In November 2017, the Institute of Health Economics hosted a pan-Canadian policy roundtable on diabetes care and management in Indigenous populations. The roundtable focused on best practices to effectively engage Indigenous communities and populations in diabetes prevention, care and management. The overarching theme from the roundtable focused on approaching care and Indigenous health differently, including Indigenous culture(s), values, worldviews and traditions as foundations in the development, implementation and evaluation of healthcare programming.
The following key themes and lessons were presented:
Historical influences and past experiences
Diabetes is inextricably linked to historical and ongoing cultural, social, political and economic factors and processes such as poverty, food insecurity, intergenerational trauma, mental health and racism. These factors must be addressed in order for diabetes treatments to be effective.
Community leadership and ownership
Care programs were improved when they were community-initiated and community-led. Further, community leadership is key in ensuring that community needs are heard, and that programming is delivered in a way that respects and upholds Indigenous culture, traditions, beliefs and values.
Working with and supporting communities
It is important to recognize the need for and benefits of community leadership and to develop them by having supportive processes and understanding from government policy, researchers and care providers. Indigenous communities and populations should be treated as a partner and these require trust, respect, honesty and reciprocity to be effective which take time, commitment and investment.
Patient and provider education
Patient knowledge is important in diabetes for effective self-management and can serve to empower and motivate patients. As this is missing in Indigenous communities and populations, it is important for healthcare providers to be aware of this and they may benefit from educating themselves on effective approaches to educate patients and facilitate knowledge transfer.
Collaboration and holistic care
For Indigenous peoples, the concept of health is defined holistically. Therefore, an approach which captures this by addressing the holistic well-being of patients and not just diabetes-related treatments is important to consider. Such approach relies on communication, collaboration and coordination between healthcare providers as well as other community services.
Program population coverage
All programs highlighted in the best practice presentations provided care and prevention programming to all age groups, supporting the development of healthy eating and living habits, and disease prevention, treatment and management across age groups which produce interesting opportunities for shared learning.
Jurisdiction and governance
The mix of federal, provincial and community responsibility for the delivery of health services in many Indigenous communities create ambiguity and unclear accountabilities and responsibilities between the partners. This then becomes even more complicated due to bureaucratic red tapes and impede access to timely care for many Indigenous people.
Capacity and sustainability
The importance of building community capacity has been recognized as a key element of developing successful and sustainable diabetes programming. Further, this may also mitigate the impact of high healthcare provider turnover and lack of resources such as shortage of healthcare providers.
Health data and community knowledge
Information system and patient registries are the foundation for screening programs and are essential supports for proactive care. This should be implemented through work with communities to reduce issues of trust, privacy, data access and control as well as for the systems to be tailored for community needs.
Evaluation is important as it may have a major impact on the findings. Hence, it is important to acknowledge the differences in Indigenous and non-Indigenous knowledge paradigms as non-Indigenous methods are often emphasized and used.
Recommendations from the roundtable:
Formal mechanisms for Indigenous perspectives in program planning
- Indigenous health programming and policy should be developed in collaboration with Indigenous leadership and communities. They must be included and consulted
Formal articulation of principles for interaction
- Principles for interaction such as trust, respect, honesty and reciprocity should be explicitly articulated when working with Indigenous communities
- Active recruitment and development of workforce from community
- Sustained engagement and mechanisms to support the sharing and development of best practices and tools for evaluation
- Reduce barriers to comprehensive range of diagnostic and treatment modalities
- Integrated population health surveillance
For this roundtable, the Institute of Health Economics received funding from Boehringer Ingelheim Canada, a pharmaceutical company that produces the diabetes drug Jardiance.
Photo Credit: Northern Journal.