I am concerned that Philip Hall's description of the health status of aboriginal people in North America before their first contact with Europeans1 might, albeit unintentionally, reinforce the stereotype of a robust, essentially disease-free "noble savage" practising good nutrition supplemented with plenty of fresh air and exercise. The only infectious disease predating European contact that Hall alludes to is syphillis; he lists tuberculosis among the post-contact diseases. In fact, M. tuberculosis acid-fast bacilli have apparently been found in the mummified remains of a young Peruvian boy whose death is estimated to have occurred approximately 800 years before the arrival of Columbus.2 Tubercular-type bony lesions have also been documented in skeletal remains discovered in a precontact ossuary in southern Ontario.2 Moreover, the traditional food supply was neither pristine nor ideal. Examination of coprolites provides evidence of meat-borne parasitic infections that could at worst infect the lungs and central nervous system or at best the alimentary tract. The maize diet produced circular dental caries similar to lesions found today in children from developing countries, a consequence of malnutrition caused by chronic diarrhea.2
I agree that the prevalence of diabetes is influenced by both geographic and genetic variables, but I would add socioeconomic variables to the list. A recent study of prescription drug utilization among aboriginal people in Canada shows higher rates of use of certain analgesic and anxiolytic drugs than among the general Canadian population; these are not unlike the differences in rates of diabetes between the 2 groups.3 However, drug utilization rates among aboriginal people are strikingly similar to the rates within the portion of the nonaboriginal population whose socioeconomic characteristics are similar to those of the aboriginal population. These characteristics include poverty, unemployment, lower education and substandard housing. Furthermore, although aboriginal Canadians with diabetes may die from the disease at a rate 2 to 4 times higher than that among other Canadians with diabetes, overall mortality rates among aboriginal Canadians are also significantly higher. We must consider factors beyond genetics and lifestyle when we explain differences in health status.
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