American Indian Culture and Research Journal

INTRODUCTION Genetic inheritance is a multilayered concept enveloped by cultural assumptions, given diverse meanings by physicians who serve American Indians and by their patients. Unfortunately, providers and clients are often unaware of the different perceptions each have. Ethnographic data about perceptions of inheritance enhance an understanding of notions about diabetes and its causes. A broader view of this topic reveals that subtle and explicit cross-cultural misunderstandings are common to individuals and to topics of all sorts, consequently affecting associated prevention and treatment courses. The words genetics and inherited are used frequently during discussions of diabetes, which is a common subject of communication between providers and their American Indian clients due to the prevalence of Type 2 diabetes among the Indian Health Service population. The age-adjusted Indian Health Service-diagnosed diabetes prevalence rate for American Indians is 69 per 1,000, whereas the overall U.S. rate is 24.7 per 1,000. Recent results from the Strong Heart Study reveal that among Arizona American Indian participants, for example, the age-adjusted rates of Type 2 diabetes are 65 percent in men and 72 percent in women. Diabetes is the second leading cause of outpatient visits to Indian Health Service facilities, after the common cold. When confronted by medical information and technology, lay people rarely remain passive. They tend to interpret and evaluate illnesses and treatments actively. Interpretations are greatly impacted by historical, social, linguistic, cultural, and educational factors as well as by the genders of providers and clients. In interviews, California and Arizona tribal members often explain inheritance as a part of biological, social, and cultural ethnic identity, while their providers define inheritance in a biological context. Multiple interpretations of a single concept by professional and lay people alike may represent underlying disagreements about etiologies which in turn influence health care behaviors.