Priscilla R. Sanderson, Ph.D., CRC, Little M, Lomadafkie B., Janis M., Trujillo O.V. , Jarratt-Snider K., Teufel-Shone N.I., Brown B.G., Bounds R
Volume 11, Number 2 (2025) 11 (2): 57-78
Keywords Diabetes Mellitus, Indigenous Health, Cultural Practices, Native American cultures, Storytelling method, Cultural relevance in healthcare
Abstract
Six elders, representing six different indigenous cultures, three of whom have academic appointments, were asked to provide their perspectives on diabetes addressing etiology, risk factors, increasing prevalence and co-morbidities. The rapid increase of this chronic disease has impacted the systems of care and financial management within Indian Health Service, the United States healthcare system established for federally-recognized American Indians and Alaska Natives. Indigenous people of North America not only have the highest incidence of diabetes in the world but also are experiencing early disease onset with rates increasing in those < 18 years of age. Giving voice to the very people affected by this disease is critical to develop a culturally relevant solution. Using a storytelling method and qualitative analysis, four themes emerged from the elders’ perspectives: a) before contact with Europeans, diabetes was not found among the indigenous peoples; b) outside influence on food choices and activity patterns have been major factors in the rise of diabetes; c) disconnection from cultural roots yielding a state of imbalance or loss of harmony is manifest in negative health outcomes, such as wide-spread diabetes; and d) hope that a solution lies in the core values and knowledge of indigenous cultures. These narratives and themes can be used to guide the practice of non-indigenous health care providers working with indigenous people.
Priscilla R. Sanderson, Ph.D., CRC
Little M
Lomadafkie B.
Janis M.
Trujillo O.V.
Jarratt-Snider K.
Teufel-Shone N.I.
Brown B.G.
Bounds R
Published August 13, 2025
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Aickin, M., Campos-Oucalt, D., Ellis, J., Steele, L., Valencia, J., & Wunsch, M. (1995). Prevalence of cardiovascular disease risk factors in a Southwestern Native American tribe. Public Health Reports, 110(6), 742-748. Academic OneFile. Web. 11 Sep. 2012.
American Indian Heritage Foundation. (2012). Lakota Indians. Retrieved from [http://www.indians.org/articles/lakota-indians.html]
Amnesty International. (2009, February). Justice and impunity: Guatemala's Historical Clarification Commission 10 years on. Retrieved from [http://www.amnesty.org/]
Arizona Department of Health Services (2012, June 28). Hopi Nation primary care area - statistical profile, 2011. Retrieved from [http://www.azdhs.gov/hsd/profiles/17310.pdf]
Bah Ray, E., Holben, D. H., & Holcomb, J. P. (2012). Food security status and produce intake behaviors, health status, and diabetes risk among women with children living on a Navajo Reservation. Journal of Hunger & Environmental Nutrition, 7(1), 91-100.
https://doi.org/10.1080/19320248.2012.649670
Barcelo, A., Gregg, E. W., Gerzoff, R. B., Wong, R., Flores, E. P., Ramirez-Zea, M.,... Villagra, L. (2012, April). Prevalence of diabetes and intermediate hyperglycemia among adults from the first multinational study of noncommunicable diseases in six Central American countries. Diabetes Care, 35(4),738-740.
https://doi.org/10.2337/dc11-1614
Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2010 March 9). Health characteristics of the American Indian and Alaska Native adult population: United States, 1999-2003. Advance Data No. 356, Table 4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistic. National Health Statistics Report, Number 20. Retreived from: http:www.cdc.gov/nchs/data/nhsr/nhsr020.pdf
Brings Him Back-Janis, M. (2011, October). A dental hygienist who's a Lakota Sioux calls for new mid-level dental providers. Health Affairs, 30(10), 2013-2016.
https://doi.org/10.1377/hlthaff.2011.0682
Bullock, A. (2009). Prenatal and early life risk factors for chronic disease. A web-based Training. When does diabetes start? -or- "How adversity gets under the skin". IHS, Division of Diabetes Treatment and Prevention. Indian Health Service. Retrieved June 28, 2012 from [http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Training/WebBased/Prenatal/prenatal_handout_508.pdf]
Choctaw Nation Division of Health. (2006). Untitled. Retrieved March 2012 from [http://www.ok.gov/health/documents/TP-Choctaw%20Nation%20Report%2006.pdf]
Choctaw Nation Cultural Services. (2012). Traditional Choctaw foods. Retrieved March 2012 from [http://choctawnationculture.com/choctaw-culture/iti-fabvssa/0210-traditional-foods.aspx]
Coe, K., Attakai, A., Papenfuss, M., Giuliano, A., Martin, L. & Nuvayestewa, L. (2004). Traditionalism and its relationship to disease risk and protective behaviors of women living on the Hopi Reservation. Health Care for Women International, 25(5), 391-410.
https://doi.org/10.1080/07399330490438314
Dabelea, D., DeGroat, J., Sorrelman, C., Glass, M., Percy, C. A., Avery, C., ...Hamman, R. F. (2009). Diabetes in Navajo youth. Prevelance, incidence, and clinical characteristics: the SEARCH for diabetes in Youth Study. Diabetes Care, 32(Suppl. 2), S141-S147.
https://doi.org/10.2337/dc09-S206
Delgado Shorter, D. (2009). We will dance our truth: Yaqui history in Yoeme Performances. Lincoln, NE: University of Nebraska.
https://doi.org/10.2307/j.ctt1dgn4rf
Eisenmann, J. C., Arnall, D. A., Kanuho, V, & McArel, H. (2003). Growth status and obesity of Hopi children. American Journal of Human Biology, 15(6), 741-745. https://doi.org/10.1002/ajhb.10211
Flora, C. B., Livingston, M., Honyestewa, I., & Koiyaquaptewa, H. (2009). Understanding access to and use of traditional foods by Hopi women. Journal of Hunger & Environmental Nutrition, 4(2), 158-171. https://doi.org/10.1080/19320240902922561
Goins, R. T., & Pilkerton, C. S. (2010). Comorbidity among older American Indian elders: The native elder care study. Journal of Cross-Cultural Gerontology, 25(4), 343-354.
https://doi.org/10.1007/s10823-010-9119-5
Hodge, E. S., Maliski, S., Codogan, M., Itty, T. L., & Cardoza, B. (2010). Learning how to ask: Reflections on engaging American Indian research participants. American Indian Culture and Research Journal, 34(4), 77-90.
https://doi.org/10.17953/aicr.34.4.122720521uwm6h73
Hopi Cultural Preservation Office. (2009a). Agriculture. Retrieved from [http://www8.nau.edu/hcpo-p/knowledge.html](http://www8.nau.edu/hcpo-p/knowledge.html)
Hopi Cultural Preservation Office. (2009b). Traditional knowledge. Retrieved from [http://www8.nau.edu/hcpo-p/knowledge.html](http://www8.nau.edu/hcpo-p/knowledge.html)
The Hopi Tribe. (2010). Official website of the Hopi Tribe. Retrieved from [http://www.hopi-nsn.gov/](http://www.hopi-nsn.gov/)
Indian Health Service. (2010). Mississippi Band of Choctaw starts with diabetes prevention activities, expands to diabetes management. Retrieved March 2012 from [http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=programsSDPIIdeasInspirations]
Indian Health Service, Navajo Area. (n.d.). Navajo Nation. Retrieved from [http://www.ihs.gov/Navajo/index.cfm?module=nao_navajo_nation]
Joe, J. R., & Young, R.S. (Eds.) (1993). Introduction. Diabetes as a disease of civilization: The impact of culture change on Indigenous peoples. (pp. 1-18). Berlin/New York: Mouton de Gruyter.
https://doi.org/10.1515/9783110853148.1
Johnson, L. G., & Strauss, K. (1993). Diabetes in Mississippi Choctaw Indians. Diabetes Care, 16 (1), 250-2.
https://doi.org/10.2337/diacare.16.1.250
Kochanek, K. D., Xu, J., Murphy, S. L., Minino, A. M., & Kung, H-C. (2011). Deaths: Final data for 2009. National Vital Statistics Reports, 60(3), 1-167.
Lee, A. (1996). The transition of Australian Aboriginal diet and nutritional health. World Review of Nutrition and Dietetics, 79(1), 1-40. https://doi.org/10.1159/000425365
Martin, D., & Goodman, A. H. (2000). Health conditions before Columbus: The paleopathology of native North Americans. In E. R. Rhoades (Ed.), American Indian health: Innovations in health care, promotion, and policy (pp. 2-40). Baltimore, MD: The Johns Hopkins University Press.
McCabe, M. (2010). Diabetes crisis in Indian Country. Address to the U.S. Committee on Senate Affairs. FDCH Congressional Testimony, June 30, 2010.
Mihesuah, D. A. (2005). Recovering our ancestors' gardens: Indigenous recipes and guide to Diet and Fitness. Lincoln, NB: University of Nebraska Press.
National Center for Health Statistics, Health. (2010). United States, 2009: With special feature on medical terminology. Hyattsville, MD. Retrieved from [http://www.cdc.gov/nchs/data/hus/hus09.pdf](http://www.cdc.gov/nchs/data/hus/hus09.pdf)
Navajo Nation Official Site. (2011.) History. Retrieved from [http://www.navajo-nsn.gov/]
O'Connell, J. M., Wilson, C., Manson, S., & Acton, K. J. (2012). The costs of treating American Indian adults with diabetes within the Indian Health Service. Research & Practice, 102(2), 301-308.
https://doi.org/10.2105/AJPH.2011.300332
Pan American Health Organization. (2007). Survey of diabetes, hypertension and chronic disease risk factors. Retrieved from [http://www.paho.org/english/ad/dpc/nc/guatemala-survey.htm]
Pascua Yaqui Tribe. (2009). Pascua Yaqui Tribe - Official site: Culture. Retrieved from [http://www.pascuayaqui-nsn.gov/](http://www.pascuayaqui-nsn.gov/)
Pascua Yaqui Tribe Diabetes Prevention and Treatment Program. (2012). Facebook site: Home. Retrieved from [http://www.facebook.com/pages/Pascua-Yaqui-Tribe-Diabetes-Prevention-and-Treatment-Program/194897083882999?sk=info]
Pleis, J. R., Lucas, J. W., & Ward, B. W. (2009). Summary health statistics for U.S. adults: National Health Interview Survey, 2008. National Center for Health Statistics. Vital and Health Stat,10(242). Retrieved from [http://www.cdc.gov/nchs/data/series/sr_10/sr10_242.pdf]
Rodríguez-Morán, M., Guerrero-Romero, F., Brito-Zurita, O., Rascón-Pacheco, R. A., Pérez, Fuentes, R., Sánchez-Guillén,... & Sánchez-Corona, J. (2008). Cardiovascular risk factors and acculturation in Yaquis and Tepehuanos Indians from Mexico. Archives of Medical Research, 39(3), 352-357.
https://doi.org/10.1016/j.arcmed.2007.12.003
Roubideaux, Y. (2002). Perspectives on American Indian health. American Journal of Public Health, 92(9), 1401-1403.
https://doi.org/10.2105/AJPH.92.9.1401
Roubideaux, Y., & Acton, K. (2001). Diabetes in American Indians. In M. Dixon & Y. Roubideaux (Eds.), Promises to keep: Public health policy for American Indians and Alaska Natives in the 21st Century (pp. 193-206). Washington, DC: American Public Health Association.
Schiller, J. S., Lucas, J. W., Ward, B. W., & Peregoy, J. A. (2012). Summary health statistics for U.S. adults: National Health Interview Survey, 2010. National Center for Health Statistics. Vital Health Statistics, 10(252).
Smith, P. K., Bogin, B., Varela-Silva, M. I., Orden, B., & Loucky, J. (2002). Does immigration help or harm children's health? The Mayan case. Social Science Quarterly, 83(4), 994-1002.
https://doi.org/10.1111/1540-6237.00128
Teufel, N. I. (1999). Nutritional problems. In J. M. Galloway, B. W. Goldberg, & J. S. Alpert (Eds.), Primary care of Native American patients: Diagnosis, therapy, and epidemiology (pp. 283-292). Boston, MA: Butterworth-Heinemann.
Teufel-Shone, N. I. (2006). Promising strategies for obesity prevention and treatment within American Indian communities. Journal of Transcultural Nursing, 17(3), 1-6. https://doi.org/10.1177/1043659606288378
Teufel-Shone, N. I., Fitzgerald, C., Teufel-Shone, L., & Gamber, M. (2009). Systematic review of physical activity interventions implemented among American Indian and Alaska Native populations in the United States and Canada. American Journal of Health Promotion, 23(6), S8-S32. https://doi.org/10.4278/ajhp.07053151
Teufel-Shone, N. I., Irwin, S., Siyuja, T. J., & Watahomigie, H. J. (2006). Community-based participatory research: Conducting a formative assessment of factors influencing youth wellness in the Hualapai community. American Journal of Public Health, 96(9), 1623-1628. https://doi.org/10.2105/AJPH.2004.054254
Trujillo, O. V. (2011). Scholars of traditional knowledge -- Our elders. Tribal News: Training & Innovation. Office of Chemical Safety and Pollution Prevention and Tribal Environmental News Exchange. United States Environmental Protection Agency. Retrieved from www.epa.gov.opptintr/tribal.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2010). Advance Data from Vital and Health Statistics. Retrieved from [http://www.cdc.gov/nchs/data/ad/ad356.pdf](http://www.cdc.gov/nchs/data/ad/ad356.pdf)
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2001, November). Strong Heart Study Data Book: A Report to American Indian Tribes. NIH Publication No. 01-3285. Retrieved from [http://www.nhlbi.nih.gov/resources/docs/shs_db.pdf](http://www.nhlbi.nih.gov/resources/docs/shs_db.pdf)
U.S. Department of Health and Human Services, Office of Minority Health. (2010). Diabetes and American Indians/Alaska Natives. Retrieved from [http://www.minorityhealth.hhs.gov/templates/content.aspx?/vIID=52&ID=3024]
U.S. Department of the Interior, Bureau of Indian Affairs. (Oct. 1, 2010a). Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairs. Federal Register, 75(190), 60810-60814. Retrieved from [http://www.bia.gov/idc/groups/xofa/documents/document/idc012038.pdf]
U.S. Department of the Interior, Bureau of Indian Affairs. (Oct 27, 2010b). Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairs. Supplement. Federal Register, 75(207), 66124. Retrieved from [http://www.bia.gov/idc/groups/xofa/documents/document/idc012039.pdf]
U.S. Department of State. (2012). Background note: Guatemala. Retrieved from [http://www.state.gov/r/pa/ei/bgn/2045.htm]
Will, J. C., Strauss, K. F., Mendlein, J. M., Ballew, C., White, L. L., & Peter, D. G. (1997). Diabetes mellitus among Navajo Indians: Findings from the Navajo Health and Nutrition Survey. The Journal of Nutrition, 127(10), 20992-2105S.
https://doi.org/10.1093/jn/127.10.2106S
Wolsey, D. H., & Cheek, J. E. (1999). Epidemiologic patterns of morbidity and mortality. In: J. M. Galloway, B. W. Goldberg, & J. S. Alpert (Eds.), Primary care of Native American patients: Diagnosis, therapy, and epidemiology (pp. 7-16). Boston, MA: Butterworth-Heinemann
Yu, C. H. Y., & Zinman, B. (2007). Type 2 diabetes and impaired glucose tolerance in aboriginal populations: A global perspective. Diabetes Research and Clinical Practice, 78(2), 159-170.
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