Type 2 diabetes (T2D) is highly prevalent in Native communities across the United States. While the number of people with T2D varies between tribal nations, there are a few factors that have increased the number of people with T2D in these communities: colonization and its impact on traditional diets, food insecurity and discrimination and racism.
Colonization, food insecurity and health discrimination
Adverse events such as forced relocation, pandemics and discrimination have affected the diets of Native communities. They have been required to desert the natural resources used in their diets, which has contributed to an increase in malnutrition, a greater dependence on Western foods and a decrease in agriculture. Those who eat a Western diet are 2.5 times more likely to develop diabetes than Natives who follow a traditional diet.
Food insecurity also plays a role in the development of diabetes. This occurs when people don’t have access to enough food in order to live an active, healthy life. While 59 percent of the US population in 2014 lived within one mile of a grocery store, only 26 percent of people on tribal reservations did.
Food insecurity is connected to the high rates of diabetes in Native communities; people who are food insecure are two times more likely to live with obesity and diabetes than those who are not. Being food insecure also makes it more challenging to manage diabetes due to the lack of nutritious foods.
Discrimination and racism are also involved in impacting the health of people in Native communities. In 2019, a survey found that 23 percent of participants reported being discriminated against in US healthcare settings, while another 15 percent avoided healthcare visits because of possible discrimination.
Avoiding care from healthcare professionals can lead to more cases of undiagnosed diabetes and make diabetes harder to manage.
Diabetes in Indigenous communities
The International Diabetes Federation (IDF) recently hosted a webinar covering the impact of diabetes on Indigenous communities. The goals of the event were to promote the IDF’s Atlas Report on Diabetes and Indigenous Populations, recognize the challenges that people in Indigenous communities face when living with diabetes and provide recommendations in response to the increasing cases of diabetes in these populations.
Featuring experts in the field such as an Indigenous Health PhD candidate, the vice chair of the UN Permanent Forum on Indigenous Issues and a person from Nepal who lives with diabetes, the event discussed the IDF’s Atlas Report, resources to be used for advocacy and the difficulties of providing diabetes care to Indigenous Peoples in Brazil and Nepal.
The IDF’s 2022 Atlas Report found a consistent increase in diabetes among Indigenous populations around the world, and it’s estimated that the prevalence of diabetes is over ten percent.
Recommendations for addressing the high number of diabetes cases in Indigenous communities include:
- Looking at the successful practices used in countries that have low diabetes prevalence
- Applying traditional Indigenous foods and practices for prevention
- Exploring the higher prevalence of diabetes among women versus men
- Increasing the reporting of the age-specific prevalence of T2D to determine physiological changes
- Conducting future research by and with Indigenous Peoples
Advice from a Navajo dietitian
Though traditional food is often demonized and said to be unhealthy, Denee Bex, a Navajo Dietitian and Certified Diabetes Care and Education Specialist, has a message for her fellow Indigenous Peoples.
When asked what she wishes Indigenous and Native communities knew about their cultural food and diabetes, she said, “I wish my community knew that we don’t need to let go of our traditional and Native foods to manage diabetes. … Incorporating these foods can still help us manage our blood sugars. … [T]hey are not just nutritious, but also they honor our history of resilience and pride in our heritage.”
She emphasized that food is more than just nutrition; it is also love, our heritage and connection to the community.
Bex also shared that she wishes more people in her community knew there is no shame in developing diabetes or other chronic conditions. Because of the stigma around diabetes, many people don’t seek medical care until it’s too late.
Diabetes also isn’t as simple as what you eat and if you exercise or not. In reality there are many factors that go into its development including stress levels, sleep patterns, family history, age, genetics and even intergenerational and historical trauma.
In addition, Bex shared that Native communities are three times more likely to be in poverty than non-Natives, and there is often limited access to grocery stores, basic utilities, clean water and inclusive healthcare services.
While it’s important to discuss challenges these communities face, she said we also need to brainstorm solutions to them. She recommends offering non-judgmental nutrition and diabetes education, creating handouts with pictures and supporting indigenous farmers.
Teaching basic cooking and diabetes management skills, providing transportation to medical appointments or health events, focusing on budget-friendly recipes and working closely with mental health professionals to address trauma were other suggestions from Bex.
Resources for Native communities
There are a variety of resources available to help mitigate problems with food access and improve the treatment of diabetes.
The Special Diabetes Program for Indians (SDPI) provides grants to 301 programs in 35 states to help decrease the number of people who suffer from diabetes and its complications.
In addition, the Navajo Nation Special Diabetes Project promotes healthy lifestyles while decreasing and preventing the number of people who have diabetes in the Navajo community.
Taking a personalized approach to diabetes management makes it easier to stick to your treatment plan. Personalizing your approach should also include taking cultural considerations into account. Find out more about why diabetes care should be tailored to each person’s culture here!
Editor’s Note: This content was made possible with support from Lilly, an active partner of Beyond Type 2 at the time of publication.