The Social-Ecological Model and Factors that Influence the Rise in Diabetes in Indigenous Women
- chantellemhs
- Jul 19, 2022
- 8 min read
Socio-ecological framework (Centre for Disease, 2022)
Ecological Model of Health - YouTube (Bedoya 2020)
There is a rise in diabetes prevalence rates; gestational diabetes; and an increasing rate of type 2 diabetes amongst Indigenous women (Hayward et al., 2017). Many Indigenous women suffer from diabetes complications and comorbidities in Canada (Hayward et al., 2017). Indigenous populations experience three times higher prevalence rates of gestational diabetes compared to non-Indigenous people in Canada (Government of Canada, 2011). Canada’s Constitution Act of 1882 recognizes three distinct Indigenous groups:
Indigenous/First Nations, Inuit, and Metis (Government of Canada, 2011). Data reveals a higher proportion of Indigenous women are diagnosed with gestational diabetes: 4.8% of the Indigenous/First Nation population, 4.0% of the Inuit people, and 2.2% of the Metis population (Government of Canada, 2011). Indigenous females experience higher rates of gestational diabetes than non-Indigenous females (Government of Canada, 2011). Diabetes and gestational diabetes are complex health issues that can be explained using concepts of the social-ecological model (SEM). SEM is the interaction between and interdependence of factors within and across all levels of a health problem (Rural Health Information Hub, n.d). It is based on the idea that an individual’s health is influenced by many factors, including physical, social, and political environments (Neufeld et al., 2020). It involves various levels of influence, including intrapersonal, interpersonal, institutional, community, and public policy, to understand better health and human behavior (Neufeld et al., 2020). More specifically, the model addresses and interprets how health and human behavior reflect one’s interaction with different social and political systems (Neufeld et al., 2020). After 1950 Indigenous people started to experience a rapid increase in diabetes, and now rates have reached epidemic levels in rural communities (Government of Canada, 2011). The burden of diabetes in both families and the overall healthcare systems in Canada is on a rapid incline, with prevalence rates more than doubled in the last decade (Hayward et al., 2017). More alarming are the widening health disparities for Indigenous peoples in Canada (Hayward et al., 2017). Indigenous women in Canada are disproportionately affected by type II diabetes and gestational diabetes versus Indigenous men (Neufeld et al., 2020). Why is this the case? It is thought that poor public policies, in combination with the eradication of Indigenous culture and the displacement of Indigenous people to rural environments, have negatively influenced the rise in diabetes amongst Indigenous women in Canada.
Indigenous women in Canada are facing barriers to optimal diabetes care due to government policies. Indigenous people experience barriers to accessing care that does not meet expected quality standards (Richardson & Crawford, 2020). Undoubtedly, optimal diabetes care is different and more pronounced in Indigenous communities in Canada than those experienced in non-indigenous communities due to a disjointed healthcare system (Neufeld et al., 2020). Social determinants of health are closely linked to the adverse health experiences that Indigenous people face (Richardson & Crawford, 2020). The World Health Organization (WHO) defines the social determinants of health as the condition in which people are born, grow, live, work, and age (Richardson & Crawford, 2020). Social determinants are closely related to the distribution of money, power, and resources and are driven by policy choices (Richardson & Crawford, 2020). WHO recognizes colonization as the single most significant social determinant of health among Indigenous people worldwide (Richardson & Crawford, 2020). It is evident in Canada that the Indigenous community does not have considerable money, power, or resources to better influence public policies to address their health care needs. This group has endured a long history of neglect and poor public policies that have negatively impacted their health. The Indian Act (Indigenous/First Nations) of 1876 gave the greater authority of the Department of Indian (Indigenous/First Nations) Affairs to intervene in a wide variety of internal issues and make policy decisions, including who would manage Indigenous resources and money; control access to intoxicants, and promote civilization (Government of Canada, 2017). The government would act as a guardian over the Indigenous population until they were fully integrated into Canadian society (Government of Canada, 2017). It is one of the most amended pieces of legislation in Canadian history. It “…became increasingly restrictive, imposing ever-greater controls on the lives…” of Indigenous people (Government of Canada, 2017). Shockingly, “racist attitudes and paternalism rationalized public health approaches that diminished Indigenous rights and sovereignty” (Richardson & Crawford, 2020). Colonialism in Canada contributed to creating the reserve system, removing children from families to attend residential schools, and many legislative policies intended to eradicate Indigenous people (Richardson & Crawford, 2020). Poor public policies on Indigenous women with diabetes have negatively influenced their health.
Indigenous culture influences the health practices of women who have diabetes. Indigenous communities are highly diverse, with many languages, traditions, and beliefs (Boyd & Furgal, 2019). A common trait of this community is that they often face more risks to health than non-Indigenous populations (Boyd & Furgal, 2019). There are disparities found among Indigenous women with diabetes rooted in colonialism which exploited their cultural practices (Neufeld et al., 2020). Colonialism tried to outlaw Indigenous culture (Richardson & Crawford, 2020). Undeniably this has affected the health of Indigenous women who have diabetes. United Nations declaration on the rights of Indigenous people revealed that this community often determines their paths to healing and health (Richardson & Crawford, 2020). Unfortunately, several communities did not implement risk reduction strategies to improve their health (Boyd & Furgal, 2019). Typical health preventative strategies were sometimes threatening or contradictory to Indigenous cultural practices and beliefs (Boyd & Furgal, 2019). For example, there were cases where Indigenous groups consumed contaminated food to follow their cultural traditions, even though it posed adverse effects on their health (Boyd & Furgal, 2019). Moreover, it is traditional in the Indigenous culture not to talk about death and disease as there is a belief it will call upon the ghosts of those who died, bringing potential harm to speakers (Boyd & Furgal, 2019). In addition, Indigenous people place a higher value on the identity of entire communities versus an individual’s identity (Boyd & Furgal, 2019). Researchers and others have often been criticized for not effectively communicating the health risks to this community (Boyd & Furgal, 2019). Poor communication strategies developed by healthcare institutions influenced Indigenous women’s health (Boyd & Furgal, 2019). Often these women did not receive effective health teaching that considered their Indigenous cultural practices to better address and improve their health care needs (Boyd & Furgal, 2019). The system was designed to destroy the rich cultures and suppress Indigenous history and identities (Government of Canada, 2022).
In addition, the rapid increase in diabetes in Indigenous women has been influenced by genetics, biological, environmental, and lifestyle factors (Government of Canada, 2011). Indigenous communities often have limited access to health care services due to geographic and language barriers, as well as access to culturally appropriate services (Government of Canada, 2011). These people often have inadequate housing, water, food, and income security (Richardson & Crawford, 2020). They are also a population recognized to be vulnerable to environmental health hazards due to their dependence and intimate relationship with local lands to practice their cultural traditions, health, and overall wellbeing (Boyd & Furgal, 2019). Environmental health hazards are defined as a factor that operates through the environment to affect human health (Boyd & Furgal, 2019). Environmental health hazards include exposure to contaminated food and pollution (Boyd & Furgal, 2019). There is often ineffective communication given to this group about environmental health hazards in their rural communities (Boyd & Furgal, 2019). Indigenous populations rely heavily on their environment, which provides critical aspects of their culture, sustenance practices, and wellbeing (Boyd & Furgal, 2019). There is also a significant gap in communicating environmental health risks to this population that is culturally appropriate (Boyd & Furgal, 2019). Colonialism removed Indigenous people from their traditional environments to live on reserves and attend residential schools (Richardson & Crawford, 2020). The federal government located reserves in remote locations, many of which were on swamplands or covered with dunes and ultimately far from service centres and essential goods (Government of Canada, 2017). They were relocated outside their traditional communities for treatment and segregated to culturally specific hospitals that provided health care not up to par compared to health centres in urban areas (Richardson & Crawford, 2020). Due to changing environments, displacement, hunting and fishing costs and restrictions, and loss of harvesting capabilities, fewer individuals consumed traditional foods, and there was a decline in physical activity amongst this group (Government of Canada, 2011). Today, Indigenous women face barriers to the availability and accessibility of primary healthcare services and professionals (Boyd & Furgal, 2019). Sociodemographic factors such as access to decent education, social services, and resources to improve their overall health are limited for this group (Boyd & Furgal, 2019). Ultimately, many rural Indigenous communities experience fewer opportunities for education and employment, “…as well as a safe and healthy food supply” (Government of Canada, 2011). Food security is the main contributor to the poor health of women with diabetes (Neufeld et al., 2020). Food systems are not simply made by individuals but are influenced by various social and environmental processes (Neufeld et al., 2020). Due to the displacement of the Indigenous community from their traditional lands and territories, Indigenous women experience a decreased ability to participate in their traditional food systems and economy (Neufeld et al., 2020). Lasting adverse health effects of colonization have disproportionately affected Indigenous women who have diabetes due to chronic food insecurity and undernutrition (Neufeld et al., 2020).
It is not hard to agree that the SEM explains how political policies such as colonialism, the eradication of the Indigenous culture, and environmental factors have influenced the rise in diabetes in Indigenous women. Indigenous communities face inadequate access to basic needs such as housing, clean water, healthy food, education, employment, income, etc., and disproportionately lower amounts of money, power, and resources. Public policies have not been able to develop viable strategies to decrease the rate of diabetes amongst Indigenous women. An amalgamative approach to caring for Indigenous women through their traditional cultural practices, effective risk management health teaching, and access to optimal healthcare could address this health issue. Allocating resources to improve their environments, such as proper access to clean water, sustainable healthy food systems, and quality health services, could ultimately improve their health.
Links:
Prevention is Key Handout
https://nada.ca/wp-content/uploads/2016/pdfs/NADA%20Resources/Prevention-is-key-handout.pdf
Gestational Diabetes: Your Guide to a Healthy Pregnancy.
Diabetes Care Sheet: Restoring Balance
https://nada.ca/wp-content/uploads/2016/pdfs/NADA%20Resources/Restoring-the-Balance-Diabetes-Care-Sheet.pdf
Ecological Model of Health - YouTube (Bedoya 2020)
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