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Unnatural Causes 4 – Bad Sugar (video transcript) 1. What will you take from this video that will be useful in future nursing practice? Ooh ooh ooh. Yeah. Diet and exercise drugs and medical care. These are what we usually associate with health. But what we don’t think about our structures. Not just physical structures but economic political and social structures. They may be hard to see yet they can be powerful determinants of our health. We’ve been doing a series of photos from book. You never get tired of taking pictures of the desert Terrell do Johnson is a member of the to hone a Auth. I’m American Indian tribes. Terrell is an artist and an activist on the reservation south of Phoenix Arizona. I was Hopi. Why did you guys do for the last 40 years the tribe has suffered the highest rate of Type two diabetes in the world. Half of tone awsome adults have Type two Diabetes. She died more than seven times the national average. Rates for children are climbing rapidly and he’s telling Grandma. Go go with them you can go to the party. Didn’t go swim. See you later. Bye guys. For hundreds of years the author MLlib selves sufficiently on temporary beads Choi a buds local game crops irrigated by rain and groundwater their way of life kept them healthy. Today that has changed. Daniele. She’s asking people when I was taking pictures of them how DDS of books than Ovid does a thoughtful about that. I think people get kinda huh. Pressed somebody has stated Well my mom my search for hashtag business I’ll probably get it anyway. So they kinda that anecdote that year. You’re eventually going to get it you know a lot of people in my family around me had diabetes and some somehow I always thought well that’s just part of growing up. But they never said they had time. They’ve always said I just have sugar. I’ve actually had failing die on the operating table during the process of an amputation. Luxuriously talking to him. A couple of weeks ago. You said the eldest Conference and it was in a wheelchair and a lot of people still don’t know. Further north is the healer River Reservation home to the Pima or the same atom tribe assistant. There desert people were just done. And where I came around which we live by the river february those little mountain for at the river is just on the phone Probably at the base of that mountain and Henrietta Lopez works with the Pima Maricopa irrigation project. At that point there they do burn it out of the river and into a canal like this. Okay this is what we call the Panama canal connecting to her Pima ancestors were master water engineers. Over the centuries they transformed the desert into farmland in the HeLa river basin. Living along the river man are live. It was a part of us having to river flowing to our community meant having natural vegetation growing along the river. The willow Mckee the cottonwood trees I don’t believe deck related non-Indian world understands how we’re tight to the water but the waters I like those were healthier times for the Pima. But within two short generations they like that to hone awesome began dying from type two diabetes. Most of our records are around a computer for years the medical community believed Pima susceptibility to diabetes was an anomaly HIPAA record. That’s something in their biology was unique. Files. Now collected from our longitudinal study. The National Institutes of Health collected hundreds of thousands of PMO blood samples tissue biopsies and medical histories are collection of EKGs these Dr. Peter Bennett has devoted most of his professional life to studying diabetes among the Pima. After 40 years $200 million worth of research has increased our understanding of the biochemistry of diabetes. But neither the cause nor a cure has been discovered and rates among the Pima continue to rise Like many researchers Bennett now turns his attention to genes for answers. The genetics of diabetes has turned out to be really quite complicated because there’s not just one or two genes involved in the predisposition. In fact today we still don’t know what combinations of gene abnormalities really lead to very high risks of disease. But research has shown that whatever genes might increase the risk of diabetes are in fact found the world over not just among the Pima. And whether they have the genes are not. Some populations do have a higher incidence of disease. Very dramatic figure out our own data about from a paper a couple of years ago. Pacific Islanders African Americans Aboriginal peoples in Australia all suffer from type two diabetes at rates double or triple the national averages. They have totally different histories. There all different populations. And yet they all have the same manifest that what’s going on. What’s the common denominator and in every case we’re talking about people who had been dispossessed of their land and their history they haven’t been able to recreate it In onlys far-flung parts of the world the social circumstance of being ripped from roots ends up with same manifestation of disease by disease three where my sister and I and other kids slip slept in the room next door was there was a two bedroom place for them to hone a awesome and many others across the globe land culture and work vanished in the last century. No indoor plumbing He used to take a showers cook and clean. And this was the only source of water. Today half the Pima awesome live below the poverty line. This condition is the real risk factor for diabetes for Dr. Donald one. Well I went into a modern medical training kind of naively thinking that I was going to make an impact on Indian Health as a primary care physician. Worn has treated Native American tribes in Arizona for years. He’s also a health policy consultant from a family of Lakota traditional healers. And in truth it can have an impact on an individual’s lives and their health care and that’s very significant and meaningful. But the health problems occur long before people get to the clinic or to the hospital. When Dr. Warren’s patients have type two diabetes their bodies make the insulin needed to convert glucose or blood sugar into energy. But the insulin isn’t used efficiently. Glucose then builds up in their bloodstream and it can choke off small blood vessels. Leading to blindness kidney failure. Amputation High in sugar and fat and carbohydrates can elevate glucose levels. But something else increases those levels as well. There is a direct biochemical connection between living in poverty and the stress that people are under and blood sugar control. When we look at measures of stress we look at different types of hormones like cortisol or epinephrine which is adrenaline. All of those chemicals increase blood sugar. And when stress hormones remain high they continue to trigger the production of glucose. Glucose builds up in the bloodstream leading to diabetes Diabetes in America has reached epidemic proportions. We spend over $132 billion a year to treat it. Obesity is a risk factor and a third of us are obese. But the other critical risk factor is low income. Americans in the lowest income brackets are at least twice as likely as those in the highest to become diabetic. Dr. worn might like to prescribe affluence but instead he prescribes a change of diet more exercise. And if this fails medication and insulin injections Picture my sister she has to take two shots. Syringes Chester fill him up to the max. And she takes him on both sides if her belly. And the doctor said that her kidneys will go as she told me that this mild or moderate for now she said what’s really been me up and said I’m a diabetic I found out in 96. And so they gave me some pills and now is stamped improved and put on that list of diabetics in the community The genocide of Native American peoples may be a familiar story but it’s unfolding varied from tribe to tribe and place to place. To understand its continued impact on the health of the Pima. Today we’d need not look far beyond one series of events. There’s a direct connection between the diversion of water in the upper killer River and the health status and economic status of payments America was. The 190s water simply and I stopped coming down the Yellow River upstream water from the heel. It was diverted by dams and water projects. Giving white settlers farmers ranchers and mining interests the water they needed. And we’re dependent upon that water to grow crops to provide for ourselves. Not even the 1908 Supreme Court decision upholding water rights for all Native Americans could protect the Pima. The Coolidge dam in 1931 of the largest in the world. Its promise to provide water for everyone. This time including the Pima Former President Calvin Coolidge celebrated its opening with politicians and businessmen. They dined on China crystal and limit. The Pima a bag lunches on makeshift tables. Coolidge past the peace pipe but in the end the Pima got little of the water. Again we were practically without water for almost an entire century were among the poorest people in the United States of America as are Indians who live in other reservations and still are in that situation Unable to grow crops unable to get out and work in the fields unable to develop economically because of the lack of water for almost a 100 years was just that that’s an absolute shame as far as this country is concerned. As far as the state of Arizona is concerned. What is a metaphor for the rest of the country to try to think about in terms of damming rivers. It would be like saying to this entire country okay survived now without money. And how would you do that how would you change your entire economy how would you change your entire culture would you change your entire lifestyle and would you be successful when people die and the Pima did die but they died from starvation. Not from diabetes. A survey conducted in 1902 found only one case of diabetes among the Pima but within 30 years of building the Coolidge dam there were more than 500. If we had not dammed the rivers back in the 19 twenties and 19 thirties we wouldn’t be able to have this lifestyle that we enjoy in Arizona with swimming pools and golf courses artificial lakes. And with this lifestyle we’re really living outside the laws of nature. And what people I think generally speaking don’t realize is that all of the prosperity of Phoenix and the prosperity of this entire state was built on the backs of the health of the local tribes. Payments lived very very difficult life at the bottom of the economic scale. Had almost no recourse except to become dependent upon governmental benefits shortly after the dams were built. The US military began distributing free commodity food to Native Americans and indefinitely bonus through the hard times. Commodities building Where they host the commodity food swear people used to come get their their cheese the beans and they’re great tools and stuff. They used to be just rows and rows and rows and rows of us. But this surplus food white flour cheese refined sugar. Lard canned foods is a diabetics nightmare as it was for Charles neighbor. We asked her How many people in your household and she said about five and The guy said well you can get five boxes of food and there’s chips and candy canned food. And I thought well that’s an idea. It is a nice idea but having food. But it’s just the wrong kind of food and I asked her I said So what kind of like with any kind of normal food she goes whether we’re cans of gravy. It was not until 1996 that fresh produce was offered in the program and authentic traditional foods are still not included. When we think of traditional American Indian food for example Fry Bread is one of the things that comes to mind will in truth tribes did not have fried bread. Historian The roots of Fry better in the commodity food program and fried bread is essentially trying to do the best you can with your commodities flower lard and vegetable shortening over generations when people grow up with that it becomes a part of the culture. It becomes acculturated into the community that that is part of the norm. There is only one small market on the 581 square mile healer River Reservation with a small produce section. A regular supermarket is an hours roundtrip drive. If you’re in an impoverished community and you don’t have healthy choices for food and he don’t have safe places to exercise. Tremendously dis-empowered when it comes to a disease like diabetes and that has nothing to do with how much medication is in the pharmacy that has everything to do with social determinants of health which include that sense of control that sense of self empowerment that is important to all of us whether we’re Native or non-Native has an impact on self-identity and it has an impact on one’s sense of hope for the future. Some of our people have just given up people lost their identity. When we last term water. Within our community we have elders that have gone. I always have that in the back of my mind that Those people will never see the water. When I leave the reservation and I see those same people that live out there and use that water how how they’ve benefited from from our loss. They benefit so much for so many years. Decisions to benefit some are made every day. They create winners and losers in wealth and in health. In upscale cities like Scottsdale Arizona the diabetes rate is only around 5%. In less affluent towns like bull-headed city the rate is closer to 11%. And on some poor Native American reservations it continues to be 50%. This is a disease pattern repeated across the country across the world. And not just for diabetes whether you are poor or wealthy or in-between is a powerful predictor of how healthy your life will be. Some longer Helen I’m human and diabetic gosh about 36 years or something like that They went close to 40. I’m losing my my eyesight that my left IS worse than my right. I really am diabetes. Margaret a caster is a respected to Honda awesome elder and crafts person. I have she’s one of terrorist teachers pass three weeks. I’ve been a little bit more serious taking a mesh of account of soft and essay shirt. It’s really really aren’t. Managing diabetes is demanding. Take eat blood sugar counts four times a day monitoring di staying productive and engaged. Some Margaret Do you think diabetes well or get your DAD I know Hangouts hasn’t. Wow I keep telling my mom and I am going to leave dilemma to diabetes entity. You can give me a studies confirm that hopefulness helps to manage diabetes C But for the awesome hopefulness has been in short supply up to now. I think I got my shot We have a 100 years of neglect in poverty makeup for have to put in water delivery system. We had to put in paved roads. We hadn’t been the hospitals and schools were a long ways behind most other segments of American society both in Arizona and nationally. Regaining water is a high priority. The Pima had been fighting for their water rights for centuries facing opposition by non tribal economic interests and skepticism and resistance at high political levels. There was difficult. There was an underlying all of this was I believe a lot of not racial hostility hostility but a lot of feelings about tribes that we didn’t deserve the water. We didn’t deserve to be in these negotiations. We didn’t have a good strong valid claim for water. By the early 19 eighties new players entered the fray citrus growers energy producers from several states. Resort developers all joined the scramble for liquid go. Ride Lewis spent several decades on the Pima legal team. We have sat down with each one of those parties Literally thousands of hours right here in this room working on deals to settle our differences is between us. All that effort led to the Arizona Water Rights Settlement Act of 2014. After a 100 years water is flowing down the healer River. Again. The Water Rights Act provides the Pima the water and resources needed to rebuild their farms. But it also promises something more. It is not about economic gain is bar. We are building our community. It had never been About personal gain it is about the return of our culture. I truly believe the warm gentle wind of heaven are once again blowing. And the pea posh. God bless you all. Stop this video river. This is during weight. We contract during Week this year in Arizona grain. Desert durum wheat that we grow here. Basically it is for the pasta manufacturers a lot of girls still goes to Italy for the making a pasta. Most time we get a better contract for that and other varieties allotment here. Well this is Gilbert wrote the tribe and some individual members are now planning to expand their farming. It’s been nearly 20 years since Tony and Tony cultivated his own allotment. That kind of make it clear a lot a lot a lot better yeah. And I just try to explain that away Argue with your next. In truth we have more control over the their problems like diabetes and we realize we can’t think of diabetes and colonization just simply from the role of the victim. The disease patterns like diabetes occur over many years. So we’re not going to see a dramatic change over night. But I think in the long run as we see more success in economic and workforce development we’re going to see improvements in health care systems education systems and in social policy we have to take more control over our own community. Things like diabetes get our attention but by focusing and diabetes you miss the underlying phenomenon. And that’s really the important. I feel like taking pictures of the graveyard. If we took everyone at risk of disease and cured them so that they were no longer at risk. It would do virtually nothing to solve our problem because new people would continue to enter the at risk population at an unaffected rate forever This is my and she died of complications of diabetes. The issue is we’re not paying enough attention to prevention. Overwhelmingly funds are spent on fixing people who are already sick. We have to change that formula. And here’s my grandpa died on diabetes. Here’s a Madison man. He was a cowboy. He was in the Navy. I don’t want to die. I don’t want to die either with one link or to make missing. I still see home And I have to die of diabetes DIA some natural costs or something. No Mm-hm. Major funding for unnatural causes has been made possible by the Ford Foundation. The John D And Catherine T Macarthur Foundation. The California Endowment WK Kellogg Foundation. The Nathan Cummings Foundation. Joint Center for political and economic studies. And Kaiser Permanente Additional funding provided by these funders This program was also made possible by the Corporation for Public Broadcasting

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