Two approaches, one problem: Cultural constructions of type II diabetes in an indigenous community in Yucatán, Mexico

Abstract

The emerging epidemic of obesity and type II diabetes in Mexico has recently propelled the nation into the public health spotlight. In the state of Yucatán, the experience of diabetes is greatly impacted by two cultural constructions of disease. In this setting, elements of Yucatec Mayan health practices as well as the biomedical model affect the approach to type II diabetes. Both frameworks offer unique understandings of the etiology of diabetes and recommend different ways to manage the condition. Based on in-depth and semi-structured interviews with both community members and clinicians, the present study seeks to understand how diabetes is understood and treated in indigenous settings in rural Yucatán. We explore the context in which community members navigate between locally available healthcare options, choose one over the other, or incorporate strategies from both into their diabetes care regimens. The tension between indigenous community members and their biomedical healthcare providers, the changing food environment of this community, and the persistence of traditional gender constructions affect the management of type II diabetes and its associated symptoms.

The importance of the cultural dimension of food in understanding the lack of adherence to diet regimens among Mayan people with diabetes

“…Some authors also note how the adoption of lifestyle changes recommended by medical staff, in particular diet, interacts with gender. For instance, similar to our data, these authors found that women with diabetes face greater barriers to diet change given their workload because of gender norms (12) .…”

“…This research also shows how poverty, cultural marginalization, and the processed food and sugary beverage industries converge in complex ways to contribute to the development of diabetes among indigenous peoples, including Mexican Mayans, and to create multiple barriers to the adoption of doctor-recommended dietary changes (12) . Page-Pliego specifically investigates the increased consumption of sugary beverages in culturally marginalized groups living in poverty, such as many Mexican Mayans, and its ties with taste but also with political and socio-economic processes that lead to easy availability of these drinks and make them socially desirable (13,48) .…”

“…Previous anthropological research on Mexican Mayans with diabetes explores how people explain diabetes and especially the central place of food in the causation of the disease (12)(13)(14) . Page-Pliego, for example, describes an array of explanatory models of diabetes, including biomedical understandings and traditional models that are based on Mayan traditions and cultural beliefs (13,14) .…”

“…On the other hand, regarding the Mexican population with diabetes, data on indigenous ethnicity are not available, as is true for other countries such as Guatemala (10,11) . Although literature exists on the lived experience of diabetes among indigenous groups in Mexico (12)(13)(14)(15) , few publications focus mainly on food and diet. Recent exceptions are a study among the Chontal in Tabasco (16) and a study by Montesi in the Ikojts in Oaxaca (17) , which discuss ambivalent food experiences among indigenous people with diabetes.…”

Living With Type 2 Diabetes in San Jose Tecoh, Yucatan, Mexico: A Phenomenological Study

“…Even when health services are covered by public insurance, individuals may be required to pay for extra services. Culturally constructed perceptions of T2DM causes and treatments, such as the relationship between stress and disease, may affect individual understanding of proper diabetes management (Frank & Durden, 2017). In addition, increased availability and lower cost of calorie-dense products in the Yucatan have led to greater consumption of foods that contribute to obesity and diabetes.…”