Margaret Everett, Anthropology
Jack Corbett, Public Administration
Portland State University
Diabetes Awareness and Prevention among Mexico’s Transnational Migrant
The health of populations is shaped by both biological and social forces. In
the southern state of Oaxaca, Mexico, migration, tourism, and emergency
displacement, among other factors, shape an array of health challenges.
Diabetes is one of the fastest growing and most significant of those health
challenges. Students will travel to Oaxaca City to work with local
organizations to assess the prevalence of diabetes and the associated risk
factors involved, and will assist these organizations in developing strategies
toward a coordinated awareness and prevention program.
Community Issue/Problem to be addressed:
In a world where international migration, tourism, emergency
displacement, and other factors provoke the movement of populations across
national boundaries these forces acquire the capacity to affect the health of
large numbers of people in short order. To effectively manage, protect, and
improve the health status of populations in movement it becomes necessary
to understand circumstances in both sending and receiving regions as both
shape status and needs. While our attention generally centers on crises and
dramatic cases such as avian flu or AIDS this reality in practice has
relevance for a wide array of health problems.
One emerging example of these complex realities is the growth of
diabetes as a transnational health concern in Mexico and the United States.
For example, the rural population from communities in the southern
Mexican state of Oaxaca, a population with substantial representation among
migrants and immigrants in Oregon, displays a high incidence of diabetes
despite a nominally low-risk diet. The incidence of diabetes therefore
challenges populations and health care providers on both sides of the border.
To better understand this phenomenon students will travel to Oaxaca to work
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with local organizations to assess the prevalence of diabetes and the
associated risk factors involved, will assist these organizations in developing
strategies toward a coordinated awareness and prevention program, and
prepare themselves to do similar work among the Mexican-origin population
According to the International Diabetes Federation (www.idf.org),
diabetes is the fourth leading cause of death worldwide. Diabetes is growing
worldwide, and Latin America is experiencing one of the fastest growth
rates (IDF estimates that parts of Latin America will experience an 85%
increase in diabetes prevalence by 2025). At least 50% of all people with
diabetes are unaware of the condition, and this rate is higher in the
developing world (www.idf.org) . Complications from diabetes include
blindness, cardiovascular disease, amputation, and kidney failure. Prevention
and early detection are critical to lowering the human and economic costs of
The exceptionally high rate of diabetes in Native American
communities is well documented. Native Americans, in fact, have the
highest prevalence of type 2 diabetes of any group, according to the Center
for Disease Control. Less is known, however, about the rate of diabetes
among indigenous Mexicans, although some studies and anecdotal evidence
suggests that the problem is increasing with urbanization and migration,
economic development, and changes in foodways and physical activity. In
the United States, Mexican Americans are almost twice as likely to have
diabetes as non-Hispanic whites of similar age, according to the Center for
Disease Control. Scientists continue to debate the relative weight of social
and biological (i.e. genetic predisposition) causes of diabetes. One of the
founding assumptions of this course, however, is that diabetes is the result of
a complex interaction of biological and social forces.
In Oaxaca, doctors in rural clinics report an especially high incidence
of diabetes. Access to screening and prevention programs is lower in rural
areas, and hindered by economic and language barriers. Many members of
rural communities emigrate to the United States, especially to participate in
seasonal agriculture. A large number of indigenous Oaxacans come to
Oregon each year, especially to the Willamette Valley and the Woodburn
area. Migration poses a number of health challenges in general, and makes
the management and prevention of chronic conditions such as diabetes
especially difficult. Additionally, many of those who stay behind in Oaxaca
are elderly and may be more vulnerable as family members and others
whom they can turn to for mutual aid leave the country. Although we
initially plan to concentrate on work in Oaxaca itself, it is impossible to
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ignore the relationship of migration to health and we anticipate that this will
be a significant focus of our project. We further see this as an exciting
opportunity for students to explore the way their home region is connected
to other countries and regions.
For students to gain first hand experience with participant observation and
immersion in an international setting.
For students to reflect on the complex ways health is impacted by social,
economic, political and cultural forces.
For students to develop collaborative and problem-solving skills.
For students to gain practical experience working with community partners,
using the model of participatory action research, in order to develop a
meaningful action plan for diabetes awareness and prevention.
For students to develop understanding of transnational populations in
Oregon and their ongoing connections to their home communities.
Academic Literature/ Reading List
NOTE: Articles in Spanish and public reports are for course
development only and will not be required reading.
Joe, Jennie, and Robert Young, eds. 1994. Diabetes As a Disease of
Civilization: The Impact of Culture Change on Indigenous People.
New York: Mouton de Gruyter.
Loustaunau, Martha, and Elisa Sobo. 1997. The Cultural Context of Health,
Illness, and Medicine. Westport, CT: Bergin and Garvey.
Sacks, Oliver. 2002. Oaxaca Journal. Washington, D.C.: National
Stephen, Lynn. Zapotec Women: Gender, Class, and Ethnicity in Globalized
Oaxaca. Durham, NC: Duke University Press.
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Anguiano, M.E. 1993. “The Migration of Indigenous Mixtecans. Population
Mobility and Preservation of Identities.” Demos 6: 16-7.
Carlson, B.A., D. Neal, G. Magwood, C. Jenkins, M.G. King, C.L. Hossler.
2006. “A Community-Based Participatory Health Information Needs
Assessment to Help Eliminate Diabetes Information Disparities.”
Health Promotion Practice 7(3, suppl): 213S-222S.
Castro-Sanchez, H. and J. Escobedo de la Peña. 1997. “La Prevalencia de la
Diabetes Mellitus no Dependiente de Insulina y Factores de Riesgos
Asociados, en Población Mazateca del Estado de Oaxaca, México.”
[Prevalence of Non-Insulin Dependent Diabetes Mellitus and
Associated Risk Factors in the Mazatec Population of the State of
Oaxaca, Mexico] Gaceta Médica de México 133(6): 527-34.
Conway, D. and J.H. Cohen. 1998. “Consequences of Migration and
Remittances for Mexican Transnational Communities.” Economic
Geography 74(1): 26-44.
Farquhar, Stephanie, Yvonne Michael, and Noelle Wiggins. 2005. “Building
on Leadership and Social Capital to Create Change in Two Urban
Communities.” American Journal of Public Health 95(4): 596-601.
Greenwood, Davydd, and Morten Levin. 1998. Introduction to Action
Research: Social Research for Social Change. London: Sage.
Guidi, M. 1993. “Es Realmente la Migración una Estrategia de
Supervivencia?” [Is Migration Really a Survival Strategy? The Case
of the Northern Oaxacan Mixteca] Review of International Sociology
McGuire, S. and J. Georges. 2003. “Undocumentedness and Liminality as
Health Variables.” Advances in Nursing Science 26(3): 185-95.
Potvin, Louise, Sylvie Gendron, Angele Bilodeau, and Patrick Chabot. 2005.
“Integrating Social Theory into Public Health Practice.” American
Journal of Public Health. 95(4): 591-595.
Rubel, Arthur, and Carole Browner. 1999. “Antropología de la Salud en
Oaxaca.” Alteridades 9(17):85-94.
Schulz, L.O. and R.C. Weidensee. 1995. “Glucose Tolerance and Physical
Activity in a Mexican Indigenous Population.” Diabetes Care 18(9):
Sims, Brian and Jeffrey Bentley. 2002. “Partipatory Research: A Set of
Tools but not the Key to the Universe.” Culture and Agriculture 24(1):
Smith-Morris, Carolyn. 2004. “Reducing Diabetes in Indian Country:
Lessons from the Three Domains Influencing Pima Diabetes.” Human
Organization 63(1): 34-46.
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Sunstein, Bonnie, and Elizabeth Chiseri-Strater. 2002. “Stepping In and
Stepping Out: Understanding Cultures” IN Fieldworking: Reading
and Writing Research. Boston: Bedford/St. Martins, pages 1-53.
Whiteford, Michael. 2006. “Homeopathic Medicine in the City of Oaxaca,
Mexico: Patients’ Perspectives and Observations” IN Health and
Healing in Comparative Perspective, Elizabeth Whitaker, ed. Upper
Saddle River, NJ: Pearson, pages 53-60.
Ysunza-Ogazon A., Diez-Urdanivia-Coria S, Lopez-Nuñez L. 1993.
“Programa de Investigación-acción comunitaria en migración y
nutrición” [A Program of Community Action Research on Migration
and Nutrition] Salud Pública de México 5(6): 569-75.
Oregon Department of Human Services. Oregon Diabetes Program. 2002.
Oregon Population-Based Guidelines for Diabetes Mellitus:
Measuring Quality of Care in Health Systems.
Oregon Diabetes Coalition. 2005. Oregon’s Action Plan for Diabetes:
Improving the Health and Quality of Life of Oregonians Affected by
American Diabetes Association (www.diabetes.org)
International Diabetes Foundation (www.idf.org)
Federación Méxicana de Diabetes (www.fmdiabetes.org)
Center for Disease Control, Diabetes Program (www.cdc.gov/diabetes)
Description of the Final Product
In the first year of the project, students will:
1. Develop a needs assessment and action plan for the second year
students to follow up on.
2. The assessment will contain all relevant findings about prevalence and
distribution of diabetes in Oaxaca, especially among indigenous
populations. The assessment will be based on first hand observations
and visits to a number of key “stake-holders” including a rural clinic,
a traditional village healer, the food bank of Oaxaca, the Center for
Attention to the Migrant, the Center for Population, State of Oaxaca,
the public health authorities.
3. This report will be produced in Spanish and English and distributed to
interested parties in Oaxaca.
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4. The report will conclude with suggestions for next steps, to be taken
up by subsequent capstone classes.
5. A preliminary report to invited guests in Oaxaca, and a public
presentation at PSU.
List of Majors
Anthropology – medical anthropology, fieldwork methods, transnationalism
Sociology – medical sociology, research methods, social determinants of
Health Studies – community health education, health promotion and disease
prevention, community-based health interventions, social determinants of
Economics – economics of health care, economics of ethnicity, Latin
American political economy, labor migration
Political science – health policy, political economy of health
Urban Studies – social aspects of urbanization and migration
Philosophy – bioethics and social justice
Native American Studies (minor) – indigenous issues, health inequalities,
Spanish – the course provides an opportunity for language immersion
through home-stay and formal language instruction while in Oaxaca;
Spanish majors and native Spanish speakers will be especially encouraged to
join the capstone
International Studies – globalization, Latin American Studies
Chicano-Latino Studies (certificate) – migration and health, cultural studies,
Academic Expertise/Professional Background
This course will be team-taught by an anthropologist and a political scientist.
Jack Corbett is Associate Professor of Public Administration in the College
of Urban and Public Affairs and Executive Director of the Instituto Welte de
Estudios Oaxaqueños, a research center in Oaxaca, Mexico. His research
interests include international migration, community development, and
resource management. He has managed over fifty short-term and semester-
length programs in Oaxaca and has taught a graduate-level course titled
Health and Society in Mexico there. Jack has worked extensively with
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public agencies, NGOs, and community governments in Oaxaca, and these
contacts provide us with access to an array of partners.
Margaret Everett is Associate Professor of Anthropology at Portland State
University, with a background in medical and urban anthropology. Dr.
Everett’s past research includes fieldwork in Bogotá, Colombia on rural-
urban migration and urban development, and more recently on health policy
making and bioethics in the U.S. She teaches several courses in medical and
applied anthropology, and has supervised graduate and undergraduate
students in community-based projects for 10 years.
Development of Community Partnership
Jack Corbett has met with people in the health professions, migrant services,
and NGOs in Oaxaca and found widespread interest in developing better
diabetes awareness and prevention. From rural doctors to state agencies
there is a clear sense that this is a critical health issue, one which has not
been addressed because it lacks drama and has little immediate relevance to
the traditional focus on children and mothers. Medical training and public
health in Mexico has tended to focus on pediatrics and maternal/child health.
The prevalence of Type II diabetes, which disproportionately affects adults
and the elderly, may partly explain why this disease has not received more
attention from health officials. Our discussions with health providers in
Oaxaca, however, suggest that this has begun to change, and chronic
diseases like diabetes are receiving more attention. A recent attempt to
create a diabetes association, although backed by a handful of doctors
concerned about long-term implications, foundered in large part because it
could not command the high visibility of other health problems. Thus there
is a sense of a need to help the general population and state officials
appreciate the number of people at risk and the long-term implications of the
spread of diabetes. This would be an important step in facilitating
development of coordinated treatment and prevention programs. The
capstone would be an important contribution to understanding diabetes
prevalence, risk factors, and potential interventions.
There are a number of local government and non-governmental
organizations with very specific interests in collaborating with this capstone.
Cesar Magani, research director of the state´s General Population Council,
and Lucia Cruz, research director of the Center for Attention to Migrants,
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are interested in diabetes incidence among the general rural population and
the migrant population, respectively. Jack Corbett has worked with Lucia
Cruz on other projects and is aware of her concern that migrants develop
untreated, often undiagnosed, diabetes during their time in the US, then
return to rural communities with serious health problems difficult to treat
given problems of poverty and isolation. The Oaxaca Food Bank is sensitive
to the fact that many of the donations from major food distributors are
heavily laced with sugar and wants to develop informational materials
helping its users to modify diets. The Oaxaca Association of General
Medical Practitioners, and particularly its former president Dr. Javier
Mendez, would like to make another attempt to create a state diabetes
association. The Instituto Welte de Estudios Oaxaqueños and other research
organizations have a continuing interest in fostering local and international
studies which contribute to a better understanding of contemporary Oaxaca.
In addition the Graduate School of Public Health at San Diego State
University, in San Diego, California, has taken a special interest in the
proposed capstone as it currently is working on a community-focused
project on diabetes prevention and treatment among Oaxacan migrants to
San Diego County. Professor Karen Coleman of San Diego State has offered
to share their Spanish-language outreach materials and would like Portland
State students to think in terms of collaborative exchange with San Diego
State students, thereby increase the significance of both projects. There
should be no problem obtaining letters of support or interest from
organizations such as the Oaxaca Food Bank, the Center for Attention to
Migrants, the Instituto Welte de Estudios Oaxaqueños, Oaxacan doctors,
and others whose contact with vulnerable populations makes them aware of
the serious health problem this project will address.
1. Inquiry and Critical Thinking
Before traveling to Oaxaca, students will meet with faculty for three class
sessions in order to learn about the region, its people and culture, and to
discuss introductory readings about health, migration, and diabetes.
Students will participate in self-assessment and group discussions
throughout the capstone experience. Like all cultural immersion
experiences, we anticipate that students will be challenged to examine
their own cultural backgrounds and worldviews. Because we will be
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focusing on health, students will have the opportunity to critically
examine the differences between “biomedical” and “folk” understandings
of disease. Drawing on their own disciplines, students will discover some
of the ways that health and illness are shaped by the physical and social
Students will have many opportunities to develop communication skills
through this experience. Working in teams, students will need to bridge
disciplinary boundaries and interact with community members in
respectful and collaborative ways. Working in a foreign country, and in
Spanish, students will need to be resourceful and creative. After returning
to Portland, the class will meet on campus to prepare a final report, and
will give a public presentation during the fall quarter. In their final report
and public presentation, students will learn to communicate in a
professional and accessible fashion, with sensitivity to a variety of stake-
3. Variety of Human Experience (Diversity)
Through home-stay and participant observation, students will experience
a place and culture that is likely quite different from their own prior
experiences. While we encourage students to approach their international
experience with an open and tolerant mind, we also encourage them to
reflect honestly on their impressions and reactions to what they
encounter. Students will learn, through preparatory reading as well as
first-hand experience, about class and racial hierarchies in Mexico, as
well as about the reasons why many Oaxacans seek work in the United
States. Students will also have the chance to experience the rich heritage
and vibrant culture of Oaxaca. Through journal writing and a series of
free writing exercises, students will explore their experience.
4. Ethical and Social Responsibility
Ethical and social responsibility is at the heart of this capstone
experience. What responsibility do wealthy nations have regarding the
health and well-being of poorer nations? What is the impact of corporate
marketing, international migration, and other forces of globalization on
the health of populations? These questions will form the basis of group
discussions and free writes.
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Additionally, we will consider how to introduce intervention programs
aimed at health promotion and illness prevention. What cultural, political,
and economic factors will need to be considered in order to develop such
intervention strategies? The model of Participatory Action Research will
provide a basis for these discussions. Briefly, participatory approaches
attempt to create sustainable positive change through community
involvement at all stages of a project, from identification of “the
problem,” program design and implementation, and assessment. Such
approaches have become increasingly popular in development schemes
and public health promotion. Participatory Action Research seeks to
avoid paternalistic relationships between “experts” and laypersons.
Consulting and partnering with a number of organizations in Oaxaca, for
example, is essential. We encourage students to consider community
members as the experts, and to seek their perspectives and priorities
whenever possible. Distributing our findings and seeking feedback will
also be important for contributing to ethical and effective social change.
McTaggart describes Participatory Action Research as an “overlapping
spiral of steps,” including planning, acting, observing, and evaluating.
Students will participate in all of these steps to some extent. McTaggart
explains, “One good way to begin a participatory action research project
is to collect some initial data in an area of general interest (a
reconnaissance), then to reflect, and then to make a plan for changed
action.” The first year of the capstone will likely be focused on the first
steps -- reconnaissance and reflection through self-assessment exercises
and the final report. Subsequent capstones will build on the work of
previous groups, developing project strategies, consulting local partners,
and implementing diabetes prevention and awareness activities.
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