An Interview with AAIP President Dr. Jim Thompson

TC: Health issues like diabetes, obesity, alcoholism and other illnesses are prevalent throughout our culture, but seem more pronounced in Indian Country. Do you think this is the case primarily because of education issues, the isolation of some tribes, or a lack of treatment or sufficient medical personnel?

JT: I think it's difficult to make a broad-brush statement about that because there are different reasons why [these conditions] are problematic. There is clearly a different presentation and different physiology of diabetes in Indian people, and that's been written about a lot. Some Indian people can have enormously high blood sugars and not have any symptoms; they don't feel bad. That's a real challenge. Most people take medicine because they feel bad or have some recognition that something is wrong. That's a continuing problem I know a lot of programs now are trying to address, including the AAIP programs in diabetes.

On alcoholism, I think the jury is out still in spite of a lot of the literature, as to how much genetic and biochemical difference there is between Indian people and non-Indians, but Indians clearly respond to alcohol somewhat differently than some other groups. I think you’ll find that alcoholism and substance abuse are high where ever there are poor socio-economic conditions and a lot of unemployment, which is certainly the case on many reservations in many rural areas, and in inner cities as well. I think it's awfully important to recognize that most Indian people do not live in rural areas; they live in the city. The census says that pretty clearly.

Another area is chronic kidney disease. I think there you can really point to a number of factors, including hypertension, or high blood pressure, in Indian people. Sometimes the diet, which is very high in salt, can lead to hypertension, and of course your implication that perhaps there aren't enough services available early enough is quite accurate. We need to catch these diseases at an early stage and start treatment earlier. But there really aren't even enough facilities to treat Indians even when they have full-blown disorders, and kidney disease is a good example of that. For example, there are very few Indians that have access to dialysis, and that's a real disparity that needs to be dealt with.

Some of the other conditions like diabetes – through the Indian Health Service and tribal programs as well as the urban clinics -- are being caught earlier; but related to diabetes is obesity, which I think is still something we have yet to get a handle on. And we have to get a handle on it because an obese person is at high risk for not only diabetes and hypertension, but all sorts of cardiac problems, and it's just goes on and on and on.