Press Releases

In order to meet the needs of all NADA members and to be environmentally responsible, effective November 7, 2012, NADA will be sending the newsletter and other diabetes resources by email only. For the purpose of improving our email communication, NADA members are encouraged to resubmit their email to NADA office. Inquiries and emails can be submitted by email at: diabetes@nada.ca or info@nada.ca

We don’t often hear about it, but many Aboriginal people have lived successfully for decades with diabetes. NADA would like to document and share these success stories through a research study that explores how some people are able to meet the challenges of living with diabetes:

-What are their stories ?

-What’s unique in their lives and what do they have in common ?

-What can we learn that will inspire and motivate others ?

We intend to make the report available online, free of charge, to anyone who is interested in, or can benefit from, the positive stories featured in this report. NADA will also be sponsoring a formal launch of the report, along with presentations.

If you would like to help make this project happen, you can contribute to NADA based on the following categories:

Platinum Donor:    $15,000+

Gold Donor:           $10,000-$14,999

Silver Donor:         $5,000-$9,999

Bronze Donor:       $1,000-$4,999

Helping Hands:      $25-$999

All donations over $25 will receive a tax receipt and donors will be acknowledged in the final report and at all presentations. To make a donation, please make a cheque payable to National Aboriginal Diabetes Association. Our mailing address is B1-90 Garry Street, Winnipeg, MB R3C 4H1. For more information, please contact NADA by phone: at (204) 927-1220.

 

 

OTTAWA (May 18, 2012)—The Codex Food Labelling Committee, a United Nations subsidiary group, has proposed a global standard for mandatory nutrition labelling for adoption by the Codex Alimentarius Commission in Rome this July. Some 220 delegates from 63 countries participated in the Ottawa Committee meeting. CSPI’s National Coordinator, Bill Jeffery, LLB, who negotiated on behalf of the International Association of Consumer Food Organizations (IACFO), made the following statement:

Adopting a global standard for mandatory nutrition labelling is one of the most important public health advances in the modern history of global food law. Poor nutrition—too much sodium, risky blood cholesterol and glucose levels, inadequate fruit and vegetable intake, and excess abdominal body fat—causes more than 20 percent of all deaths globally, or about 14 million annually. It makes sense to ensure that consumers get objective nutrition information on labels. Universal nutrition labelling can help better inform consumers, spur companies to market more nutritious products, and serve as a building block for other public health nutrition measures, such as aligning food taxes with nutrition advice, implementing school nutrition standards, and monitoring food companies’ compliance with trans fat and sodium-reduction goals.

The move by Codex will help hasten the adoption of national nutrition labelling laws in the 80 percent of the 194 United Nations member countries that do not now require nutrition labels. Codex rules generally act as a ceiling, not a floor, for national health and consumer protection; governments are reluctant to risk having stronger national standards undermined by WTO challenges.

Regrettably, the Committee makes standards by following global trends in national laws, rather than driving them and, this year, rejected calls to modify the standard to help countries to mandate easier-to-understand front-of-pack nutrition labelling using familiar colour-coding (e.g., traffic lights red, yellow and green) and numerical ratings, which would help consumers easily locate the healthiest packaged foods.

Last September, a High Level Meeting of the United Nations General Assembly unanimously pledged to:

“…reduce the impact of…unhealthy diet… through the implementation of relevant international agreements and strategies, and education, legislative, regulatory and fiscal measures.”

Codex does help consolidate progress made by individual member countries on nutrition laws, but may not be up to the task of driving change and eliminating WTO obstacles to national policy innovation. A framework convention on nutrition and food marketing, analogous to the Framework Convention on Tobacco Control, may be necessary to fulfill the UN disease prevention goals in a timely fashion.

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For more information, call: Bill Jeffery, National Coordinator of CSPI at 613-244-7337 (ext. 1). IACFO’s written submission to the Committee can be found at: http://www.cspinet.org/canada/foodlabelling.html

Here is a wonderful article published by American Diabetes Association on the concept that eating healthy does not necessarily mean spending a lot of money: http://www.healthcastle.com/diabetes_pantry_budget.shtml

NADA is pleased to showcase new Complete Guide to Type 2 Diabetes written by an award winning author Karen Graham. The books are available through Karen Graham at www.karengraham.ca  [Download not found]

By A. Paul Chris, OD

Vision Institute of Canada

 

Canada is home to an Aboriginal population of over 1.2 million people, of whom 61% are First Nations, 34% are Métis (mixed native-European descent), and 5% are Inuit. These three distinct groups all have unique “local geographic and linguistic heritages, cultural practices and spiritual beliefs.” Slightly more than half live in urban areas but maintain strong connections to their communities of origin. (1) Although there has been an increase in the number of Aboriginal people living in urban areas, there has actually been a net migration back to First Nations communities in the last 40 years. (2) There are 615 native communities (reserves or bands) in Canada. British Columbia has the largest number of reserves at 198 followed by Ontario with 153. Ontario has more remote First Nations communities than any other region.

 

Aboriginal people make up 3.8% of the Canadian population, ranking second in the world to New Zealand, where the Maori people make up 15% of the population. In the United States and Australia, approximately two percent of the general population is Aboriginal. (2) According to the 2006 Aboriginal Census, Ontario has the largest native population (243,000), followed by BC (196,000), Alberta (188,000), Manitoba (175,000), Saskatchewan (142,000), and Quebec (108,000). The remaining 25,000 live in the other provinces and territories. (3)

 

The Aboriginal community is also the largest growing segment of the Canadian population, increasing at a rate six times faster than non-Aboriginal people. Almost half the native population is below 25 years of age, compared to 40 years for the non-native population.

 

Aboriginal history in Canada reflects years of government forced assimilation and colonization efforts with the “appropriation of land and loss of traditional livelihoods.” The residential school system, established in 1892, resulted in the mandatory removal of children from their homes and their placement in boarding schools where they were “forbidden to speak their own languages.” Many suffered emotional, physical, and sexual abuse, turning to drugs and alcohol in later life to deal with their trauma. The attendant loss of self-esteem and the destruction of family bonds and parenting skills have caused a cultural shock resulting in ill health, poverty and family breakdown. (4)

 

One of the most significant consequences of the “psychosocial stress” associated with colonization and the loss of traditional foods and lifestyles is the epidemic of diabetes that is eroding the health and lives of Aboriginal people. The extent to which Aboriginal people have been affected is both complex and astonishing. This is a phenomenon affecting indigenous people worldwide. The long-term complications associated with diabetes, such as blindness, heart disease, kidney disease, infectious disease and amputations, are an emerging public health crisis. (5)

 

Before 1950, diabetes was rare in native communities. (6) Diabetes was not detected in 1500 First Nations people who underwent a tuberculosis survey in Saskatchewan in 1937. (7) Today twenty percent of the Canadian Aboriginal population lives with diabetes, a number that has doubled in the last two decades, most likely due to environmental (nutrition and lifestyle) factors. (6) (7) Across Canada, type 2 diabetes is three to five times higher in Aboriginal people than in the general population. According to a Saskatchewan study published in January 2010, the rate of diabetes among Aboriginal women of child-bearing age is four times greater than women in the general population. Native women also have much higher rates of gestational diabetes, which dramatically increases a woman’s risk of developing diabetes later in life, and also makes her offspring more prone to the disease. (7)

 

Diabetes is the leading cause of adult blindness in Canada. According to one report, the rate of progression and severity of diabetic retinopathy, unlike kidney disease, is no greater in Aboriginal people than that of the general population. (8) As recently as 2005, there was limited data on the prevalence of diabetic retinopathy in Aboriginal Canadians. A study published that year involving the Sandy Lake First Nations community in Northern Ontario reported the following prevalence rates: non-proliferative diabetic retinopathy 24% (NPDR), macular edema (5%) and proliferative diabetic retinopathy 2% (PDR). (9)

 

These findings were consistent with an earlier study in 2002 by Maberley, et al. (10) The authors of the 2005 study suggested that the relatively low prevalence rates of macular edema and PDR “possibly reflect low median duration of diabetes or the presence of protective genetic factors.” (9)

 

A more recent report from 2007, the Southern Alberta Study of Diabetic Retinopathy, showed that prevalence rates of diabetic retinopathy in type 2 diabetes in native and non-native subjects were identical, with a prevalence rate of 40%, “far higher” than the Sandy Lake study. Native subjects also tended to have more advanced retinopathy changes indicating that Aboriginal ethnicity does play a role in the severity of retinal complications. (11)

 

Despite conflicting research, what is clear is that with the disproportionate and increasing number of native people with diabetes, and its occurrence at a much early age than the general population, diabetes will lead to a more significant burden of preventable vision loss in Aboriginal communities than in non-Aboriginal groups.

 

According to a fact sheet published by the International Diabetes Federation:

 

1.) 74 percent of people who have diabetes for 10 years or more will develop some form of diabetic retinopathy.

2.) Approximately 14 percent of people with diabetes have diabetic macular edema and prevalence increases to 29 percent for people with diabetes who use insulin for more than 20 years.

3.) Left untreated, 25 percent of people with diabetic macular edema will develop moderate vision loss within three years.

4.) Estimates of the rate of annual eye exams vary greatly by country and study, but the rate of screening is generally fairly low (from 40 to 65 percent).

5.) Worldwide guidelines recommend annual screenings with a dilated eye exam from an eye care specialist for people with diabetes. (12)

 

There are few statistics available to show the rate of annual dilated eye examinations being received by Aboriginal Canadians. If trends from other services are any indication, access to annual dilated eye exams for many Aboriginal people with diabetes is limited by geography and the availability of an optometrist or ophthalmologist. Several telemedicine projects using digital retinal cameras have been established but are not filling the need for the diagnostic vision care services that is required. There is also a lack of published data on the relationships between diabetic retinopathy, macular edema severity and visual acuity. (13)

 

In the United States the National Eye Institute was created by Congress in 1968 as part of the National Institutes of Health. In 1991 it established the National Eye Health Education Program which released a report in 2004 titled: American Indian and Alaska Native Diabetic Eye Disease Communication Plan. This communication plan was designed to improve the eye health of American Indians and Alaska Natives with diabetes and to raise awareness about the importance of annual dilated eye exams in this population. (14)

 

An environmental scan produced in 2007 by the National Collaborating Centre on Aboriginal Health based at the University of Northern British Columbia, states:

 

“.…a review of the international literature suggests that Canada is well behind other countries in addressing Aboriginal eye health and vision care services. Both the United States and Australia have developed innovative, Aboriginal specific, community-controlled programs and promotional material….” (15) 

 

Canada has a larger native population than the United States but is indeed well behind in addressing the Aboriginal vision health issues that are becoming an emerging public health crisis. More Canadian funding and research are required to fill the gap in scientific knowledge about Aboriginal vision health. Optometry, its partners and professional organizations, need to work with Aboriginal people and their organizations to create an effective Canadian communication strategy to help educate Aboriginal health care workers and eye care professionals about Aboriginal eye health issues and the importance of annual dilated eye exams for native Canadians living with diabetes.

 

 

(1) Macaulay AC. Improving aboriginal health: How can health care professional contribute? Can Fam Phys. Vol. 55: April 2009

 

(2) Bailey S; Native population growing. The Canadian Press; Jan 15, 2008

 

(3) Atkinson DL Preschool Vision Screening and Aboriginal Eye Health: An Environmental Scan and Literature Review. BC Initiatives; April 2007

 

(4) Macaulay AC. Improving aboriginal health: How can health care professional contribute? Can Fam Phys. Vol 55: April 2009

 

(5) Hanley AJ. Diabetes in Indigenous Peoples: Medscape Diabetes and Endocrinology. July 2006; http://cme.medscape.com/viewarticle/540921

 

(6) Young TK, et al. Type 2 diabetes mellitus in Canada’s First Nations: status of an epidemic in progress. CMAJ; September 5, 2000; 163 (5)

 

(7) Dyck R, et al. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults.  CMAJ February 23, 2010 182(3)

 

(8) Harris SB. Diabetes in indigenous peoples: Program and abstracts of the American Diabetes Association 66th Scientific Sessions; June 9-13, 2006; Washington, DC.

 

(9) Hanley AJG, et al. Complications of Type 2 Diabetes among Aboriginal Canadians:

Prevalence and associated risk factors.  Diabetes Care; August 2005 Vol 28 no. 8 2054-2057

 

(10) Maberley D, et al. Digital photographic screening for diabetic retinopathy in the James Bay Cree. Ophthalmic Epidemiol 9: 169–178, 2002

 

(11) Ross SA, et al. Diabetic Retinopathy in Native and Nonnative Canadians. Exp Diab Res. Vol 2007: Article ID 76271

 

(12) International Diabetes Federation. http://www.idf.org/international-diabetes-federation website accessed July 15, 2010.

 

(13) Tucker D, et al. Investigation the links between diabetic retinopathy, macular edema severity and visual acuity in patients with diabetes. Expert Review of Ophthalmology; Dec 2008 Vol 3 No 6 (673-688)

 

(14) National Eye Health Education Program: American Indian and Alaska Native Diabetic Eye Disease Communication Plan. US Department of Health and Human Services: National Eye Institute; January 2004

 

(15) Atkinson DL. Preschool Vision Screening and Aboriginal Eye Health: An Environmental Scan and Literature Review. BC Initiatives; April 2007

 

A. Paul Chris, OD

Vision Institute of Canada

16 York Mills Road, Suite 110

Toronto, Ontario.

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