The Enduring Legacy of Nuclear Tests: Barriers to managing type 2 diabetes among Marshallese Pacific Islanders in the United States

Introduction / Rationale: Nuclear tests conducted by the United States caused significant damage to the environment and traditional food sources in the Marshall Islands. The Marshall Islanders began to depend on imported processed food, but the change of diet resulted in significant increases in chronic diseases, in addition to cancers and birth defects associated with nuclear radiation. Since the 1986 Compact of Free Association, over 15,000 Marshallese have relocated to the United States, and the majority live in one U.S. state. This community of Marshallese has the highest prevalence rate for type 2 diabetes in the world. Objectives: identify the underlying social, cultural, and economic problems associated with high prevalence and poor management of type 2 diabetes among Marshallese in the United States. Methods / Approach: A semi-structured questionnaire was used to collect data through focus groups involving several Marshallese communities in one U.S. state. Data were analyzed using thematic analysis. Results / Practice Implications: A number of problems emerged: 1) unaffordability of healthy foods, 2) difficulty maintaining physical activity; 3) lack of transportation, which limits access to medical facilities and food stores, 4) cultural, social, and family events that do not provide healthy food options. Conclusion / Contribution to the occupational therapy profession: Due to cultural, social and economic barriers, improving diabetes care among the Marshallese living in the in the United States will require the development of uniquely tailored, affordable, culturally appropriate intervention programs that consider their unique history and circumstances.