01:11diet and exercise drugs and Medical Care
01:15these are what we usually associate with
01:19health but what we don't think about are
01:22structures not just physical structures
01:25but economic political and social
01:28structures they may be hard to see yet
01:32they can be powerful determinants of our
01:40health we've been doing a series of
01:44book I never get tired of taking
01:49desert Terell du Johnson is a member of
01:52the Tona aam American Indian
01:54tribe Terell is an artist and an
01:57activist on the reservation south of
02:07do for the last 40 years the tribe has
02:11suffered the highest rate of type 2
02:16world half of Tona aam adults have type
02:192 diabetes how could she move she died
02:23more than seven times the national
02:25average rates for Children Are Climbing
02:28rapidly are you with grandma huh go go
02:32with them you can go to the party you
02:34can go swim we'll see you later bye bye
02:40guys for hundreds of years the atham
02:43lived self-sufficiently on tempy beans
02:45choya buds local game crops irrigated by
02:49rain and groundwater their way of life
02:54healthy today that has
03:01Danny I was just asking people when I
03:03was taking pictures of them how diabetes
03:06affects them if it does affect them what
03:09their thoughts were about that I think
03:11some people they get kind of uh
03:14depressed somebody had stated while my
03:17mom my sister has diabetes so I'll
03:19probably get it anyway so that kind of
03:22that attitude that you're you know
03:24you're eventually going to get it you
03:27know a lot of people in my family and
03:29around me had diabetes and some somehow
03:33I always thought well okay that's just
03:37up but they never said they had diabetes
03:40they've always said I just have bad
03:43sugar I've actually had family members
03:46die on the operating table during the
03:51amputation he lost his leg you know oh
03:54he did a couple of weeks ago yeah oh no
03:57he was at the elders conference was in
04:01a lot of people still don't
04:07know further north is the hila River
04:10Reservation home to the
04:13Puma we're the same Autumn tribe it's
04:16just that they're desert people which
04:19just and we're aimar which we live by
04:22the river see where those little
04:24mountains are at the river is just on
04:27the south probably at the base of that
04:30there Henrietta Lopez works with the
04:32Puma Maricopa irrigation project at that
04:35point there they diverted out of the
04:37river and into a canal like this okay
04:40this is what we call the Puma Canal you
04:43know connecting to the river her Pima
04:45ancestors were Master water
04:48Engineers over the centuries they
04:50transformed the desert into Farmland in
04:56Basin living along the river meant our
04:59life it was a part of
05:01us having the river flowing through our
05:04community meant having natural
05:06vegetation growing along the river The
05:09Willow The mosqu the cottonwood
05:12trees I don't believe that really the
05:15non-indian world understands how we're
05:18tied to the water but waterers our
05:23life those were healthier times for the
05:27Puma but within two short gener ations
05:30they like the Tona aam began dying from
05:36diabetes most of our uh Records are uh
05:40are computerized for years the medical
05:42community believed Puma susceptibility
05:44to diabetes was an anomaly that
05:47something in their biology was unique
05:50these are files that have been uh
05:54collected from our longitudinal
05:57study the National Institute of Health
06:00collected hundreds of thousands of Puma
06:02blood samples tissue biopsies and
06:06histories our collection of EKGs these
06:10are Dr Peter Bennett has devoted most of
06:12his professional life to studying
06:14diabetes among the Puma running the
06:16lipid panels on the after 40 years $200
06:21million worth of research has increased
06:24our understanding of the biochemistry of
06:27diabetes but neither the cause nor a
06:29cure has been discovered and rates among
06:32the Puma continue to
06:34rise like many researchers Bennett now
06:38turns his attention to genes for
06:40answers the genetics of of diabetes has
06:43turned out to be really uh quite
06:45complicated it appears that there are
06:47not just one or even two genes involved
06:50in the in the predisposition in fact
06:52today we still don't know what
06:54combinations of Gene abnormalities
06:56really lead to a very high risks of the
07:01disease but research has shown that
07:03whatever genes might increase the risk
07:05of diabetes are in fact found the world
07:08over not just among the Puma and whether
07:11they have the genes or not some
07:13populations do have a higher incidence
07:17disease really very dramatic figures
07:20these are not our own data but from a
07:22paper a couple years
07:25ago Pacific Islanders African-Americans
07:30Aboriginal peoples in Australia all
07:33suffer from type 2 diabetes at rates
07:35double or triple the national
07:38averages they have totally different
07:40histories they're all the different
07:43populations and yet they all have the
07:45same manifest what's going on what's the
07:49denominator and in every case we're
07:51talking about people who have been
07:53dispossessed of their land and of their
07:56history they haven't been able to
07:59in all these far-flung parts of the
08:02world this social circumstance of being
08:06ripped from Roots ends up with the same
08:08manifestation of disease but this used
08:11to be where my sister and I and all the
08:14kids slip slapped in and the room next
08:17door was it was a two-bedroom place you
08:21know for the Tona aam and many others
08:25across the globe land culture and work
08:31century No indoor plumbing we used to
08:34take our showers cook and um
08:39clean and this was the only source of
08:43water today half the Pima and the Tona
08:46aam live below the poverty
08:52line This condition is the real risk
08:55factor for diabetes for Dr Donald waren
08:59well I went into my modern medical
09:01training kind of naively thinking that I
09:02was going to make an impact on Indian
09:04Health as a primary care
09:07physician Warren has treated Native
09:09American tribes in Arizona for years
09:12he's also a health policy consultant
09:14from a family of Lakota traditional
09:17healers and in truth you can have an
09:19impact on individuals lives and their
09:22health care and that's very significant
09:23and meaningful but the health problems
09:25occur long before people get to the
09:27clinic or to the hospital
09:31when doctor warns patients have type 2
09:33diabetes their bodies make the insulin
09:36needed to convert glucose or blood sugar
09:38into energy but the insulin isn't used
09:42efficiently glucose then builds up in
09:44their bloodstream and can choke off
09:46small blood vessels leading to blindness
09:55amputation diets high in sugar fat and
09:58carbohyd hydrates can Elevate glucose
10:01levels but something else increases
10:06well there is a direct biochemical
10:09connection between living in poverty and
10:13the stress that people are under and
10:15blood sugar control when we look at
10:18measures of stress we look at different
10:19types of hormones like cortisol or
10:22epinephrine which is adrenaline all of
10:25those chemicals increase blood
10:29and when stress hormones remain high
10:32they continue to trigger the production
10:33of glucose glucose builds up in the
10:36bloodstream leading to
10:39diabetes diabetes in America has reached
10:42epidemic proportions we spend over $32
10:46billion a year to treat it obesity is a
10:49risk factor and a third of us are obese
10:53but the other critical risk factor is
10:59Americans in the lowest income brackets
11:01are at least twice as likely as those in
11:04the highest to become
11:07diabetic Dr Warren might like to
11:10prescribe affluence but instead he
11:12prescribes a change of diet more
11:15exercise and if this fails medication
11:24injections it's a picture of my
11:26sister she has to take two shots the
11:31syringes she has to fill them up to the
11:33Max and she takes them on both sides of
11:37belly and the doctor said that her um
11:39kidneys would go but she told me that um
11:42with a smile I'm all right for now she
11:44said which really bmed me out that was
11:48sad I'm a diabetic I found out in
11:52'96 and so they gave me some pills and
11:56boom you know I was stamped and proved
11:58and put on that list of diabetics in
12:11Community the genocide of Native
12:14American peoples may be a familiar story
12:17but its unfolding varied from tribe to
12:24place to understand its continuing
12:27impact on the health of the p today we
12:30need not look far beyond one series of
12:34events there's a direct connection
12:36between the diversion of water in the
12:37upper hila River and the health status
12:40and economic status of p mopus in the
12:431890s water simply stopped coming down
12:46the hila River Upstream water from the
12:50hila was diverted by dams and water
12:52projects giving white settlers Farmers
12:55ranchers and Mining interests the water
13:00and we are dependent upon that water to
13:01grow crops to provide for
13:04ourselves not even the 1908 Supreme
13:07Court decision upholding water rights
13:09for all Native Americans could protect
13:15Pima the kulage dam in 1930 one of the
13:20largest in the world its promise to
13:23provide water for everyone this time
13:31former President Calvin kulage
13:33celebrated its opening with politicians
13:37businessmen they dined on China Crystal
13:42linen the Puma ate bagged lunches on
13:49tables coolage passed the peace pipe but
13:53in the end the Puma got little of the
13:57again we were practically without water
14:00for almost an entire
14:02Century we are among the poorest people
14:04in the United States of America as our
14:07Indians who live in other reservations
14:08and still are in that situation unable
14:10to grow crops unable to get out and and
14:13work in the fields unable to develop
14:16economically because of the lack of
14:17water for almost a 100 years was just
14:21that's an absolute shame as far as this
14:23country is concerned as far as the State
14:27concerned what is a metaphor for the
14:31rest of the country to try to think
14:33about in terms of damning the rivers it
14:36would be like saying to this entire
14:38country okay survive now without money
14:41and how would you do that how would you
14:42change your entire economy how would you
14:44change your entire culture how would you
14:46change your entire lifestyle and would
14:48you be successful would people
14:51die and the Puma did die but they died
14:56starvation not from diabetes
15:02abetes a survey conducted In 1902 found
15:05only one case of diabetes among the Puma
15:09but within 30 years of building the
15:10coolage dam there were more than
15:17500 if we had not damned the rivers back
15:20in the 1920s and 1930s we wouldn't be
15:23able to have this lifestyle that we
15:25enjoy in Arizona with swimming pools and
15:27golf courses and artificial lakes and
15:30with this lifestyle we're really living
15:34nature and what people I think generally
15:37speaking don't realize is that all of
15:39the prosperity of Phoenix and the
15:41prosperity of this entire state was
15:43built on the backs of the health of the
15:46tribes humans lived a very very
15:49difficult life at the bottom of the
15:51economic scale we had almost no recourse
15:54except to become dependent upon
15:56governmental benefits shortly after the
15:59dams were built the US military began
16:02Distributing free commodity foods to
16:04Native Americans and it definitely
16:06bought us through the hard times this is
16:09the Commodities building where they hose
16:12the commodity food this is where people
16:14used to come get their their cheese
16:17their beans and their grape juice and
16:20stuff they used to be just rosing rows
16:22and rows and rows of those but this
16:24surplus food white flour cheese refin
16:28sugar lard canned foods is a diabetics
16:32nightmare as it was for Terrell's
16:35neighbor they asked her how many people
16:37are in her household and she said about
16:38five and the guy said well you can get
16:42five boxes of food and there was chips
16:45and candy and canned food and I thought
16:49well that's an idea that's a nice idea
16:50about having food but it's just the
16:53wrong kind of food and I asked her I
16:55said so what kind of like were there any
16:56kind of normal food she goes well there
17:00gravy it was not until 1996 that fresh
17:04produce was offered in the program and
17:07authentic traditional foods are still
17:12included when we think of traditional
17:14American Indian food for example fried
17:17bread is one of the things that comes to
17:18mind well in truth tribes did not have
17:21fried bread historically the roots of
17:24fry bread are in the commodity food
17:25program and fry bread is essentially
17:27trying to do the best you can with your
17:29Commodities flour lard and uh vegetable
17:32shortening over Generations when people
17:35grow up with that it becomes a part of
17:37the culture it that becomes acculturated
17:39into the community that that is part of
17:43norm there is only one small Market on
17:46the 581 squ mile hila River Reservation
17:50with a small produce section a regular
17:53Supermarket is an hour's roundtrip
17:56drive if you're in an impoverished
17:59community and you don't have healthy
18:01choices for food and you don't have safe
18:03places to exercise you're tremendously
18:05disempowered when it comes to a disease
18:07like diabetes and that has nothing to do
18:10with how much medication is in the
18:12pharmacy it has everything to do with
18:14social determinants of Health which
18:16include that sense of control that sense
18:18of self-empowerment that is important to
18:20all of us whether we're native or
18:21non-native it has an impact on
18:23self-identity and it has an impact on
18:26one's sense of hope for the future
18:31some of our people have just given
18:34up people lost their identity when we
18:39water within our community we have
18:42Elders that have gone I always have that
18:45in the back of my mind that those people
18:50water when I leave the reservation and I
18:53see those same people that live out
18:55there and use that water how how they've
18:58benefited from from our
19:02loss they've benefited so much for so
19:09years decisions to benefit some are made
19:12every day they create winners and losers
19:19health in upscale cities like Scotsdale
19:22Arizona the diabetes rate is only around
19:265% in less affluent times like Bullhead
19:29City the rate is closer to
19:3111% and on some poor Native American
19:35reservations it continues to be
19:4050% this is a disease pattern repeated
19:43across the country across the world and
19:48diabetes whether you are poor or wealthy
19:51or in between is a powerful predictor of
19:54how healthy your life will
20:00so marar how long have you been a
20:01diabetic oh gosh about 30 36 years or
20:06something like that maybe went close to
20:0940 I'm losing my my eyesight and that my
20:14left eye is worse than my right eye
20:19diabetes Margaret aosta is a respected
20:22Tona aam Elder and crafts person I have
20:25she's one of Terrell's teachers in the
20:26past 3 weeks I've been a little bit more
20:29serious taking my sugar count as often
20:32as I should it's really really hard
20:35managing diabetes is demanding taking
20:38blood sugar counts four times a day
20:40monitoring diet staying productive and
20:44engaged so Margaret do you think
20:46diabetes will will get you at the end
20:56so how does that make you feel
21:01well I keep telling everybody I'm going
21:04to leave till I'm 100 and I am going to
21:07leave till I'm 100 I tell that to
21:12day you're not going to get me
21:17yet studies confirm that hopefulness
21:19helps to manage diabetes but for the
21:22atham hopefulness has been in short
21:35shot we have a 100 Years of neglect and
21:39poverty make up for we have to put in
21:42water delivery system we have to put in
21:45paved roads we have to put in the
21:46hospitals and schools we're a long ways
21:50behind most other segments of American
21:52society both in Arizona and and
21:55nationally regaining water is a high
21:58priority the Puma have been fighting for
22:00their water rights for centuries facing
22:03opposition by non-tribal economic
22:05interests and skepticism and resistance
22:08at high political levels it was
22:11difficult and there was underlying all
22:14this was I believe a lot
22:20um um not racial hostility hostility but
22:24a lot of uh feelings about tribes that
22:27we didn't deserve the water we didn't
22:29deserve to be in these negotiations we
22:31didn't have a good strong valid claim
22:34Water by the early 1980s new players
22:37entered the fry Citrus Growers energy
22:41producers from several States Resort
22:43developers all joined the Scramble for
22:47gold Rod Lewis spent several decades on
22:50the Puma legal team we have sat down
22:52with each one of those parties spent
22:55literally thousands of hours right here
22:57in this room working on deals to settle
22:59our differences as between
23:02us all that effort led to the Arizona
23:05Water right Settlement Act of
23:102004 after a 100 years water is Flowing
23:13down the heila river again the water
23:16rights act provides the Pima the water
23:18and resources needed to rebuild their
23:20Farms but it also promises something
23:24more it is not about economic gain
23:28is about rebuilding our
23:32community it has never been about
23:37gain it is about the return of our
23:43believe the warm gentle Winds of
23:47Heaven are once again
23:54blowing on the AR aam and the PE
24:03all God bless the heila
24:12wheat we contract Duran wheat this year
24:14is with Arizona grain desert Duram wheat
24:18is what we grow here basically it's for
24:20the pasta manufacturers a lot of it
24:23grows to goes to Italy for for the
24:25making of pasta most time we get a
24:28better contract for that than other
24:34varieties L that you're in is in section
24:3712 okay and this is Gilbert Road right
24:40the tribe and some individual members
24:42are now planning to expand their farming
24:45refering to it's been nearly 20 years
24:48since Tony Antone cultivated his own
24:50allotment so does that kind of make it
24:52clearer a lot a lot a lot better than
24:54how you know just trying to explain over
24:58that way I won't argue with you next
25:03time in truth we have more control over
25:07the the problems like diabetes than we
25:09realize we can't think of diabetes and
25:14colonization just simply from the role
25:16of the victim the disease patterns like
25:20diabetes occur over many years so we're
25:22not going to see a dramatic change
25:23overnight but I think in the long run as
25:26we see more success in economic and
25:28Workforce Development we're going to see
25:29improvements in healthare systems
25:31education systems and in social policy
25:34we have to take more control over our
25:42Community things like diabetes get our
25:45attention but by focusing on Diabetes
25:47you miss the underlying phenomena and
25:52importance I actually like taking
25:59if we took everyone at risk of disease
26:02and cured them so that they were no
26:04longer at risk it would do virtually
26:06nothing to solve our problem because new
26:09people would continue to enter the at
26:11risk population at an unaffected rate
26:19aunt she died of complications of
26:23diabetes the issue is we're not paying
26:26enough attention to prevention
26:28overwhelmingly funds are spent on fixing
26:31people who are already sick we have to
26:34formula and here's my
26:37grandpa he died on Diabetes he was a
26:40Madison man he was a cowboy he was in
26:46Navy I don't want to die of this you
26:48know I don't want to die either with one
26:52leg or two legs missing I still see hope
26:56I don't have have to die of diabetes you
26:59know I'll die of some natural cause or
29:06major funding for unnatural causes has
29:09been made possible by the Ford
29:13Foundation the John D and Katherine T
29:18Foundation the California
29:22endowment WK Kellogg
29:30Foundation Joint Center for political
29:39Permanente additional funding provided
29:53funders this program was also made
29:56possible by the corpor pration for
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