In 2021, the world marked the 100th anniversary of the groundbreaking discovery of insulin, a momentous achievement that forever transformed the landscape of diabetes care, offering a ray of hope to countless individuals. Yet, as we reflect on a century of progress, it is abundantly clear that diabetes persists as a prevalent chronic disease in Canada.
Type 2 diabetes is the most widespread form of diabetes, affecting over 3 million Canadians. What is even more concerning is that the impact of diabetes continues to surge, with a staggering 6.1% of Canadian adults are deemed prediabetes, and an elevated risk of developing Type 2 diabetes contributing to the annual growth rate of 3.3% (Public Health Agency of Canada, 2022).
Type 2 diabetes is complex with multiple risk and contributing factors such as family history, race and ethnicity, socioeconomic status, older age, smoking, poor nutrition, physical inactivity and overweight or obesity, (Centers for Disease Control and Prevention, 2022). Furthermore, the consequences of Type 2 diabetes are severe, encompassing blindness, kidney failure, heart attacks, strokes, lower limb amputations, and, in the worst cases, premature mortality (Pan American Health Organization, n.d.).
In Canada, specific communities including First Nations, Métis, and individuals of African, East Asian, and South Asian heritage, experience notably higher rates of Type 2 diabetes. These disparities are driven by social determinants of health, systemic racism, and for our indigenous peoples the lasting effects of colonization (Public Health Agency of Canada, 2019). Socioeconomic factors also play a pivotal role in shaping an individual's capacity to manage their diabetes effectively, significantly influencing the risk of diabetes-inflicted health complications (Public Health Agency of Canada, 2022).
Multilevel Understanding of Health
The Social Ecological Model Applied to Type 2 Diabetes
Navigating the complexities of Type 2 diabetes and its wide-ranging influences, the social ecological model proves to be an invaluable framework. This model delves into how various levels of influence interact to mold an individual's health and well-being, recognizing that individuals are intricately connected to their environment and social context, emphasizing that health is not solely the result of individual choices but rather a complex interplay of factors across various levels (Ventura, 2021).
When applying this model to the context of Type 2 diabetes, it becomes imperative to scrutinize the multifaceted factors at various levels that contribute to its prevalence and management.
Individual Level
At the heart of this model lies the individual level, where the spotlight is on personal determinants including genetics and lifestyle factors. In the context of type 2 diabetes, this implies that certain individuals may have an inherent genetic predisposition to the condition. However, some may develop it due to unhealthy dietary habits, a sedentary lifestyle leading to unhealthy weight, or obesity. Notably, insulin resistance is a common occurrence in overweight individuals, often leading to the onset of Type 2 diabetes (Wonkmkun, 2020).
Crucially, an individual's health-conscious lifestyle choices can serve as a potent defense, delaying the onset or even preventing the condition. However, it is vital to recognize that a significant aspect of individual focus is centered on the adherence to care management, encompassing medication compliance and self-care behaviours in Type 2 diabetes (Hernandez-Tejada, M., Campbell, J., Walker, R, et al., 2012). These measures collectively aim to mitigate the complications associated with this disease.
Interpersonal Level
Moving to the next level, interpersonal relationships, which encompass family, friends, and social support networks, hold the power to significantly influence an individual's diabetes management. This notion finds backing in the study by Hendryx et al. (2020), revealing that "beyond healthy behaviors like diet and physical activity, strong social relationships, particularly among older women, may play a vital role in diabetes prevention." Moreover, as demonstrated by Brinkhues et al. (2018), certain attributes within one's social network can diminish complications and should be factored into the formulation of strategies aimed at enhancing glycemic control, improving quality of life, and reducing cardiovascular complications. Interpersonal relationships wield considerable sway over a person's health, shaping behaviors, emotional well-being, and the support available for health-related choices.
Community Level
Advancing to the next tier of the model, we encounter the community level, which delves into the physical and social environment within which individuals reside. Here, we consider critical factors like accessibility of healthcare services, availability of nutritious food options, physical activity opportunities, and presence of community resources. At this level, communities can bolster or impede health, contingent on these determinants.
Supportive of the importance of this level, Diabetes Canada underscores the pivotal role of the built environment in enabling active transformations in public transportation access, walkability, and the availability of essential resources like food and community support. Features of the built environment not only serve as protective measures against the adverse effects of poverty but also create a conducive setting where individuals naturally engage in health-promoting behaviors. Consequently, policies that shape the built environment to support physical activity and the availability of wholesome foods offer a significant opportunity to foster health equity among the Canadian population, both in preventing and managing Type 2 diabetes.
This level further encompasses schools and workplaces, settings where policies and practices can exert a substantial impact on type 2 diabetes. For instance, schools can institute nutrition education programs and provide healthier meal choices for students. Simultaneously, workplaces can champion physical activity initiatives, explore screening programs, and offer comprehensive wellness and educational initiatives for their employees.
Societal Level
Finally, we delve into the societal dimension within the social ecological model. At the societal tier, many overarching social, economic, and cultural factors come into play. Socioeconomic disparities can profoundly impact an individual's susceptibility to Type 2 diabetes, with those of lower incomes often contending with limited access to nourishing food and essential healthcare resources. Cultural norms and values wield considerable influence, molding preferences in dietary choices and patterns of physical activity. Also, government policies hold considerable influence over diabetes prevention and management. These policies, whether linked to healthcare access, food labeling, taxation on sugary beverages, or public health campaigns, have the potential to either fortify or hinder endeavors aimed at tackling Type 2 diabetes on a population-wide scale.
Colonization in Canada provides an illustration of societal influences and cultural factors that have left a profound impact on Indigenous cultures and identities, making it a fundamental determinant of Indigenous peoples' health. The enduring effects of colonization, including the loss of traditional lifestyles and spirituality, displacement, marginalized land bases, sociocultural upheaval, assimilation, systemic disadvantages, socio-economic marginalization, and the erosion of community well-being, have intricately interwoven with the prevalence of Type 2 diabetes. These factors contribute to power imbalances, stress, racism, discrimination, and the enduring legacy of intergenerational trauma (National Collaborating Centre for Aboriginal Health, 2013).
In conclusion, the Social Ecological Model provides a comprehensive framework for understanding the various layers of influence that contribute to Type 2 diabetes in Canada. To effectively address this complex chronic disease, we must extend our comprehension beyond individual choices and encompass the broader spectrum of social, cultural, and environmental factors. By doing so, we can navigate the intricacies of diabetes and enhanced prevention and management, addressing this critical public health issue in Canada more effectively.
References
Brinkhues, S., Dukers-Muijrers, N., Hoebe, C., et al. (2018). Social Network Characteristics Are Associated With Type 2 Diabetes Complications: The Maastricht Study. Diabetes Care, 41(8), 1654–1662. https://doi.org/10.2337/dc17-2144
Centers for Disease Control and Prevention. (2022, July 28). What Causes Type 2 Diabetes. Diabetes. https://www.cdc.gov/diabetes/library/features/diabetes-causes.html
Hendryx, M., Nicholson, W., Manson, J., et al. (2019). Social Relationships and Risk of Type 2 Diabetes among Postmenopausal Women. The Journals of Gerontology, 75(7), 1597-1608. https://doi.org/10.1093/geronb/gbz047
Hernadez-Tejada, M., Campbell, J., Walker, R., et al. (2012). Diabetes Empowerment, Medication Adherence and Self-Care Behaviors in Adults with Type 2 Diabetes. Diabetes Technology & Therapeutics, 14(7), 630-634. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389377/
National Collaborating Centre for Aboriginal Health. (2013). Health Inequities and the Social Determinants of Aboriginal Peoples Health. https://www.ccnsa-nccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf
Pan American Health Organization. (n.d.). Diabetes. https://www.paho.org/en/topics/diabetes#:~:text=Diabetes%20is%20a%20major%20cause,these%20complications%20and%20premature%20mortality.
Public Health Agency of Canada. (2019). Inequalities in Diabetes in Canada [Infographic]. Canada.ca. https://www.canada.ca/content/dam/phac-
Public Health Agency of Canada. (2022, October 10). Framework for diabetes in Canada. Government of Canada.https://www.canada.ca/en/public-health/services/publications/diseases-conditions/framework-diabetes-canada.html?wbdisable=true
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