Common knowledge shows that Indigenous Peoples are disproportionately affected by chronic illness due to their history and current policy issues. One of the chronic diseases that affects the indigenous communities disproportionately when compared to non-indigenous peoples is diabetes. Diabetes is a chronic metabolic disorder characterized by elevated blood glucose levels due to either inadequate insulin production, ineffective insulin action, or both. The Indigenous communities experience this disease at higher rates than even their predisposition makes them more vulnerable than other populations. Even though their resilience and strength are remarkable, structural and individual factors affect their access to health services, explaining the large numbers obtained in health statistics. One of those influencing factors is their colonization and history, which plays a significant role even today when structural limitations like healthcare inequities influence how they access health services, including health education and promotion. This paper will discuss how diabetes disproportionately affects indigenous populations, the influence of colonization and history, and incorporate the Truth and Reconciliation Commission of Canada (TRC) meaning and intent of Calls to Action 19 to discuss how achieving the relevant Calls to Action will impact diabetes rates in these communities.
How Diabetes Disproportionately Affects Indigenous Populations
The social determinants of health are the first culprit when discussing how diabetes disproportionately affects indigenous populations because they face socioeconomic disparities from lower income levels to limited access to education and healthcare services. When individuals lack health education, they are more likely to live behind the shadow of unhealthy lifestyles where there is obesity, physical inactivity, and poor nutrition. According to Cheran et al. (2023), there is a prevalence of obesity among indigenous women of reproductive age, which can contribute to the discussion on how diabetes numbers are higher among indigenous populations. Elamurugan et al. (2022) add that gestational diabetes mellitus (GDM) is prevalent in indigenous populations because of the existing social and structural determinants.
Genetic predisposition has also been discussed as one of the factors contributing to the disproportionate effect on the populations. Leung (2016) reports that diabetes mellitus significantly contributes to the higher morbidity and health disparities among First Nations when compared to the non-Aboriginal groups. This prevalence ranges between 2.7% and 19%, which is higher- 3 to 5 times in comparison to the non-indigenous cohort (Leung, 2016). Genetic and biological factors are linked to these high numbers based on an explanation that the indigenous peoples acquired the “thrifty gene” from their hunter-gatherer lifestyle, and with evolution, they were able to conserve energy during starvation and harsh environmental changes. Leung (2016) explains that the thrifty gene theory would then be modified into the “thrifty phenotype” theory, which is argued based on maternal malnutrition and lack of exercise and starvation after birth, hence the predisposition to obesity and diabetes. Therefore, the disproportionate effect of diabetes as a chronic illness on the indigenous peoples is attributed to their lifestyle in their earlier years, which has contributed to their genetic makeup.
How Colonization and History Has Impacted the Disproportionate Diabetes
Colonization and the history of the indigenous peoples are characterized by intergenerational trauma stemming from colonization activities like forced displacement, cultural assimilation policies- especially residential schools, and systemic discrimination. A majority of these factors have had significant impacts on the communities’ health and well-being, given the traumas contribute to social and psychological stressors that can increase the risk of chronic diseases like diabetes. Lewis et al. (2021) support the role of trauma in contributing to the risk of diabetes by explaining that cultural connection and enculturation can protect against cardiometabolic disease, which was not the case for the indigenous peoples who were traumatized for generations. Not only do Lewis et al. (2021) admit to the existence of a relationship between indigenous-specific traumatic life experiences and increased risk for cardiometabolic disease, but they also give insights that mental health and psychophysiology are significant determinants. Therefore, alienation from their culture was contributing to their poor mental health, as well as insufficient culturally competent healthcare services. Significantly, mistrust has been a big issue because of the trauma, and the indigenous peoples shy away from healthcare systems given the already preconceived cultural insensitivity and safety.
The signing of treaties between Indigenous peoples and the Canadian government is part of the Indigenous history that often resulted in the displacement of Indigenous communities from their traditional lands and resources. Moreover, this displacement caused a disruption of traditional lifestyles and access to traditional foods, contributing to the adoption of less healthy diets. Halseth (2019) writes that ever since the Indian Act got into effect, the indigenous peoples of Canada’s health has been negatively impacted by strikes on their traditional economies and foods that they have been using to sustain themselves for decades. In other words, the assimilation attempts also affected the type of meals consumed, hence compromising their immune systems. The same goes for the Sixties Scoop, which saw children being taken away from their way of life, causing disruption to the cultural connections and the subsequent psychological stressors that are known to contribute to chronic diseases like diabetes. In general, Halseth (2019) quotes de Leeuw, Lindsay, and Greenwood (2015), that colonization, through its effects on the cultures and identities of Indigenous communities, is recognized as the most fundamental factor influencing the health of Indigenous populations and it continues to exert a significant and persistent influence on the well-being of Indigenous peoples, remaining a dynamic and ongoing presence in their lives.
TRCC and Call to Action 19
The indigenous peoples have taken part in advocacy processes, including change of policies to include the indigenous communities in national processes and benefits to remove systematic inequalities. One of these strategies is the Truth and Reconciliation Commission of Canada (TRCC), which was to address the legacy of residential schools in Canada and promote reconciliation between Indigenous and non-Indigenous peoples. TRCC is part of the Indian Residential Schools Settlement Agreement, a class-action lawsuit settlement between the Canadian government, churches, and Indigenous peoples who were affected by the residential school system (Weiss, 2015). The main mandates of the commission were to document the history and impact of residential schools on Indigenous peoples and their communities and provide a forum for survivors of residential schools to share their experiences and testimonies. TRCC also developed recommendations for reconciliation and healing between Indigenous and non-Indigenous peoples, in which Call to Action #19 is derived.
Call to Action #19- Legacy: Health
Call to Action #19 (Appendix A) takes note of the existing gaps in healthcare and calls for the Federal government to work in collaboration with the indigenous peoples to set specific, measurable objectives that aim to address the disparities in health outcomes between the Indigenous peoples and non-indigenous cohort. The commission also suggests that the annual progress reports be published, which is meant to show accountability and progress in actualizing the wishes of the commission. At the same time, tracking and publishing trends are one of the strategies TRCC seeks to ensure transparency alongside the accountability of the government in addressing the health needs of the indigenous communities.
What Achieving Call to Action #19 Means for Diabetes in Indigenous Communities
TRCC calls for annual progress reports to be published and the long-term trends to be assessed by the federal government. Getting action, such that the annual reports are published, means that the disparities in diabetes rates will be identified with regard to the indigenous communities and non-indigenous groups. At the same time, when the disparities are known, it will allow for the development of measurable goals, i.e., the indigenous communities will work collaboratively with the government to reduce the gaps in diabetes rates between Indigenous and non-Indigenous communities, especially in the prevalence, management and control, and diabetes-related complications.
The call to action also includes chronic disease incidences, which it hopes that fulfilment will have proved accountability. As identified earlier, social determinants also influence the disproportional rates of diabetes among the indigenous communities, meaning that achieving call #19 will address the social determinants of health, which significantly impact the diabetes numbers in these communities.
Conclusion
Indigenous history and colonization, disparities, and genetic predisposition play a significant role in understanding why diabetes rates are high among the indigenous peoples. Including the TRCC in advocacy was meant to understand how the federal government and indigenous communities are addressing the social determinants of health to promote prevention and education and monitor progress. Nonetheless, achieving the #19 call to action can reduce the prevalence and improve the management and control of diabetes.
References
Cheran, K., Murthy, C., Bornemann, E. A., Kamma, H. K., Alabbas, M., Elashahab, M., Abid, N., Manaye, S., & Venugopal, S. (2023). The Growing Epidemic of Diabetes Among the Indigenous Population of Canada: A Systematic Review. Cureus, 15(3), e36173. https://doi.org/10.7759/cureus.36173
de Leeuw, S., Lindsay, N.M., & Greenwood, M. (2015). Introduction – Rethinking determinants of Indigenous peoples’ health in Canada. In M. Greenwood, S. de Leeuw, N.M. Lindsay, & C. Reading (eds.), Determinants of Indigenous peoples’ health in Canada: Beyond the social (pp. xi-xxix). Toronto, ON: Canadian Scholars’ Press.
Elamurugan, K., Esmaeilisaraji, L., Strain, J., Ziraldo, H., Root, A., MacDonald, H., … & Ysseldyk, R. (2022). Social inequities contributing to gestational diabetes in indigenous populations in Canada: a scoping review. Canadian Journal of Diabetes, 46(6), 628-639. https://doi.org/10.1016/j.jcjd.2022.05.003
Halseth, R. (2019). The prevalence of type 2 diabetes among First Nations and considerations for prevention. Prince George, BC: National Collaborating Centre for Aboriginal Health. https://www.nccih.ca/docs/health/RPT-Diabetes-First-Nations-Halseth-EN.pdf
Leung L. (2016). Diabetes mellitus and the Aboriginal diabetic initiative in Canada: An update review. Journal of family medicine and primary care, 5(2), 259–265. https://doi.org/10.4103/2249-4863.192362
Lewis, M. E., Volpert-Esmond, H. I., Deen, J. F., Modde, E., & Warne, D. (2021). Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan. International journal of environmental research and public health, 18(4), 1821. https://doi.org/10.3390/ijerph18041821
TRCC. (2015). Truth and Reconciliation Commission of Canada: Calls to Action. https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf
Weiss, J. J. (2015). Challenging Reconciliation: Indeterminacy, Disagreement, and Canada’s Indian Residential Schools’ Truth and Reconciliation Commission. International Journal of Canadian Studies, 51, 27-56. https://doi.org/10.3138/ijcs.51.27
Appendix A: Call to Action # 19
“We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes Calls to Action between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services” TRCC, 2015)
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