Using Culture and Tradition to Fight Diabetes 

By Brigette Settles Scott, MA


Closing the Gap, Diabetes • September/October 2002


Diabetes is one of the most serious health challenges facing 

American Indians and Alaska Natives (AI/AN) in the United 

States today. The disease is very common in many tribes, 

and morbidity and mortality from diabetes can be severe. Approximately 15.1 percent of all AI/AN adults have diabetes. On average, 

American Indians are 2.6 times more likely to have diabetes than 

Whites. 

Great diversity in culture, language, location, lifestyles, and genetic 

heritage exists among American Indians and Alaska Natives. Currently, more than 500 Native American tribal organizations exist in 

the United States—making it more challenging to reach each with 

culturally and linguistically appropriate diabetes prevention and control messages or strategies. Other challenges include poverty, cultural 

perceptions of diabetes, and inadequate health delivery systems. 

Awakening the Spirit 

The American Diabetes Association (ADA) launched Awakening the Spirit-Pathways to Diabetes Prevention and Control program in 

late 1999. Designed to promote community wellness and to share 

messages about the seriousness of diabetes, the campaign uses cultural 

traditions as a means to educate and empower tribal leaders and community members to live healthier lifestyles that will help prevent or 

delay the onset of diabetes and its related complications. 

“The name—Awakening the Spirit—came to us after having 

spent some time praying and pondering on how to best reach our 

indigenous populations with messages that they themselves have the 

spirit and knowledge to do something about diabetes. The message is 

‘let us awaken the spirit within ourselves—that same spirit that has 

brought our ancestors to endure hardships, and the same fighting 

spirit that we will pass on to our children.’ The goal is to reactivate and 

reenergize this spirit to fight diabetes,” said Dr. Lillian Tom-Orme 

(Navajo), program chair. 

The program centers on the theme of changing destructive 

lifestyle habits that have placed Native people—some as young as 

five—at risk for diabetes. According to Tom-Orme, because of the 

prevalence of diabetes in Native communities, many people are now 

thinking in terms of “when I get diabetes” rather than “if I get diabetes.” To help change this mindset, the program messages work to drive 

home the fact that diabetes can be prevented. 

“We wanted to create a program that not only helps us understand how to cope with diabetes, but how we can adopt better eating 

habits and healthy lifestyle choices to further prevent the onset of 

diabetes and/or delay its life-threatening complications,” said TomOrme. “The primary fight against type 2 diabetes among our people 

does not necessarily require insulin injections or modern technology. 

In fact, we Native people, known for our survival skills, can once 

again delve into our ancient, yet reliable techniques of 

strengthening our spirits...” wrote Tom-Orme in a program brochure. 

Awakening the Spirit relies primarily on the work of volunteers to 

achieve its objectives. As a true community-based initiative, it works 

with tribal leaders and others to both become and train others to 

become diabetes educators. “Our program is unique because any 

community member can be involved. They do not have to have a 

certain degree or initials after their name to be involved,” said TomOrme. “We have trained community health workers, volunteers, and 

some professionals on how to reach American Indian and Alaska Native people with positive messages about diabetes control and staying 

healthy. We have also conducted train the trainer programs so as a 

result we now have trainers available nationally.” 

The campaign is also working closely with other organizations to 

further promote diabetes education in Indian Country. “We have 

several partners including the Federal government. The Indian Health 

Service (IHS) has a diabetes nurse consultant that works with us and 

provides activity updates from IHS to ensure that we do not duplicate 

efforts. We also work with the Tribal Leaders Diabetes Committee 

(TLDC) who have participated in our advocacy visits to Capitol Hill,” 

said Tom-Orme. She believes that partnering with others increases 

the campaigns reach and impact. As a result, ADA will be a cosponsor with TLDC and others on a diabetes conference that is scheduled for later this year. 

Measuring Success 

ADA partnered with the University of New Mexico to implement and evaluate the campaign. The training curriculum was tested 

in four regions—Oklahoma, the Northwest, Arizona and the Great 

Lakes—and modified to meet each community’s needs. 

“Since its launch, the campaign has successfully trained more 

than 300 American Indians as mentors, and has reached 2,500 people 

across many tribes through the country,” said Brenda Broussard, program coordinator. The University of New Mexico has documented a 

decrease in glycohemoglobin (A1c) levels overall, and in various communities. 

“We have collected beautiful stories from people with diabetes 

and tribal program staff on how this program is making a difference in 

their communities. Some of these differences include learning how to 

use a glucose meter which translates into better diabetes control, receiving better foot care and thus avoiding amputations, learning about 

diabetes and being able to share the information with children, youth 

camps where children learned about health and healthy lifestyles, and 

fears being allayed through counseling upon diagnosis,” concluded 

Tom-Orme. 

For more information on Awakening the Spirit, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or 

Dr. Lillian Tom-Orme, program chair directly at 801-585-5246 or 

ltomorme@hrc.utah.edu

Office of Minority Health Resource Center U.S. Department of Health and Human Services