IDF21-0422 Two Anniversaries, Two Pandemics, Two Histories

Abstract

Background: As we remember the therapeutic development of insulin one hundred years ago, in Tulsa, Oklahoma we remember a race massacre in the same year. Are these connected? How? Elbert Huang, University of Chicago’s Center for Chronic Disease Research and Policy, writes that diabetes has been called a “slow moving pandemic.” As U.S. outbreaks surge, a study finds 40% of people who have died with COVID-19 had diabetes (Terhune et al, 7/24/2020 Reuters). The Center for Disease Control (2020) shows the prevalence of diabetes is highest among American Indians/Alaska Natives (14.7%) Hispanics (12.5%), non-Hispanic Blacks (11.7%), and non-Hispanic whites (7.5%). American Indians, Latinos and Blacks are suffering from COVID-19 in the same disproportionate numbers. COVID-19 can grow vigorously in a high blood sugar environment and may cause new cases of diabetes. A woman with diabetes loses a longtime relationship when her friend refuses to wear a mask around her. There are complex interactions between previously adaptive survival mechanisms, pre-Columbian culture and diet. Conquest by Europeans resulted in genocide, great poverty and oppression of indigenous peoples across the Americas. It brought slavery to the Americas when large numbers were needed to grow tobacco and sugar cane from new demands. During high or chronic levels of stress, the adaptive mechanism known as fight or flight allows people to protect themselves in emergency conditions, becomes destructive when people are not allowed to fight or flee. Cortisol, produced during these times, becomes toxic to the body and the brain, impairs immune systems, increases heart and vascular diseases, and lowers resistance to diabetes. In the extreme situation of genocide and slavery, stress becomes chronic and the levels of cortisol remain elevated. In times of famine, the ability of the individual to “store” fat in the abdomen was critical. In times of feast, the survival mechanism is no longer adaptive and can result in obesity, diabetics and death. What then are the factors that make these populations vulnerable to obesity, diabetes and Covid? Violence, poverty and racism remain for peoples whose once adaptive survival responses now contribute to disease and death. Many in the Hispanic community have the same story of conquest. The majority are poor. To the extent that they are considered to be “undocumented aliens,” their lives are precarious. “Black Lives Matter” is the response not only to poverty and racism but violence, especially the killing of innocent blacks by law enforcement. The legitimate fear of driving while black and brown is part of daily life. Native Americans have the highest numbers of violence of any group. It is statistically Caucasian male against Native male and female. Present examples are the large numbers of trafficking and murder of Native American women. These concerns are important to understand in our Native American organization with minority clients. Their concerns are about obesity, genetics, intergenerational/ongoing trauma, medication side effects, racism, community mistrust, lack of education, blame, confusion about diets, surgical intervention, family/friend support, and possibility of remission.