In Battle Against Diabetes, Promoting a Return to Traditional Foods

The report on the Traditional Foods Project is part of CDC supplement on reducing healthcare disparities.

In the 1940s and 50s, when America conquered rivers with giant dams, it often did so at the expense of tribes that had lived off the land before the Europeans arrived. Creating water supplies for cities and ranches often meant pushing Native Americans and Alaskans from their homes, away from the places they had farmed and fished for millennia.

In the decades since, the legacy of those acts has been rising rates of diabetes, as tribal diets and days filled with activity were replaced with convenience foods, since tribes live far from grocery stores.

Today, within a special issue of its Mortality and Mortality Weekly Report, the CDC recounts efforts help Native Americans and Alaskans reclaim their food heritage, in discussion of the Traditional Foods Project, 2008-2014.

Authors led by Dawn Satterfield, PhD, from the Native Diabetes Wellness Program of the CDC’s Division of Diabetes Translation outline the need for the program: there was likely little type 2 diabetes (T2D) in the 1940s, and it remains uncommon among Native American and Alaskan youth. But among those ages 15-19, T2D rose 68% from 1994 to 2004.

Health problems start early: In 2009, 20.7% of Native American and Alaskan children ages 2-4 were obese, putting them at risk for T2D in the future.

The man-made nature of the diabetes epidemic was hard to ignore. CDC examined one Native American tribal group in Arizona whose farming lands had been ruined the 1950s by a dam project; by 2006, 38% of the adults 20 and older had T2D. But tribal people of the same heritage living in Mexico who continued to farm and consume the same food they had for generations had a T2D rate of just 6.9%.

As far back as 1997, Congress began allocating funds to address soaring diabetes rates among Native Americans. But it took until 2008 to fund a tribal-driven program to re-educate children in traditional food patterns and values, creating stories and a special book series to promote the concepts of harvesting healthy foods, physical activity, gratitude, generosity, stewardship, and courage.

The Traditional Foods Project operated at 17 sites in the continental United States and Alaska, with each site receiving $100,000 per year to run local programs. After an initial 5-year run, the program was funded for a sixth year in 2014. According to the today’s paper, data collected at 6-month intervals over the 6-year period are being analyzed by the CDC.

“In recent decades, many tribal nations are reclaiming the water and foods specific to their landscape, history and culture,” the authors state. “Tribal nations are part of the global food sovereignty movement that maintains the rights of all persons to define their own policies and strategies for sustainable food and agriculture systems.”

Already, CDC’s analysis is yielding several important observations about the ways tribal leaders are reclaiming their food culture:

· Working off the land, Mother Earth, holds deep meaning for tribal members. Self-governance is an essential component of reviving subsistence programs. Programs offered included cooking, hunting, fishing, preserving foods, and environmental stewardship.

· Tribal leaders are promoting a “food sovereignty” movement to protect foods specific to the landscape. Some leaders incorporated their efforts into the 2008 Farm Bill and other initiatives of USDA.

· Reviving systems that worked for generations demands respect for traditional knowledge of local ecology, passed on from person to person.

· Messages about traditional foods are consistent with overall values about health, gratitude, sharing the harvest with other families, and a sense of community.

· The role of elders is emphasized. These leaders informed the development of the program, and taught subsistence practices to youth, passing along names of foods in tribal languages.

· The Traditional Foods Project promotes discussion about health, including the importance of exercise and ways that it can be promoted through practices such as dancing. The program led to the creation of materials on healthy traditional foods.

· Education was a pillar, through sharing stories, recipes, food demonstrations, taste tests, and club activities. Traditional food were served in the school cafeteria or were provided as commodity supplies.

· Planning efforts came from the ground up, to ensure ongoing success after 2014.

Reference

Satterfield D, DeBruyn L, Santos M, et al. Health promotion and diabetes prevention in American Indian and Alaska Native communities 2008-2014. MMWR 2016;65(suppl no.1)4-10.