Diagnosing the Legacy, by Larry Krotz, is not just about the prevalence of type 2 diabetes in Indigenous youth but also about colonialism, history, the future of healthcare, and how personal narratives are part of a bigger picture. In this list, Krotz recommends further reading on these topics.
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Diagnosing the Legacy began as a medical history documenting the work of pediatric endocrinologists in Manitoba responding over a period of 30 years to a mystifying new condition in Indigenous children originally from remote northern First Nations.
However, by the time research and writing was finished, the book had turned into something much more. It turned out to be impossible to tell the historic or medical story without encountering and taking into account explosive side issues, including how the diabetes crisis necessitated (and continues to necessitate) exploration of new ways to deliver health care; the importance of providing documentation of family and community struggles; and an exploration of how poverty and colonialism affect health.
These all encompass a field where much more study will ensue—and will be built on the work of many other scholars and writers.
Diabetes is the most recent manifestation of a series of diseases that have plagued Indigenous Canadians since first contact with Europeans. In Clearing the Plains: Disease, Politics of Starvation and the Loss of Aboriginal Life, James Daschuk examines the roles that Old World diseases played over two centuries in the deaths—and, sadly, the subjugation—of thousands of Indigenous people. Daschuk shows how infectious diseases such as smallpox, measles, and tuberculosis (on top of what he claims was state-supported starvation) combined to create a creeping, relentless catastrophe that persists today.
Moving Aboriginal Health Forward, by University of Ottawa scholar Dr. Yvonne Boyer, is a stark and fascinating study of the intersections between the health needs of Indigenous peoples in Canada and the Canadian healthcare system. Boyer looks at the social determinants of health as well as how jurisdictions affect levels of care and attention. She examines everything from the early ban on traditional practices to the constitutional division of powers (including who is responsible for off-reserve Indians under the Constitution), and she contrasts the state of Aboriginals' health in pre-contact days with their health today.
The uptick of diabetes in Indigenous populations is a global phenomenon, and the cause of the increase is a critical field of study. “The Double Puzzle of Diabetes,” by Jared Diamond (author of Guns, Germs, and Steel), is a long magazine article that explores why the prevalence of type 2 diabetes mellitus is now exploding. Diamond looks at the fact that the phenomenon is more prevalent in non-European populations and concludes that, “The genetic and evolutionary consequences of geographical differences in food history may provide the answer.”
The Gift of Diabetes, by Brion Whitford and John Paskievich, is not a book, but an excellent NFB film from 2005. It is a feature-length documentary exploring the diabetes epidemic within Indigenous communities through the eyes of an Ojibway filmmaker, Brion Whitford. A member of the Sandy Bay First Nation in Manitoba, Whitford lived with the pain of advanced diabetes but for some time shunned traditional Indigenous medicine and healing practices. However, as his health deteriorated, he had a change of heart, connecting with his culture again and trying to re-establish balance in his life. Brion passed away at the age of 50 in 2006.
In the late 1980s, pediatric endocrinologists at the Children’s Hospital in Winnipeg began to notice a new cohort appearing in their clinics for young people with diabetes.
Indigenous youngsters from two First Nations in northern Manitoba and northwestern Ontario were showing up not with type 1 (or insulin-dependent diabetes), but with what looked like type 2 diabetes, until then a condition that was restricted to people much older. Investigation led the doctors to learn that something similar had become a medical issue among young people of the Pima Indian Nation in Arizona though, to their knowledge, nobody else.
But these youth were just the tip of the iceberg. Over the next few decades more children would confront what was turning into not only a medical but also a social and community challenge.
Diagnosing the Legacy is the story of communities, researchers, and doctors who faced—and continue to face—something never seen before: type 2 diabetes in younger and younger people. Through dozens of interviews, Krotz shows the impact of the disease on the lives of individuals and families as well as the challenges caregivers faced diagnosing and then responding to the complex and perplexing disease, especially in communities far removed from the medical personnel a facilities available in the city.
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