Determinants of Wellness: A Perspective on Diabetes and Indigenous Health

      It is well established that Indigenous populations of all ages experience higher rates of diabetes, particularly type 2 diabetes (T2D) and gestational diabetes (
      • Gracey M.
      • King M.
      Indigenous health part 1: Determinants and disease patterns.
      • Chrowshoe L.
      • Dannenbaum D.
      • Green M.
      • Henderson R.
      • Naqshbandi Hayward M.
      Clinical practice guidelines: type 2 diabetes and indigenous peoples.
      ). The social (and sometimes structural) determinants of health (SDOH) provide a framework for describing inequities in health outcomes related to race and ethnicity, income, education, housing, built environments, food security and other factors unique to social contexts. Although SDOH disaggregated by Indigenous status have provided some insight into drivers of health inequity, caution must be exercised when findings are generalized across Indigenous peoples. Pan-Indigenous research flattens diverse cultures, communities, realities and data into a single “Indigenous” identifier. Although it may not be intentional, pan-Indigenous approaches lead to erroneous conclusions and possibly harmful interventions that risk perpetuating health inequities. In Canada, researchers must understand the differences between the 3 federally recognized Indigenous Peoples (First Nations, Métis and Inuit), but, more importantly, the diversity within groups and the plurality of knowledge systems.
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