Chapter 11: Endocrine System and Diabetes
Amanda Perkin
Social Determinant Considerations and Culturally Responsive Practice Points for Health Care Providers
Chronic conditions, like diabetes, are seen at much higher rates in Black and Indigenous populations on Turtle Island than in White populations. This has been very easily misconstrued as a genetic difference between racial populations (Chadha, Lim, Kane, & Rowland, 2020; Hogarth, 2017). However, there is growing evidence that these disparities in incidence are attributed to the social determinants of health and racism, not race. This conclusion is supported by the WHO. Race is a social construct, not a biological one, and there is more genetic variation within racial groups than there is between groups (Chadha et al., 2020; National Human Genome Research Institute, 2023). Reducing the explanation of health disparities to a genetic difference in race is “misleading, ignores structural factors that perpetuate disease and tends to perpetuate notions of racial inferiority and negative stereotyping” (Chadha et al., 2020, p. 12). This is a dangerous cyclical paradigm that has real effects on real people’s lives, and it must be interrupted.
Diabetes will present in people the same way, and the objective physical assessment will not change. However, it is present at disproportionate rates in Black and Indigenous populations, which also experience higher rates of complications of this chronic condition (Diabetes Canada, n.d.). A full and accurate assessment for diabetes includes the subjective assessment, which is where you will find the most important information. There is a stigma around this diagnosis, and people often feel like they did something to cause it or they didn’t do enough to prevent it (Diabetes Canada, n.d.). There is also a feeling of blame or shame when blood sugar levels cannot be controlled within a normal range (Diabetes Canada, n.d.; National Indigenous Diabetes Association [NIDA], n.d.). When this happens, people may not be open with their health care provider about what is affecting them (Diabetes Canada, n.d.; NIDA, n.d.). There are also many people who cannot afford their medications or insulin and who therefore start to ration the medications they have access to. This leads to higher blood glucose levels and higher rates of burden of disease (Dawson, 2018; Diabetes Canada, n.d.; NIDA, n.d.).
Food security, or access to healthy foods, can be another issue. There is also a huge misunderstanding of what “healthy food” consists of. Canada’s food guide has historically been depicted as a plate with sections of four food groups that show a typical North American diet. The most recent update of this guide does make room for cultural considerations. However, the uptake in application at the clinical level is lacking. As a result, there can be misinterpretations of what a diabetic diet can look like. For example, plain white rice is considered a food that should not be consumed beca