Diabetes rates have exploded in recent years. And unfortunately, some groups are at higher risk than others. According to a recent study, about 8 in 10 First Nations young adults will develop diabetes in their remaining lifetime.
The study also found that rural First Nations people had a higher lifetime risk that those who lived in urban environments.
For many healthcare professionals, these findings will come as no surprise. But they do highlight some important diabetes-related questions that haven’t received enough attention recently. For example: why is there a discrepancy between First Nations people in the city vs those in more remote settings?
Both rural First Nations patients and those living on reserves face unique barriers to high-quality diabetes care. Looking ahead, healthcare practitioners and policymakers must work to understand the risk factors and the role environment plays.
In this post, we’ll look at some of the obstacles the healthcare system needs to address.
Limited availability of nutritious foods
Weight can play a major role in the development of type 2 diabetes. Once a person has been diagnosed, a poor diet (especially one that’s high in refined sugars) can lead to complications. A whole host of negative consequences, such as nerve damage, can result.
So, how does diet impact diabetes rates in rural and remote communities?
In the United States, the concept of food deserts has received a lot of media attention in recent years. There are areas where fresh fruit and vegetables—along with other nutritious whole foods—are scarce.
Similar factors are at work in many First Nations communities. In addition to limited access to fresh foods, the availability of processed items that are high in fat and sugar is an issue. Needless to say, these conditions don’t bode well for diabetes rates—nor do they set up diabetic community members for success.
Only by investigating the factors contributing to this situation—including historical oppression—can policymakers begin to address them.
Luckily, communities are taking steps toward remedying the problem. As one example, community greenhouses are improving the availability of fruit and vegetables in the North.
Poor access to health care practitioners
In general, rural and remote communities face unique healthcare challenges. But in remote First Nations communities, care can often be described accurately as substandard.
Dr. Michael Kirlew is an outspoken critic of the healthcare resources available in these communities.
In front of a recent standing committee, Kirlew explained that crucial medications—such as painkillers—are often in short supply on reserves. He also highlighted the lack of access to specialist care, such as mental healthcare, speech language therapy, and autism therapy.
It goes without saying that these issues can have serious implications for community members with diabetes. For self-care activities, insulin and glucose-testing devices are often crucial. And in many cases, managing the disease requires help from experts such as endocrinologists and dieticians.
With the right policies, the government can begin to address medication and supply challenges. But access to specialized care is an especially tricky issue due to the geographic distances that are often involved.
Luckily, advanced communication and information-sharing technologies can help to close the gap. Connecting patients and practitioners over long distances enables better support for patients in remote communities.
According to the Northern Health authority in British Columbia, “the goal of cultural safety is for all people to feel respected and safe when they interact with the health care system.”
All practitioners should feel comfortable supporting the idea behind this statement. That said, cultural safety is about more than putting an effort toward eliminating racism and discrimination in healthcare.
Providing culturally safe care means building trust with First Nations patients, communicating respect for patient beliefs, and recognizing the role of socioeconomic conditions. (This information comes from a Canadian Medical Association Journal article that can be found here.)
Why is this concept so important in treating diabetes—and specifically, patients with diabetes who live in remote communities?
Diabetes is a chronic disease that requires ongoing management. From frequent glucose testing to careful adherence to dietary and lifestyle changes, patients must be collaborators in their own care.
Of course, patients who have had negative experiences with the healthcare system are less inclined to seek the help they need. And without intervention, prediabetes is far more likely to become full-blown diabetes. Without support, patients who already have diabetes are far less likely to engage in rigorous self care.
Nursing stations in many First Nations communities have been found to provide substandard care (sometimes with tragic consequences). Needless to say, these aren’t places where every patient feels safe.
If policies—and attitudes—evolve to embrace cultural safety in a real way, diabetes care (and care in general) is bound to improve.