Promoting self-empowerment and change through healthy choices and policies.
by Susan Gay, M.A.Ed., CHES., public health training coordinator, Southern Plains Tribal Health Board
You may already know that some racial/ethnic groups have higher rates of diabetes. This is true for Native Americans who have the highest prevalence (existing cases) of diagnosed diabetes among racial/ethnic groups in the United States. What you may not hear often though, are the personal stories of those with diabetes. Travel with me to a small town in Indian Country (Oklahoma), meet Karen, and listen as she shares the story of her journey with type 2 diabetes.
“It’s been five years since I was diagnosed with diabetes. When I found out that I had it, I was devastated and scared. I couldn’t believe it. I remember feeling sad for a few months, but things got better when I talked to friends that had it and they helped me learn more about it,” shared Karen. When I asked her if she felt she was going to get diabetes because she is Native American, she replied, “I knew I might be at higher risk because a lot of the women in my family have it, and I tried to be more active.”
She also shared, “I have the information and resources I need to successfully manage my diabetes. In the beginning, I learned a lot from other people I knew that had diabetes, like my mom and friends. I started asking my doctor more questions and met with the diabetes program at our clinic and learned more about what diabetes is and what foods to eat. It was really hard to balance my life with diabetes sometimes, but I saw my A1C [a blood test for type 2 diabetes and prediabetes] go from an 11 to a 5.9 and stay there just by sticking with a few healthy changes. I felt better physically and emotionally.” She continued, “Now, to control my diabetes, I watch what I eat a lot more and make sure to take my meds and schedule my doctor checkups. I stopped eating most foods with added sugar and the “white stuff” like white bread, white pasta, and cut back on potatoes.”
She ended by sharing some advice, “Always get your blood sugar checked every year and ask your doctor lots of questions. Talk with other people who have diabetes and see what worked for them. Stick to eating more fresh foods like fruits, veggies, meats, nuts and seeds. I usually pack carrots, a piece of fruit, and some peanuts with me when I’m on the go because sometimes it can be hard to find healthy foods.”
I shared Karen’s story because putting a face to a disease helps us to better understand its impact. It may also encourage those struggling with similar issues. Here are some points resulting from Karen’s story:
- After finding out that she had diabetes and feeling sad for a few months, she began to seek out information from her doctor and others with the disease by asking. It is important for people to empower themselves with the knowledge, skills, and resources to be able to manage their health condition.
- They should see themselves as the most important person on their healthcare team, even ahead of their doctor. They know the symptoms of their disease, how they feel, what works for them and what doesn’t, and thus, are in a better position to engage with their doctor who they may only see once a month.
- Karen took responsibility for her own health and began making decisions that would help her manage. She made changes in her food choices by choosing healthier options. As a result, she saw a huge improvement in her A1C levels. This in turn affected how she felt physically and emotionally and likely increased her self-confidence in her ability to manage the disease.
What Karen did in taking responsibility for her health is called the individual level in health behavior change. This level has to do with a person’s knowledge, motivation, ability to act, and norms. The individual level is where most health care professionals focus in behavior change. Although it is important that people take the necessary steps to improve their health, it is not the only level that affects health outcomes. Good health depends on many things. Some of these things are:
- Climate and Environment – Are people able to breathe clean air when they are physically active outside?
- Neighborhoods – Do children and their families live in safe neighborhoods where they can walk to and from school, or do they fear getting shot or seeing criminal activity on the street corner? Are there parks, sidewalks, cross walks, and other areas where the community can be physically active?
- Food & Nutrition – Do communities have access to the foods that contribute to good health, such as fresh fruits and vegetables, or are they surrounded by fast food restaurants that make calorie-dense foods more available?
- Income – Do people with chronic diseases like diabetes make enough money to avoid having to choose between buying wholesome food, paying rent, or taking care of other family expenses?
- Health Care – Are people with diabetes able to afford health insurance and other health care costs? Do they have to choose between medical expenses and other necessities such as food, housing, transport, and clothing?
These are all important things to consider because they all affect health. In other words, health is also affected at the social environmental level (family, friends, social networks), the organizational and community levels (organizations, institutions services, products, leadership, etc.), and the public policy level (national, state, and local laws, economics, natural environment, etc.). These factors affect Native Americans.
Karen recognized that she was at greater risk for diabetes because it was in her family. She made a step towards being more physically active. After she developed diabetes, she took other steps such as changing the way she ate, which significantly reduced her glucose.
There is an important lesson here; though genetically Native Americans and some other races and ethnicities may be at greater risk for diabetes, it doesn’t mean that they must develop it. Taking a fatalistic or a “no-matter-what-I-do-I-will-eventually-get-diabetes” approach will most likely lead to a lack of self-empowerment in making healthy choices and changes. There is growing evidence to suggest that lifestyle behaviors such as inactivity and diet play a greater role than genes in developing diseases like diabetes.
Karen also took advantage of the resources that were available to help her manage diabetes, such as her tribe’s diabetes program.
Programs such as the Special Diabetes Program for Indians, the National Diabetes Prevention Program, and diabetes self-management education help people at risk for diabetes and those with diabetes by providing them with knowledge, resources, and skills that can either prevent them from getting diabetes or help them manage it. Both prevention and management are crucial to preventing diabetes-related complications.
Here’s what you can do:
If you have diabetes, empower yourself, ask questions, and advocate for your own health. If you are a health care professional, a community leader, a politician, or just have an interest in public health, think about health conditions like diabetes using a comprehensive approach that focuses on all levels, as previously mentioned. Advocate for a health-in-all-policies approach that seeks to deal with health issues upstream through policies and strategies that focus on prevention and not merely treatment and rehabilitation. Let’s work together to make the healthy choice the easy choice for all. Is diabetes your destiny? It’s not the Native American’s!
November Health Observances:
- American Diabetes Month
- Native American Heritage Month