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Health care experiences of Indigenous people living with type 2 diabetes in Canada

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Authors:
Summary:

It is acknowledged that specific determinants contribute to inflated rates of diabetes and other illnesses among colonised peoples, negatively affecting disease management and outcomes in unique ways. These researchers explored the health care experiences of Indigenous people with type 2 diabetes, in an attempt to clarify how such determinants are embodied and enacted during clinical encounters. This study is part of a larger investigation known as “Educating for Equity” and forms one component of an international research collaboration between New Zealand, Australia and Canada. Five Indigenous organisations from the provinces of British Columbia, Alberta and Ontario were invited to participate in sequential focus groups and interviews concerning diabetes care. Participants self-identified as Indigenous, were aged ≥18 years, had type 2 diabetes, had received care from the same physician for the previous 12 months and spoke English. A phenomenological thematic analysis framework categorised patient experiences according to 4 themes: the colonial legacy of health care; the perpetuation of inequities; structural barriers to care; and the role of the health care relationship in mitigating harm.

Comment:
An important paper. Data shows that the greatest inequities in diabetes rates and outcomes exist between Indigenous and non-Indigenous peoples living in Australia and Canada. As I tell students, the common factor for Indigenous peoples’ poor health is not our genes but colonisation. The authors suggest a potential pathway from colonisation to health outcomes, with guidance on how to intervene at each step of the path.
Reference: CMAJ. 2017;189(3):E106-E112
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

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