Type II diabetes is a very concerning disease which affects the sufferers physical, financial and emotional wellbeing. Type II diabetes is the most predominant form of diabetes that is suffered by Indigenous people. Around 98% of all Aboriginal diabetes mellitus is type II, and about 2% is type I.3 Type I diabetes mellitus is acquired via genetic predisposition and the body cannot produce any or enough of the hormone insulin which is required to regulate blood sugar.3 However, type II diabetes is acquired mainly through lifestyle conditions and the body becomes unable to effectively use the insulin that is produced and becomes tolerant of it.3 Therefore, type II diabetes is of such a concern because the complications of the disease and the grave impact it has on a person’s life can be prevented to an extent. Type II diabetes can shorten a person’s life expectancy. It puts sufferers at an increased risk of developing cardiovascular disease, nerve damage, kidney disease, and retinopathy.3 These complications put a person at an increased risk of death by heart failure, a heart attack or a stroke. These physical impacts are devastating however, it greatly affects the financial and emotional aspects of one’s life too. Regulating type II diabetes is an added expense, one which many Indigenous people struggle to pay for. As diet is such an important factor in regulating type II diabetes, being able to afford fresh and healthy food is vital. The added expense of medical supplies, medicines and treatment for diabetes can create a circle of burden, where treating the disease financially disables the required healthy lifestyle needed to give one the best chance to fight the disease. Type II diabetes effects Indigenous people on many different levels, and it is the combined effect of all of these physical and economical factors which make the disease so concerning.
There are many underlying causes that contribute to the higher incidence of diabetes within the Australian Indigenous community. One of the major contributing factors is genetic makeup. Before English settlement in Australia, Aborigine’s lived off the natural food that came from hunting and gathering. This was their way of life for many years, and their metabolism had adjusted to their “high-fibre, low-fat meals such as wild animals, vegetables and fish, [and] they were protected from becoming obese or developing diabetes”4 due to their diets and active lives. However, with English settlement came a, “move to the missions [causing] the shift to a more sedentary lifestyle [and the] people were no longer able to hunt and gather on their lands or to feast on traditional foods”5. The Aboriginal people were unable to live their traditional and very spiritual lives so in, “spiritual desolation, [they] could do nothing but join in with the queue at the local store”5. It was at these stores where they received rations of tea, sugar, flour, and bully beef5; a vast change from their previous low fat, high fibre diets. Unfortunately, the Indigenous people’s metabolism could not cope with this amount of sugar in their diet due to their many years of eating vastly different foods. They were forced to become like the white man as their former way of life was taken away from them and, “sadly these losses still continue to contribute to [their] health standards today”5. Other issues also contributed to the prevalence of diabetes; namely the emotional and socio-economic factors. In 1997, an enquiry was made into the effects of the forced removal of Aboriginal children from their homes. The report, “clearly established that people who were separated from their families experience more health problems than those who were not separated”3. These health problems include, “higher rates of emotional distress, depression, anxiety, heart disease and diabetes”3. We must not forget that the removal of Indigenous children did not happen very long ago and still continues to be a great source of pain and emotional turmoil, causing feelings of inadequacy because of the treatment they received. Aboriginal people also reportedly have a high number of stressors causing high stress levels.3 These include the “death of a family member or close friend, overcrowding at home, alcohol or drug-related problems, not being able to get a job and serious illnesses and disabilities”3. In an AIHW report, it was found that the presence of these stressors was linked to poorer health conditions.3 Financial factors also contribute to the prevalence of the disease. Family’s who do not have enough money due to reduced employment opportunities are not able to buy fresh fruit and vegetables or healthier meal options.3 Instead, less expensive and processed, unhealthy food is bought. Now days, foods that are high in sugar and fat are abundant and cheap. There also may not be enough education available to Indigenous people in rural and remote areas about healthier food options and how to prepare healthier meals. The use of alcohol is also another risk factor for developing diabetes and Aboriginal communities have high instances of alcoholism.3 It is the combination of all of these factors which put Indigenous people at a higher risk of developing diabetes; among these are conditions which were forced upon them by the people who invaded their land.
Currently, there are groups and organisations that recognise that the prevalence of diabetes must be addressed at the community level through different healthy lifestyle schemes and health care options. One such organisation is Diabetes Australia. Although this government group does not specifically target Indigenous Australian’s, they provide a great number of vital services. Diabetes Australia has developed a group called the National Diabetes Services Scheme.5 Membership to this group is free and members can receive free “blood testing strips, insulin syringes, urine testing strips and injection strips”5. The Diabetes Centre in SA is also a part of the team fighting diabetes. This organisation provides education and information about the illness and prevention.5 There is a service where it is possible for a person to receive individual consultation and information about how to manage their diabetes.5 Their staff provides, “assessment of eating habits”5 and conduct public seminars which can involve cooking demonstrations and blood glucose testing.5 The Menzies School of Health Research (MSHR) is an organisation the focus on the health and care of Indigenous Australian’s.6 They have been working with Aboriginal people to try and reduce the occurrence of many diseases and conditions such as diabetes. The basis of the, “intervention has been to improve the quality of diets, increase physical activity, and reduce smoking while fostering a rich spiritual life”6 at the community level. In 2000, a study called Living with Diabetes; the SA Aboriginal Experience, was created.5 It focused on the community based health care available for Aboriginal people. Of the 960 Indigenous residents of the Murray Bridge sub region, 192 were reportedly suffering from diabetes.5 This area had a fortnightly diabetes screening service and a home visits service.5 This area also had an Aboriginal Fair day and Healthy living posters; an initiative designed to help educate Aboriginal people about their lifestyle choices.5 It was also noted that it was, “hard for clients to understand healthy food and fat contents messages”5 and, “the Aboriginal community was not accessing mainstream diabetes services”5. This observation shows that although there are many mainstream diabetes services, Aboriginal people can be hesitant to go to them due to cultural differences and past experiences. In 2000, the Anangu Pit lands were home to 30 Aboriginal Health workers, providing services at 6 main clinics.5 Baring in mind that there were around 9,390 Aboriginal people residing in these lands, 1,878 of which who reported having diabetes, the number of Aboriginal health care workers was too small. This area did not have a dietician or podiatrist to help with the education of lifestyle choices and the complications of diabetes and an optometrist and ophthalmologist visited yearly.5 However, this area had recognised the importance of beginning Aboriginal dietary awareness at schools5; a community based intervention which I believe would be very beneficial. This area also had an open clinic and weekly BGL testing services.5 It becomes apparent after researching the diabetic education services in the Aboriginal community, that there is still a lot that needs to be done. I believe that the MSHR is the type of group that is significantly helping Aboriginal people as they offer a more holistic approach and attempt to address the spiritual and cultural aspects of what it means to be Aboriginal, instead of simply focusing on the physical aspects.
The prevalence of diabetes among Indigenous Australian communities is statistically high and creating many negative health circumstances; significantly reducing the Indigenous expected life span. I hope that within the next few decades, the number of Indigenous Australian’s who suffer from diabetes can be reduced through the education of children at schools and necessary lifestyle changes. It was distressing for me to realise the extensive role which English settlement played upon, and continues to affect the health of Aborigine’s today and I believe that it is important to break the barriers that have been created by the past. I feel that doctors and other professionals in the Australian health care system need to actively educate themselves about the culture of the Indigenous people through the acknowledgement of wrong doing and the expression of compassion to enhance communication between the patient and the practitioner. Although in saying this, I would also like to acknowledge those who already do this and congratulate their empathetic insight. I hope and believe that this is something which I can achieve when I am a practicing physician.
Bibliography
- Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey, Australia 2004-05, Canberra
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Diabetes 2006, viewed on 20 July 2007,
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AIHW, The health and welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005, viewed on 7 July 2007,
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MIMS, Diabetes in Aboriginal Australians, viewed on 30 July, 2007,
- Wanders, Fran and Wilson, Myra, (2000), Living with Diabetes, The SA Aboriginal Experience, Australia
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MSHR, Research Divisions, viewed on 5 Aug, 2007, =
- O’Dea, Kerin, Diabetes in Society; The Price of ‘Progress’? Indigenous Australians, Diabetes Voice, Dec 2005 Volume 50 Issue 4, pages 28-30