September 5, 2023
The impact of type 2 diabetes on global Indigenous Populations
Type 2 diabetes disproportionately affects Indigenous Populations worldwide, making the condition in these communities a global health emergency.
By Justine Evans
Approximately 476 million Indigenous People live in 90 countries, just over 6% of the global population. Although there is incredible diversity within and across each population’s culture, history and relationship with member states and national governments, one of the most consistent observations has been an increase in type 2 diabetes among many Indigenous Peoples. Diabetes is now one of the most common health disparities that disproportionately impacts these populations worldwide.
Meanwhile, some Indigenous communities show low rates of type 2 diabetes and no signs of an increase. Experts attribute this to keeping traditional foods that are naturally low glycaemic and practices and ceremonies that integrate movement. By encouraging these inherently healthy lifestyle choices, communities are able to safeguard against the condition.
The impact on women, indigenous children and future generations
Data published in The IDF Diabetes Atlas 11th Edition Report on Diabetes among Indigenous Peoples indicates that more than 10% of Indigenous Peoples live with type 2 diabetes, with a higher prevalence among Indigenous women.
According to Dr Emily Papadimos, paediatrician and paediatric endocrinologist, preconception, pregnancy and lifespan stages are critical to preventing childhood obesity and type 2 diabetes. She stresses the need to support the health and well-being of mothers and children, particularly in the first years of life.
Most young people affected by type 2 diabetes will have a first-degree relative living with the condition. And so, the child may have inherited a genetic susceptibility to developing type 2 diabetes, which, when coupled with sedentary lifestyles and disruptions to food systems, increasing rates of obesity and the presence of other adverse social determinants of health, may precipitate their risk of developing type 2 diabetes``, Dr Emily Papadimos, Paediatrician and Paediatric Endocrinologist (Australia).
Studies worldwide have examined the association of women with gestational diabetes during pregnancy and shown them to be more at risk of developing type 2 diabetes later in life. One study, Chamberlin and colleagues 2016, found that Indigenous Australian women have more than a fourfold risk of developing type 2 diabetes within eight years of having gestational diabetes. These findings issued an urgent call for improving postpartum screening among Indigenous women in Australia with gestational diabetes.
The prevalence of type 2 diabetes increases with age. Although uncommon in Indigenous children, in some Indigenous Populations, type 2 diabetes is now more common in young people than type 1 diabetes. The previously mentioned studies also found that children born to mothers with gestational diabetes are at greater risk of developing type 2 diabetes, thus creating an intergenerational cycle among Indigenous communities.
The role of food systems and cultural reclamation
Cultural reclamation is another essential aspect of addressing type 2 diabetes in Indigenous communities. Courtney Fischer-Claussen, MPH and Indigenous Health PhD Candidate, North Dakota State University, has emphasised in her work that sustaining Indigenous culture and reclaiming traditional practices is vital to Indigenous People’s overall health and well-being.
It's important to note that not all Indigenous Nations have seen a consistent increase in type 2 diabetes, and a number of nations have little to no diabetes prevalence. But for those who have seen rapid and consistent increases, many studies often point to acculturation and adopting a Western lifestyle, including the disruption of food systems and Indigenous ways of life through colonisation,`` Ms Courtney Fischer-Claussen, MPH and Indigenous Health PhD candidate (USA).
Increasing evidence supports the theory that the consumption of traditional Indigenous foods can modify diabetes outcomes. Through colonisation, the food system in many Indigenous communities is dominated by highly processed food, contributing to the cycle of diabetes in younger and younger generations.
The Traditional Foods Program in the US is one example of initiatives to strengthen traditional food cultures and promote Indigenous food preservation. Using traditional foods and sustainable ecological approaches for health promotion and type 2 diabetes prevention in American Indian and Alaska Native communities was a 6-year cooperative agreement that championed 17 tribal programmes. The tribal programmes worked to restore access to local, traditional foods and physical activity to promote health.
Improving information and support for Indigenous communities
Indigenous-led awareness campaigns are key to understanding and reducing the risk of type 2 diabetes. Global diabetes advocates and policymakers highlight the need for strength-based approaches, agreeing that all approaches must integrate Indigenous People into healthcare decisions and systems to break the intergenerational cycle of diabetes.
One such example of this comes from Canada, where efforts are underway to address diabetes among Indigenous Populations through a national framework. The framework recognises the disproportionate impact of diabetes in these communities and aims to provide a comprehensive approach to prevention and management. It seeks to empower Indigenous communities and promote culturally appropriate resources and interventions by collaborating with Indigenous leaders, health professionals and community members.
The Role of Policy and Advocacy
Policy and advocacy play crucial roles in addressing diabetes disparities among Indigenous Populations. The 76th World Health Assembly resolution on the health of Indigenous Peoples calls for a global action plan to be submitted to the World Health Assembly in three years. Geoffrey Roth, Vice-chair of the UN Permanent Forum on Indigenous Issues, stresses that this plan needs to cover multiple diabetes-related determinants in Indigenous communities, such as lifestyle nutrition, physical activity, socioeconomic status, urbanisation and health outcomes strongly related to diabetes.
As part of the support for indigenous involvement, the United Nations Permanent Forum on Indigenous Issues provides Indigenous leaders and advocates opportunities to raise awareness and influence policy decisions. By engaging in these dialogues, Indigenous Peoples can ensure their voices are heard, and their health concerns are addressed globally.
We must take advantage of the momentum that our collective efforts have created through the approval of the World Health Assembly's Indigenous Health resolution, and we need to utilise examples of existing Indigenous evidence-based practices and tools as a springboard for advancement,`` Geoffrey Roth, Vice-chair of the UN Permanent Forum on Indigenous Issues.
To reinforce Indigenous involvement, the Permanent Forum members are advocating for the creation of a high-level Indigenous Advisory Group to assist in implementing the WHO resolution and drafting the plan. Members also suggested using the Indigenous Determinants of Health study as a framework since it is a tool to educate policymakers on the risk and protective factors holistically connected to Indigenous health.
The growing prevalence of type 2 diabetes among Indigenous communities, especially among Indigenous women, necessitates culturally responsive and community-tailored approaches. Efforts to reduce the risk of and manage type 2 diabetes should address the unique challenges that Indigenous Populations face, including access to healthy food, cultural reclamation and limited information and support.
For more insights on the causes and impact of type 2 diabetes on Indigenous Populations:
Tune in to the dedicated episode of D-Talk, the podcast series of the International Diabetes Federation.
How advocacy can make an impact
Watch the IDF online event held on 24 August that explores the prevalence of type 2 diabetes among Indigenous Peoples and looks at government and community initiatives and programmes from Brazil, Canada, Nepal and the USA.
Justine Evans is Content Editor at the International Diabetes Federation