Global health knows no boundaries. There are no dividing lines that respect illness and disease, nor are there places where prevention is irrelevant. I was privileged to join a group recently who saw what a dedicated community can do to protect itself from the threat of non communicable disease, in this case the Tohono O’odham reservation in Arizona. The Tohono O’odham Nation is composed of approximately 30,000 Native Americans, most of whom live on a 2.8 million acre reservation just west of Tucson, Arizona, along th.... During my visit, I learned that more than half of the Nation’s adults now live with type II diabetes.
I was in Arizona to take part in the University of Arizona, Mel & Enid Zuckerman College of Public Health, Global Health Institute's inaugural “New Frontiers in Global Health Leadership: Building Strong Health Systems to Respond to Non-Communicable Diseases” conference, the entire first day of which took place at the Tohono O’odham Nation. O’odham Chairman Ned Norris, Jr. began the day with startling statistic – approximately three quarters of all Tohono O’odham 6th-8th graders are now overweight or obese. This is a comparatively new phenomenon, which began in the 1960s and emerged with force in the 1990s. In Norris’ view, there are many causes for the diabetes epidemic including sedentary lifestyles for Tohono O’odham members. However, the main culprit, he says, has been the introduction to the reservation of processed foods high in fat, salt and sugar, which took the place of traditional O’odham foods. The Tohono O’odham Nation is now embarked on a program to reintroduce local foods, such as tepary beans, cholla buds and wild spinach, into the diet. Funded largely by income from the Nation’s Desert Diamond Casinos, and a grant from the US Centers for Disease Control and Prevention, the Nation has also built seven fitness centers around the reservation, to provide opportunities for exercise and health education to Nation members and others. An ambitious program called Healthy O’odham Promotion Program (HOPP), under program manager Tina Aguilar, is engaging thousands of Nation members at the centers and in their villages in diabetes prevention and early detection activities.
At the same time, Dr. Norris noted that the Tohono O’odham are also taking steps to prevent and control cancer, rates for which are also increasing. Prior to 2001, members of the O’odham Nation could move freely between land on the US and Mexican sides of the border. However, after that time, the border area has become much more difficult to cross, and even the O’odham – several thousand of whom live on the Mexican side – have difficulty. Norris pointed out that farmers on the Mexico side are not required to follow the same sustainable practices as those living north of the border, and since cross-border traffic has slowed, they are free to use chemicals in their farming that would be illegal in the United States. The resulting “haze” of agricultural pollution is clearly having adverse health effects, particularly in terms of generating respiratory illnesses. Norris and Gary Chavez, who directors the Tohono O’odham Cancer Partnership, note also that much of the water on the reservation comes from the Mexican side of the border, and it arrives bearing extremely high levels of arsenic, which is a known carcinogen.
However, between HOPP and the Cancer Partnership, there are signs of progress. Obesity levels are starting to plateau after years of continuing rises, and cancer detection is improving. There are still challenges, and Norris and others acknowledge that even given the outreach programs and health promotion, there are still many Tohono O’odham who cannot access the health services they need. Still, it was exciting to see the new HOPP centers around the reservation, and the gleaming exercise equipment in them available for use. Norris said he was proud that not only O’odham members use the centers – even US Border Patrol members use the equipment.
But the most important lesson of the day came from Verlon Jose, chairman of the Chukut Kuk District of the Nation that lies on the Mexican border. “There are many things we O’odham can blame on others, but obesity is not one of them,” he said. Jose is a heavy set man who joked that he knows a thing or two about the subject. “We created this problem for ourselves and that’s why it’s important that we pull ourselves up by our own bootstraps and solve it right here.” I am betting that given the proactive attitude and emphasis on prevention, the Tohono O’odham will do just that.