CMAJ • October 10, 2006; 175 (8). doi:10.1503/cmaj.1060104.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Promotion of traditional lifestyles

Ediriweera Desapriya* and Ian Pike{dagger}

Department of Pediatrics, Centre for Community Child Health Research, Vancouver, BC;* Director, BC Injury Research and Prevention Unit, Vancouver, BC{dagger}

Jeff Reading discusses some of the work being done to understand and alleviate the problem of diabetes among Aboriginal people in Canada.1 Although the risk factors associated with diabetes and hypertension within Aboriginal communities are now reasonably well understood, the prevention and control of these conditions are not straightforward. Genetic factors alone cannot explain the prevalence of these conditions; rapid changes in lifestyle leading to unhealthy diets and physical inactivity, now widespread in Aboriginal communities, are also involved.

There is a lack of trained community health workers, nutritionists and health educators who understand the cultural heritage of Aboriginal communities and their peripheral services. This must be remedied before effective diabetes programs can be developed.

Implementing proven behavioural interventions,2 especially those involving weight management, requires resources that take into account Aboriginal language, customs and cultural references. Furthermore, the problems of obesity and diabetes must be addressed in the context of the lifestyle "choices" available in Aboriginal communities. The promotion of exercise (as opposed to productive physical activities) is questionable if people do not have access to and cannot afford sports and recreational facilities.

The "best evidence" approach to the prevention and control of diabetes in Aboriginal populations must be comprehensive and multidisciplinary, taking into account not only biophysiologic and lifestyle influences but also the politico-economic environment and social structures. Politico-economic policies and social structures conducive to healthy lifestyles must be ranked above health promotion and pharmacologic interventions to control diabetes in Aboriginal people.

The question of what "best practices" mean for Aboriginal people, specifically in relation to traditional indigenous knowledge, is an area that deserves special attention. Community control and autonomy,3 a high level of social integration,4 community development and local control of health care systems may be important protective factors in preventing ill health and negative social outcomes among Aboriginal groups.5

REFERENCES

  1. Reading J. The quest to improve Aboriginal health [editorial]. CMAJ 2006;174(9):1233.[Free Full Text]
  2. Diabetes Prevention Program Research Group. Reduction of the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:1190-6.
  3. Chandler MJ, Lalonde CE, Sokol BW, et al. Personal persistence, identity development, and suicide: a study of Native and Non-native North American adolescents. Monogr Soc Res Child Dev 2003;68(2):vii-viii,1-130.
  4. May PA, Serna P, Hurt L, et al. Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. Am J Public Health 2005;95(7):1238-44.[Abstract/Free Full Text]
  5. Kirmayer LJ, Gregory M, Tait L. The mental health of Aboriginal peoples: transformations of identity and community. Can J Psychiatry 2000;45(7):607-16.[Medline]




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