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, an