Introduction
The indigenous population in Canada suffers disproportionately from diabetes. Multiple variables, including diet, lifestyle, environment, and heredity, have contributed to the dramatic rise in diabetes prevalence among indigenous populations. Significant socio-cultural transformations in the lifestyle and environment of Canada’s aboriginal peoples, especially the Metis and Inuit populations. Additionally, they have been documented since the latter half of the twentieth century, have had severe consequences for people’s health, and have contributed significantly to the increased prevalence of diabetes among this population. A lack of physical exercise, unhealthy eating habits, being overweight, and being obese are undesirable choices; however, an unhealthy lifestyle is a significant risk for developing type 2 diabetes, especially among indigenous populations.
There are substantial health and socioeconomic inequalities between aboriginal people living on and off reservations, whether in rural or urban settings. One’s access to higher education and job options is limited while living in a rural region. The aboriginal population’s health is negatively impacted by medical care, inadequate housing, and inadequate access to clean and healthy food (“Diseases That May Affect First Nations and Inuit Communities,” n.d.). Geographical hurdles, language difficulties, financial barriers, and the lack of culturally appropriate treatments all contribute to the lack of access to health care that members of the Aboriginal community face. The obstacles above affect the prevalence of type 2 diabetes in indigenous communities, limiting access to effective treatment, prevention, and care (Food and Nutrition | HealthLink BC, n.d.). Many scientists have speculated that a genetic predisposition to diabetes, dubbed the “thrifty gene effect,” may account for the disease’s disproportionately high incidence among indigenous communities. It is hypothesized that repeated bouts of famine due to the indigenous Canadians’ hunting lifestyle made them genetically inclined to economize on food intake. However, because of changes in diet and lifestyle, indigenous cultures are at a greater risk of developing diabetes.
Since poverty is pervasive in first nations communities, many people cannot afford healthy meals. In September 2016, researchers from the University of Calgary analyzed data from 70,631 indigenous people and 2,779 people of non-indigenous backgrounds. Neither group was 18 years old (Food and Nutrition | HealthLink BC, n.d.). From birth forward, aboriginal males have a 75.6% lifetime chance of developing diabetes, while aboriginal women have an 87.3 % risk. At birth, the risk for non-Aboriginal males was 55.6%; for non-Aboriginal women, it was 46.5% (Food and Nutrition | HealthLink BC, n.d.). According to studies, prevalence rates among Canadians range from 2.7% to 30% (Food and Nutrition | HealthLink BC, n.d.). The statistics show the population of persons suffering from the disease.
Description of Health Disparity
Diabetes mellitus is a chronic illness that severely threatens world health. With a projected growth of 214% from the year 2000 to 2030, there exists a rising prevalence of diabetes in both emerging and wealthy nations (Yazbeck & Soucat, 2019). Compared to non-Aboriginal Canadians, the community of Canada—which includes the First Nations, Inuit, and Metis—has a much higher morbidity rate and a more significant health gap due to diabetes mellitus (Brock et al.,2021). In light of this, the Federal Government of Canada developed the Aboriginal Diabetes Initiative (ADI) in 1999 as a component of the larger Canadian Diabetes Strategy to offer a more robust framework for surveillance, public education, and community-based care of diabetes. ADI originally had a 5-year cycle planned (Brock et al., 2021). However, it was twice renewed with total financing of C$523 million between 2005 and 2010 and then again in 2011. Given the ADI’s long history of operation and the enormous amount of money being invested, it is essential to examine the background information and pertinent data that had influenced the ADI and, more importantly, to critically assess the advantages and impacts of the ADI in terms of the social inequalities.
Additionally, the health of Canada’s First Nations and Inuit is affected by type 2 diabetes. Diabetes is three to five times more common in First Nations people living on reservations than in the rest of Canada. Since risk factors, including obesity, physical inactivity, and bad eating habits, are prevalent, diabetes rates among the Inuit are predicted to climb dramatically in the future. Therefore, the Aboriginal Diabetes Initiative (ADI), launched in 1999, received $58 million in initial financing spread over five years. Then, in 2005, it was enlarged with a $190 million five-year budget (Carraway & Lavin, 2022). As the government continues to promote health promotion and diabetes preventive initiatives and services, Health Canada is now providing more than $50 million annually to support the ADI’s third phase.
Health Promotion Strategy
This financing laid the groundwork for introducing preventative and health promotion strategies in Aboriginal communities. Therefore, the Aboriginal Diabetes Initiative (ADI) was a crucial part of the Canadian Diabetes Strategy (CDS), which received $115 million in funding over five years in 1999 (Alam, 2020). Given the severity of the issue among first nations, $58 million of the $115 million budget was allotted to the Aboriginal Diabetes Initiative (Alam, 2020). The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
The strategy involved decreasing the prevalence of type 2 diabetes among Aboriginal people by promoting health and funding primary prevention programs and services provided by community diabetes educators and other qualified healthcare professionals. In more than 600 First Nations and Inuit communities throughout Canada, renewed financing has allowed communities to continue building on prior achievements (Alam, 2020). The Aboriginal Diabetes Initiative works with Tribal Councils, First Nations organizations, Inuit community groups, and Provincial and Territorial governments to implement a variety of primary prevention, screening, and treatment initiatives.
How the Strategy Addresses Health Disparity
To increase community wellness and eventually lessen the burden of type 2 diabetes, First Nations and Inuit communities are urged to adopt creative, culturally appropriate strategies using local knowledge. Walking clubs, weight-loss groups, diabetic seminars, fitness programs, community kitchens, community gardens, and healthy school food policies are a few examples of community initiatives that may be sponsored via the ADI and vary from town to community (Olson & Albensi, 2021). The ADI encourages daily pursuits, including gathering and preparing traditional cuisine, kayaking, drumming, dancing, and customary games.
The Urban First Nations, Inuit, and MĂ©tis Diabetes Preventive (UFNIMDP) Stream of Phase 3 of the ADI continues to fund health promotion and diabetes prevention initiatives for MĂ©tis and First Nations people who live outside of their traditional areas. Enhancing health promotion and diabetes prevention initiatives calls for a sustained effort to fortify connections and better integrate with federal, provincial, territorial, First Nations, Inuit, and MĂ©tis partners.
The UFNIMDP stream, which offers time-limited, proposal-based financing for culturally appropriate diabetes prevention and health promotion programs, just had its request for proposals procedure closed by the ADI. Due to this procedure, the UFNIMDP stream currently supports 28 diabetes prevention and health promotion initiatives targeting First Nations, Inuit, and MĂ©tis communities across Canada (Olson & Albensi, 2021). The ADI promotes a network of community workers who have received it by providing ongoing training and encouraging the exchange of knowledge, resources, and best practice models. Additionally, $190 million was allocated in Budget 2005 over five years to improve screening and treatment services, expand the number of healthcare providers, and promote community-based diabetes promotion and preventive initiatives. This ADI phase was built on four essential elements.
Meeting Health Promotion Requirements
The strategy chosen gets to meet the requirements for health promotion since in more than 600 First Nations and Inuit communities, a wide range of community-led and culturally appropriate health promotion and prevention programs have been made available to raise awareness of diabetes, encourage good eating, and encourage physical exercise as parts of healthy lives (Richards et al., 2019). Additionally, walking clubs, exercise programs, weight-loss organizations, community gardens, and various school-based activities for kids have all been among the activities that have varied from town to community. Collaborating with nearby schools, the Aboriginal Diabetes Initiative initiatives have created healthy food policies (Richards et al., 2019). The elimination of vending machines from many schools that sold youngsters high-sugar, high-fat foods and sugar-sweetened sodas has resulted in significant.
Traditional events like picnics, dancing, and games have been a part of community-based efforts. These enable communities to conserve and disseminate priceless conventional knowledge and have significant social advantages. Furthermore, to extend the alternatives for physical exercise, some cities have opted to invest in treadmills and stationary bicycles; many fitness centers install new equipment yearly to keep up with demand. Fitness programs benefit significantly from partnerships, such as when community members use school facilities after school hours or when local law enforcement officials serve as coaches.
Community programming has displayed creativity as health professionals have worked to involve many individuals in activities. Adapting popular game and television show forms has created practical instructional tools. Visual aids have been utilized to illustrate the advantages of nutritious diets or the impacts of diabetes, such as puppet shows, drawings, and other interactive activities and materials. Various strategies have been used in cooking workshops for people of all ages to emphasize different health-promoting techniques for preparing regional cuisine.
The Aboriginal Diabetes Initiative’s Screening and Treatment component has encouraged expanded and frequent screening for the early detection of diabetes complications and has given persons with diabetes and their families information and assistance. The objective has been to improve service integration and coordination while increasing diabetic self-management. Therefore, the initiatives for mobile diabetes screening are now in four locations (British Columbia, Alberta, Manitoba, and Quebec) (Beaubien-Souligny et al., 2022). In certain areas, screening is done by neighborhood healthcare practitioners. Several villages have partnered with nearby provincial healthcare providers to boost screening chances.
Barriers to Accessing Health Promotion Strategy
Based on the challenges, only a tiny percentage of doctors claimed to recommend patients to particular lifestyle treatments or programs in their clinics or neighborhoods. There were several obstacles and facilitators found. The primary issues that patients face as barriers are a lack of willingness to make lifestyle changes, limited funding, a lack of treatments with a history of success, and a lack of knowledge of neighborhood health promotion initiatives. The presence of a PN, teamwork with other disciplines, and accessibility to interventions in their practice are the most often mentioned facilitators (Jaeger et al., 2019). Six distinct GP types were discovered regarding attitudes, ranging from “ignorer” to “nurturer” and representing the primary subjects that connect to perspectives (Jaeger et al., 2019). Nearly all of the themes relevant to PNs’ opinions regarding initiatives for health promotion were favorable.
Additionally, the care that Indigenous peoples get is hampered by several obstacles. These affect how frequently and effectively people can manage their diabetes. These obstacles include fragmented health care, a dearth of culturally appropriate treatment, inadequate management of chronic diseases, a high staff turnover rate in the medical field, persistent underfunding of health services for Indigenous people, and insufficient monitoring of new cases of diabetes. Traditional healing methods, medicines, knowledge, and well-being are not reflected in western medicine. Indigenous people’s health has been harmed by social and economic injustices brought on by colonialism, such as oppression, cultural extinction, forced displacement, forced assimilation, and institutionalized racism. These disparities also influence the primary risk factors for the onset of type 2 diabetes and its consequences.
Evidence that the Strategy is Effective
Therefore, Diabetes Canada is dedicated to assisting in culturally appropriately reducing the diabetes burden in Indigenous communities. We firmly pledge to carry out this commitment in a manner that respects and upholds the Calls to Action of the Truth and Reconciliation Commission of Canada. This entails a promise to do all the reorganizations swear to prevent harm to Indigenous peoples and mitigate the damage done by Canada’s long history of colonial regimes. Diabetes Canada is dedicated to engaging in dialogue with and supporting Indigenous-led groups to foster partnerships based on mutual respect and decency. We wish to support Indigenous-led initiatives, interventions, and policy development in whatever way these organizations see fit.
The Food Skills for Families Program (FSFP) is a successful example of a program promoting a healthy diet. The British Columbia Ministry of Health provided the funding through the ADI, while the Canadian Diabetic Association oversaw its administration. This FSFP is a continuing initiative that debuted in September 2008. It educated community facilitators who provide a 6-week curriculum to schools and communities, including lectures and culinary demonstrations. These initiatives were to educate the Aboriginal people on nutrition and culinary techniques and to increase capacity in the target areas by training community facilitators who would reach out to implement the program. Therefore, help improve child nutrition and food security initiatives in the community and academic settings. Up to 16,000 Aboriginal adults and children have benefited from 660 programs that 328 community facilitators had given by the end of June 2013 (Jacklin et al., 2017). The Train-the-Trainer program uses master trainers who are nutritionists to assure sustainability. An online curriculum was created with the option to request a DVD version to make it easier for students to refer to their fundamental knowledge.
Examples of Current Use of Strategy
The SLICK initiative immediately eliminates healthcare disparities caused by geographic and accessibility barriers for Aboriginal patients with diabetes by providing hardware and software in mobile units to deliver screening and medical advice on the spot. The FSFP addressed access and networking constraints by deploying community facilitators to Aboriginal villages and schools, which were underserved in terms of health education (Hay, 2018). Before attending the FSFP, Aboriginal participants listed a lack of nutritious recipes as the top four typical barriers to healthy eating; Healthy food is too expensive; Healthy cooking techniques are unknown, and Healthy food is strange. The number of participants reporting the same four obstacles dramatically decreases after completing the workshop, except that nutritious food is too expensive.
Discussion
Between Aboriginal communities and the government health care providers, the mobile unit from SLICK serves as a shuttle to bridge social and cultural divides. This assisted in eradicating the social injustices brought on by racial and cultural isolation, which may breed widespread mistrust and alienation. There was agreement in the FSFP assessment report that the program significantly improved social connections and interactions across various communities and parties by enabling participants to meet new acquaintances, exchange phone numbers, and host other participants at their homes for meals. Additionally, participants reported feeling more motivated to encourage their kids and other family members to lead better lifestyles through increased physical activity and wholesome meals. This promotes family values and lessens societal injustices brought on by dysfunctional households.
Rating of Strategy Effectiveness
A key aim is to improve diabetes diagnosis and screening among indigenous people. Programs for diabetes education and assistance should be adapted to the requirements of native populations. There is a tremendous opportunity for improvement in diabetes research involving Canadian indigenous peoples and funding for projects aimed at preventing and treating the disease. Individuals must remember that indigenous health is a complex issue requiring various treatments. Collaboration between the federal, provincial, and territory governments, indigenous communities, and healthcare professionals will be necessary to reduce diabetes among Canada’s indigenous population.
Recommendations
Native Canadians experience a variety of health problems in addition to diabetes. Other crucial issues include access to programs for diabetes education and support that are appropriate for indigenous people’s cultures and improved diabetes screening and diagnosis among this population. In Canada, there is a chance to advance research on diabetes and indigenous peoples through increasing funding for diabetes prevention and treatment programs. Governments, healthcare providers, researchers, and communities must collaborate to assist indigenous Canadians with diabetes. Indigenous people in Canada suffer from a severe health issues with diabetes. Numerous elements, including a dearth of culturally appropriate educational and therapeutic initiatives and inadequate access to preventative healthcare, are responsible for this issue—a rise in the amount of money allocated to research & development of healthcare.
A multi-stakeholder approach is required to enhance the health of indigenous people in Canada. Diabetes is a big issue among native Canadians that might be significantly reduced with better screening, treatment, and education programs (Jaeger et al., 2019). Diabetes affects not just indigenous peoples but also their families, friends, and communities among the indigenous inhabitants of Canada. While there are many contributing factors, improving education and intervention programs for indigenous communities can help reduce some risk factors, such as poverty, a lack of access to healthcare, poor eating habits, and a lack of physical exercise.
Conclusion
The population health problems affecting Canada’s indigenous people with diabetes are varied and intricate. Regarding diabetes and Canada’s indigenous population, there are several possibilities, goals, and suggestions. Improving diabetes screening and diagnosis among indigenous people should be a top focus. Another ultimate goal is to provide indigenous people with access to diabetes education and support services suitable for their cultural context. Additionally, there are several chances to advance Canadian indigenous people and diabetes research and raise money for organizations that prevent and cure diabetes. Ultimately, it is critical to remember that indigenous people’s health is a complicated issue that calls for a multifaceted response. Collaboration between the government and healthcare organizations will be necessary to address diabetes among indigenous people in Canada.
References
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