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Sapiens: Can Medical Anthropology Solve the Diabetes Dilemma?

As the number of sufferers continues to rise, SMU anthropologist Carolyn Smith-Morris focuses on how culture and lifestyle shape diabetes in Arizona’s Pima culture.

As the number of sufferers continues to rise, some researchers are moving in new directions to figure out how culture and lifestyle shape disease outcomes.

Sapiens reporter Kate Ruder covered the research of SMU anthropologist Carolyn Smith-Morris, who has studied diabetes among Arizona’s Pima Indians for more than 15 years.

Smith-Morris wrote about what she learned from her research in her 2006 book, “Diabetes Among the Pima: Stories of Survival.”

The Pima have the highest prevalence of diabetes ever recorded, although the disease is alarmingly on the increase throughout the United States. In an effort to understand the rise of the disease, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) from 1965 to 2007 focused on the Pima to carry out the largest continuous study of diabetes in Native Americans. Researchers examined the environmental and genetic triggers of the disorder, management of the disease, and the treatment of thousands of Pimas.

Smith-Morris is a medical anthropologist and associate professor in the SMU Anthropology Department in Dedman College. Her research addresses chronic disease, particularly diabetes, through ethnographic and mixed methodologies. She has conducted ethnographic research among the Gila River (Akimel O’odham) Indian Community of Southern Arizona, Mexicans and Mexican immigrants to the U.S. and veterans with spinal cord injuries.

The Sapiens article, “Can Medical Anthropology Solve the Diabetes Dilemma?” published Aug. 22, 2017.

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By Kate Ruder

Mary (a pseudonym) was 18 years old and halfway through her second pregnancy when anthropologist Carolyn Smith-Morris met her 10 years ago. Mary, a Pima Indian, was living with her boyfriend, brother, parents, and 9-month-old baby in southern Arizona. She had been diagnosed with gestational diabetes during both of her pregnancies, but she didn’t consider herself diabetic because her diabetes had gone away after her first birth. Perhaps her diagnosis was even a mistake, she felt. Mary often missed her prenatal appointments, because she didn’t have a ride to the hospital from her remote home on the reservation. She considered diabetes testing a “personal thing,” so she didn’t discuss it with her family.

As Smith-Morris’ research revealed, Mary’s story was not unique among Pima women. Many had diabetes, but they didn’t understand the risks. These women’s narratives have helped to explain, in part, why diabetes has been so prevalent in this corner of the world. An astonishing half of all adult Pimas have diabetes.

Medical anthropologists like Smith-Morris are helping the biomedical community untangle the social roots of diabetes and understand how and why the disease is exploding in the United States. Smith-Morris, based out of Southern Methodist University in Dallas, Texas, has been working on this cause for over 15 years—from a decade spent among the Pimas, to a new study sponsored by Google aiming to prevent diabetes-related blindness. Anthropology, she says, provides the most holistic perspective of this complex problem: “Anthropology seems to me the only discipline that allows you to look both closely at disease … and from the bird’s eye perspective.”

More than 30 million people in the United States are estimated to have diabetes, and it’s on the rise. If trends continue, 1 out of every 3 American adults could have diabetes by 2050, according to the Centers for Disease Control and Prevention.

The condition involves insulin, a hormone that regulates the way the body uses food for energy. In type 1 diabetes, the body stops making insulin entirely; those affected need daily insulin injections to survive. In type 2 diabetes, which accounts for the vast majority of cases, change is more gradual.The body slowly makes less insulin and becomes less sensitive to it over the years. Gestational diabetes, which strikes during pregnancy, can give mothers a dangerous condition called preeclampsia, which is related to high blood pressure and can harm both mothers and babies. Women with gestational diabetes are more than seven times likelier to later develop type 2 diabetes than women who do not have the condition in pregnancy, and their children are at higher risk of obesity and diabetes. If left untreated, diabetes can cause heart disease, kidney failure, foot problems that can lead to amputation, and blindness.

The preventative measures for type 2 and gestational diabetes are seemingly straightforward: eat healthy foods, lose weight, and exercise. Treatment for both can include taking medications. Yet prevention, lifestyle, and treatment cannot entirely solve the problem; family history, ethnicity, and other factors play a critical role in a person’s susceptibility to type 2 and gestational diabetes. Both forms of diabetes continue to plague Americans, particularly certain groups, including Native Americans. “My interest in diabetes grew out of an interest in Indigenous groups,” says Smith-Morris. “I took on diabetes because it was important to them.”

From 1965 to 2007, the Pimas of Arizona were the focus of the largest continuous study of diabetes in Native Americans. Conducted by researchers from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), it examined the environmental and genetic triggers of the disorder, management of the disease, and the treatment of thousands of Pimas. It also documented that they had the highest prevalence of diabetes ever recorded. The pivotal work told researchers much of what they know about diabetes today, including that obesity is a significant risk factor, and that a mother’s diabetes during pregnancy can pass risk along to her children.

The political and economic contributors to the Pima people’s health problems have long been well-known: Their traditional farming practices collapsed during the late 1800s and early 1900s when non-Native settlers upstream diverted essential water resources, contributing to poverty, sedentariness, and a lack of fresh food. Yet Smith-Morris felt something integral was missing from this picture: the Pimas’ stories.

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By Margaret Allen

Senior research writer, SMU Public Affairs