A political economy of diabetes, pregnancy, and identity in the Gila River Indian Community

Abstract

More than half of all Pima Indians over age 35 have Diabetes Mellitus and prevalence rates continue to rise; this despite billions of dollars spent every year on research and prevention activity by the National Institute of Health, the American Diabetes Association, and the Indian Health Service nationwide. Because of the many health problems which can occur in conjunction with uncontrolled diabetes, including heart disease, kidney disease, neuropathy, retinopathy, and depression, the insidious or symptomless nature of this disease creates an urgent need for early detection, prevention, and effective treatment. Several anthropological studies of Native Americans have been conducted over the last century, but few have focused on Native American understandings of and response to diabetes, particularly its sometimes "latent" quality, as in gestational diabetes which "goes into remission" after childbirth. Biomedical concepts such as risk, prevention, disease latency, and genetic predisposition or heritability are critical to the prevention of many chronic illnesses, but do not translate well or effectively across cultural lines. This dissertation presents a focused ethnography examining this process of integration between Native American and biomedical health models at the Gila River Indian Community, particularly around the issue of diabetes. Because diabetes is a complicating factor in pregnancy and childbirth due to fetal stress, high birth weight, and necessitated cesarean-section deliveries, and due to the relationship between gestational diabetes and the subsequent health of both the mother and infant, pregnant women are the focus of this research.