The Indigenous peoples of Canada have shown great resilience through many acts of settler-colonialism. One of the modern fallouts of colonization are the systemic inequities in healthcare for Indigenous peoples. A notable example of this reality is the growing diabetes epidemic in the Indigenous peoples of Canada. Systemic change is necessary to tackle this ongoing disparity in health. One method of addressing this problem is through the HI-5 method using multilevel model of health known as the Health Impact Pyramid.
The Health Impact Pyramid is used to address various social determinants of health at different levels of public health interventions (Frieden 2010). The lower tiers impact larger populations and require less effort from an individual, as the tiers go up, smaller population groups are impacted, and interventions require a higher individual effort (Frieden 2010). The bottom tier: socioeconomic factors, relates to systemic changes regarding social determinants of health. From a public health standpoint, at this tier, systemic changes regarding determinants of health would be addressed in a health intervention setting (Frieden 2010). The second tier involves public health officials changing the environment in which the population resides in order to have them make healthier decisions (Frieden 2010). The third tier: long-lasting protective interventions, involves clinical methods that can address the problem in one visit for the long-term (Frieden 2010). The fourth tier involves clinical interventions, consistent medical care that is accessible (Frieden 2010). Finally, the top tier involves the education of the general public and counselling to provide context and understanding to the population (Frieden 2010).
HI-5 method, or Health Impact in 5 years is based upon the Health Impact pyramid, and focuses on the bottom two tiers, as they impact most of the population involving the least amount of individual effort (CDC 2021). In the case of the diabetes epidemic within the Indigenous population of Canada, the HI-5 approach could lead to meaningful and effective change. 17.2% of Indigenous peoples living on-reserve, 12.7% off-reserve, 4.7% of Inuit peoples, and 9.9% of Métis people suffer from diabetes compared to 5.0% of the general population (CDA 2023). Poorly developed social determinants of health, lack of access to healthcare, lack of income, and lack of healthy food choices in communities are all causes of this epidemic (Cheran et al. 2023).
The diabetes epidemic must be addressed on all levels of public health policy, the HI-5 method can be the catalyst to lasting systemic changes. To begin, addressing socioeconomic factors such as: access to childcare, access to work opportunities and income, and access to healthcare could greatly improve the daily lives of Indigenous Canadians. Next, changing the environment in which decisions are made by implementing programs at school that encourage physical activity and healthy eating habits, healthy cooking classes for adults, and reducing prices for healthy foods in supermarkets on-reserve, are all essential steps to diminishing diabetes rates. These changes, implemented through the HI-5 method, would certainly lead to a future in which Indigenous Canadians are less susceptible to diabetes.
References
CDC. (2021). HI-5: Health Impact In 5 Years. https://www.cdc.gov/policy/hi5/docs/hi5-overview-v6.pdf
Cheran, K., Murthy, C., Bornemann, E., Kamma, H., Alabbas, M., Elashahab, M., Abid, N., Manaye, S., & Venugopal, S. (2023). The Growing Epidemic of Diabetes Among the Indigenous Population of Canada: A Systematic Review. California Institute of Behavioral Neurosciences & Psychology. https://doi.org/10.7759/cureus.36173
Canadian Diabetes Association [CDA]. (2023). Indigenous communities and diabetes. Retrieved 24 October 2023 from https://www.diabetes.ca/resources/tools---resources/indigenous-communities-and-diabetes
Frieden, T. (2010). A framework for public health action: the health impact pyramid. Am J Public Health. 100(4): 590-5 https://doi.org/10.2105/AJPH.2009.185652
Wix. (2023). Diabetes [Image]. https://www.wix.com
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