Watching Bad Sugar in class and reflecting on the diabetes epidemic was particularly sobering since diabetes- related conditions account for 19.5 percent of Pima deaths (“Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes” by Carolyn Smith-Morris). The complex interplay between genetics, political-economic, and cultural domains make a simple solution seem unlikely if not impossible. However, certain considerations such as cultural sensitivity, political-economic transformation, financially stable and sustainable models of care that reflect community values and promote access, along with community participation and buy in are helpful considerations. The fact that the tribe is now running the health clinic may be a step in the right direction despite setbacks and administrative difficulties. Admittedly, health considerations and treatment tend to be palliative rather than preventative. The most sustainable solutions may be lifestyle changes involving diet and exercise. Unfortunately, due to the high poverty rate on the reservation and food desert situation that may be difficult to change. Of course, Bash’s cannot suddenly begin to stock healthy food if that food is unlikely to sell due to cost and cultural changes which now prioritize fry breads and certain junk foods over traditional O’odham staples. In addition, with farming no longer being a primary activity for the O’odham, exercise levels have decreased further contributing to obesity and the onset of diabetes.
Nonprofits such as Tohono O’odham Community Action are working to address multiple food-related issues on the reservation to “create a healthy, culturally vital and sustainable community” (TOCA Website). TOCA runs the Desert Rain Café, which serves some traditional and healthier foods while the TOCA store sells tepary beans and other ingredients. TOCA also works to preserve the history and cultural knowledge of the tribe by promoting the work of local artists. According to their Facebook page, they even hosted an oral storytelling event earlier this year. These types of grassroots efforts by and for tribal members might be the most sustainable solution yet to reducing the diabetes epidemic among the O’odham.