First Nation health conditions and medical services linked to transportation systems
Transportation, rising medical costs linked
Barry Prentice - Dec 14 2007 - NORTHERN development policy is attracting increasing attention. The prohibition on a hydro right-of-way down the east side of Manitoba has awakened the latent demand for all-weather roads to remote communities. The road debate has environmental, social and economic aspects. Environment has dominated the discussion because of damage to the landscape and negative impacts of roads on wild populations. The social and economic costs of all-weather roads are complicated and receive less attention. This author posits an indirect link between the rising medical costs associated with diabetes in the First Nations and the transportation cost to these communities.
Spending to treat kidney disease and renal failure is increasing. The province, for example, is spending $20 million on the problem, including adding 30 dialysis stations. Two more dialysis stations will go to Norway House and six new ones will go to Peguis First Nation. Forty per cent of these dialysis stations are needed to treat the end-stage of diabetes. The 30 new dialysis stations will allow another 132 patients to get treatment. The Manitoba Renal Program reports that more than 275 new patients start chronic dialysis therapy every year.
More dialysis stations are the leading edge of rising diabetes-related health-care costs. Diabetes is called a silent disease because people succumb gradually after many years without warning. The incidence of diabetes in the First Nations is epidemic. Experts estimate that Type 2 diabetes affects more than two-thirds of adults in some First Nations of Manitoba. As the First Nation population ages, the health authorities will soon be looking for another $20 million, and another, and another.
Type 1 and Type 2 diabetes are due to genes interacting with environmental triggers. However, different genes and different triggers cause these two types of diabetes. The environmental triggers for Type 1 diabetes are ubiquitous and, therefore, Type 1 diabetes cannot be prevented. Type 2 diabetes is largely preventable. In almost 90 per cent of cases, Type 2 diabetes is associated with overweight or obesity, which in part results from our "obesogenic" environment that is filled with junk food, fast food, sugar-sweetened beverages and items that promote sedentary behaviours. Dr. Francine Kaufman explains the obesity-diabetes epidemic that threatens North America in her book Diabesity. Type 2 diabetes that used to be a late life problem is now showing up in kids below the age of 12.
Dr. Heather Dean of the University of Manitoba is renowned for research on Type 2 diabetes in First Nations children. She reports that children with diabetes in the early 1980s are now forming families and the next generation is even more at risk, but this disease is avoidable. In the words of Dean's address at the Airships to the Arctic III conference: "Heredity loads the cannon, but obesity and other factors pull the trigger."
During the 1960s, rampant Type 2 diabetes was identified in the Pima Indians of Arizona, but it was observed that the identical Pima Indians of Mexico had no diabetes. The difference lay in their diet and lifestyle. The Pima of Arizona had adopted the high-sugar/high-fat American diet.
High transportation costs promote bad diets. A litre of milk is three times more expensive in a remote community than a Winnipeg store. Welfare incomes stretch furthest at the cost per calorie of sugar and fat. The most economic diet in the remote communities leads to obesity and diabetes with its complications of heart disease, strokes, amputations, blindness and finally kidney failure.
In sad irony, at the same time that the province was announcing new dialysis stations, a company owned by the Tribal Councils Investment Group (TCIG) received PepsiCo's "Canadian bottler of the year" award. TCIG obtained double-digit sales increases providing soft drinks across northern communities. Now they are negotiating with Frito Lay to distribute potato chips and other processed snack foods to the First Nations.
Schools are banning the sale of what Kaufman calls "liquid candy" to students because of obesity concerns, while the purveyors of sugary soft drinks to the First Nations are receiving national awards. It would be easy to suggest that the TGIC is in the diabetes business, but they did not invent the demand for Pepsi-Cola to the remote communities. The junk-food market in remote communities exists because of poverty. Poverty exists because of unemployment that results from the high cost of transportation that excludes these communities from normal commerce and access to nutritional food at reasonable prices.
Governments are in the diabetes-treatment business because they have not invested enough in northern transportation to spur economic development. They can either spend on transportation so the remote communities can join the market economy, or watch as the suffering and expenditures on diabetes balloon instead.
Barry Prentice is a professor in supply chain management at the University of Manitoba.