Employment and on-the-job training for local community members also are benefits of having a local operation.
Philpotts is passionate about her work and food security, driven by her belief that “food is a right and not a privilege.”
ACFN also organizes seasonal harvests for traditional foods and distributes food hampers to its community of approximately 130 households. The sharing of traditional foods is prioritized for elders as well as special occasions such as “Dene Days” celebrations.
ACFM members do most of the harvesting for the community, which “give(s) them a chance to go in the lake and the land and give(s) them some pride … That’s what we grew up with,” says Lily Marcel, AFCN’s Youth & Elders Lodge manager.
Expanding trust, and access, to traditional foods and ways of life are positive steps toward addressing the diabetes epidemic in Indigenous communities.