New research presented at the World Diabetes Congress in Vancouver, Canada — organized by the International Diabetes Federation (IDF) — has produced the unexpected finding that First Nations Canadians most exposed to discrimination have the lowest prevalence of diabetes. These and other findings are presented by Roland Dyck, MD, of the Canadian Center for Health and Safety in Agriculture, University of Saskatchewan in Saskatoon, Canada, and colleagues.
Aboriginal (First Nations) peoples in Canada are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonisation. The purpose of this study was to investigate the possible role of racism, residential school attendance, and cultural disruption on diabetes occurrence among First Nations adults.
This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognised factors such as age, sex, lifestyle, and social determinants; and also colonisation-related factors.
Responses were obtained from 874 (56%) men and women aged 18 and older living in 406 (70%) households. Diabetes prevalence was 16% among women and 10% among men. As with people of all ethnicities, increasing age and adiposity were significant predictors of diabetes, with those First Nations people aged over 50 eight times more likely to have T2D than those under 30; and those with a body mass index (BMI) of over 30 almost 9 times more likely to have diabetes compared to those with a normal BMI (18.5-25).
Residential school attendance and cultural disruption were not predictive of diabetes in this study but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4% versus 13.6%). Those experiencing the most discrimination were more likely to be employed or students, married, and to have higher incomes.
Explaining these unexpected findings, Dyck says: “Known diabetes risk factors were important individual-level determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not. In contrast, those experiencing the highest levels of discrimination had very low levels of diabetes. While the reasons underlying this latter finding remain unclear and require validation, it appears to relate to increased engagement with society outside of the predominantly First Nations reserve communities from which they come.”
“If confirmed, our findings emphasise a difficult dilemma faced by First Nations peoples,” he continues. “Those who spend more time off-reserve to seek work and educational opportunities may experience an improvement in their social determinants of health which are known to have certain physical health benefits. However our findings suggest that this is offset by a high emotional price resulting from exposure to increased levels of discrimination in a largely non-Indigenous environment.”
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