Diagnosing the Legacy
The Discovery, Research, and Treatment of Type 2 Diabetes in Indigenous Youth
In the late 1980s, pediatric endocrinologists at the Children’s Hospital in Winnipeg began to notice Indigenous youth from two First Nations in northern Manitoba and northwestern Ontario coming to clinics with what looked like type 2 diabetes, until then a condition only seen in adults. But these young patients were just the tip of the iceberg. Over the next few decades more children would confront what was turning into not only a medical but also a social and community challenge.
Through dozens of interviews, Krotz shows the impact of type 2 diabetes on the lives of individuals and families, as well as the challenges caregivers face diagnosing and then responding to the complex and perplexing disease, especially in communities far removed from the medical personnel and facilities available in the southern Canada.
Includes a foreword by Frances Desjarlais and an afterword by Heather Dean, Jonathan McGavock, Michael Moffatt, and Elizabeth Sellers.
Diagnosing the Legacy vividly describes the impact of this ‘new disease’ on the lives of individuals and communities and outlines clinicians’ attempts to diagnose, treat, and control it. It illustrates the limits of biomedicine in dealing with the totality of the personal and communal costs of this public health crisis and highlights the need to recognize and to integrate traditional ways and knowledge in an effort to counter it.”
– J.T.H. Connor, Professor, History of Medicine, Memorial University
“The United Nations-sponsored World Health Organization (WHO) has declared type 2 diabetes a rapidly growing epidemic. Diagnosing the Legacy addresses this complex issue through interviews with members of the reserves of Island Lake (St. Theresa Point, Garden Hill, Red Sucker Lake) in Northern Manitoba and Sandy Lake in Northern Ontario. Krotz also interviews local health-care providers, including retired pediatric endocrinologist, Dr. Heather Dean; researcher, Jonathan McGavock; Dr. Ron Mundy; and professor and physician, Dr. Michael Moffatt. Their stories personalize the struggles of those living with the disease and the ways in which communities are working together to address this epidemic.”
“As a whole, academically trained researchers and practitioners are making very little difference to the lives of Indigenous children with type 2 diabetes. We need to advocate, not for longer-acting or more concentrated insulins, or a better pill, but for better relationships, such as those between the Manitoba team and these remote communities, as described in the compelling stories of Larry Krotz’ book.”
– Ellen L Toth, The Lancet Diabetes & Endocrinology
“Diagnosing the Legacy is at once detective story, indictment, and scientific investigation. It problematizes existing approaches to type 2 diabetes among the First Nations of Canada. Krotz, a writer and filmmaker, does an outstanding service in using the lens of type 2 diabetes mellitus—which is increasingly diagnosed in young people, a population not previously thought to be at risk for this condition—to critically examine the political, social, economic, and biological features of this chronic disease among the people of the First Nations. Importantly, the book emphasizes the biological aspects of genetic risk together with the origins of health and disease, arguing that genetic risk—in conjunction with a fetus’s intrauterine environment—both impact that individual’s metabolism. This biopsychosocial perspective moves beyond genetic determinism to consider inequities in diabetes prevalence and treatment from an individual and community standpoint. Krotz stresses the importance of strengthening resilience among First Nations, shifting the locus from individual risk and responsibility to structural factors and solutions. Moreover, the book was written in cooperation with, and supported by, First Nations communities, who are partnering with academics to develop their own solutions to the growing spread of type 2 diabetes among their youth.”
“An engaging narrative and insights into the limits of biomedicine and public health when dealing with the type 2 diabetes, as our understanding of the disease and the public health crisis evolved.”
– Raglan Maddox, St. Michael’s Hospital/University of Canberra, American Review of Canadian Studies
About the Author
Larry Krotz has, as writer and filmmaker, explored the ways our actions affect our world from Africa to Canada’s North. He is the author of five books, including Piecing the Puzzle: the Genesis of AIDS Research in Africa. Visit Larry’s website.
Other contributors: Frances Desjarlais, Heather Dean, Jonathan McGavock, Michael Moffatt, Elizabeth Sellers.