Type 2 diabetes is a health concern among Canada's First Nations and Inuit. First Nations on reserve have a rate of diabetes three to five times higher than that of other Canadians. Rates of diabetes among the Inuit are expected to rise significantly in the future given that risk factors such as obesity, physical inactivity, and unhealthy eating patterns are high.
Aboriginal Diabetes Initiative
Established in 1999, the Aboriginal Diabetes Initiative (ADI) had initial funding of $58 million over 5 years. It was then expanded in 2005 with a budget of $190 million over 5 years. Currently, Health Canada is investing over $50 million per year to support the ADI's third phase, as the Government continues supporting health promotion and diabetes prevention activities and services.
The goal of the ADI is to reduce type 2 diabetes among Aboriginal people by supporting health promotion and primary prevention activities and services delivered by trained community diabetes workers and health service providers. Renewed funding has enabled First Nations and Inuit communities to continue to build on past successes in more than 600 First Nations and Inuit communities throughout Canada.
The Aboriginal Diabetes Initiative delivers a range of primary prevention, screening and treatment programs in partnership with Tribal Councils, First Nations organizations, Inuit community groups and Provincial and Territorial governments.
Through these activities, the ADI supports prevention, health promotion, screening and care management initiatives that are community-based and culturally appropriate.
The renewed ADI features several areas of enhanced focus, including:
- Initiatives for children, youth, parents and families;
- Diabetes in pre-pregnancy and pregnancy;
- Community-led food security planning to improve access to healthy foods, including traditional and market foods; and
- Enhanced training for health professionals on clinical practice guidelines and chronic disease management strategies.
Using local knowledge, First Nations and Inuit communities are encouraged to develop innovative, culturally relevant approaches aimed at increasing community wellness and ultimately reducing the burden of type 2 diabetes. Community activities funded through the ADI vary from one community to another, and may include walking clubs, weight-loss groups, diabetes workshops, fitness classes, community kitchens, community gardens and healthy school food policies. The ADI also supports traditional activities such as traditional food harvesting and preparation, canoeing, drumming, dancing, and traditional games.
Phase 3 of the ADI continues to support health promotion and diabetes prevention projects for First Nations and Inuit living outside their traditional communities and Métis through the Urban First Nations, Inuit and Métis Diabetes Prevention (UFNIMDP) Stream. A continued effort to strengthen linkages and better integrate with federal/provincial/territorial and First Nations, Inuit and Métis partners is emphasized to enhance health promotion and diabetes prevention activities.
The ADI recently concluded a request for applications process for the UFNIMDP stream which provides time-limited, proposal-based funding for culturally relevant diabetes prevention and health promotion projects. As a result of this process the UFNIMDP stream is now funding 28 diabetes prevention and health promotion projects across Canada reaching First Nations, Inuit and Métis populations.
The ADI supports a network of community workers trained in diabetes prevention and health promotion, through continuing education and sharing of information, tools and best practice models.
Budget 2005 provided $190 Million over five years to strengthen community-based diabetes promotion and prevention activities, increase the number of health service providers, and improve screening and treatment services. This phase of ADI was based on four key components.
Primary Prevention and Health Promotion
A wide range of community-led and culturally relevant health promotion and prevention activities have been offered in over 600 First Nations and Inuit communities to promote diabetes awareness, healthy eating and physical activity as part of healthy lifestyles.
Activities have varied from one community to another, and have included walking clubs, weight-loss groups and fitness classes, community kitchens and gardens, and a range of activities for children in schools. Aboriginal Diabetes Initiative projects, working with local schools, have developed healthy food policies. An important consequence has been the removal from many schools of vending machines that sell sugar-sweetened soft drinks and high-sugar, high-fat snacks to children.
Community-based initiatives have included traditional activities such as berry picking, picnics, dancing, and games. These have important social benefits and also enable communities to preserve and share valuable traditional knowledge.
Some communities have chosen to invest in treadmills and stationary bicycles in order to increase options for physical activity; many, in order to meet growing demand, add new equipment to their fitness centre each year. Partnerships are of particular benefit to fitness activities: community members using school facilities outside school hours, for example, or community-based police officers and others acting as coaches.
Creativity has been evident in community programming as health workers have sought to engage more and more people in activities. The well-known formats of games and television programmes have been adapted to become effective educational tools. Visual aids, such as puppet shows, sketches and other interactive activities and materials have been used to demonstrate the benefits of healthy foods or the effects of diabetes. Cooking classes for all ages have employed a range of approaches to highlight various health-promoting methods for preparing local foods.
Screening and Treatment
The Screening and Treatment component of the Aboriginal Diabetes Initiative has supported increased and regular screening for the early diagnosis of diabetes complications, and has provided education and support for people living with diabetes and their family members. The goal has been to increase diabetes self-management and establish links in order to improve the coordination and integration of services.
Currently, there are mobile diabetes screening initiatives in place in four regions (British Columbia, Alberta, Manitoba and Quebec). In other regions, screening is carried out through local healthcare providers. Some communities have formed partnerships with neighbouring provincial healthcare services to increase screening opportunities.
Capacity Building and Training
The Capacity Building and Training component of the Aboriginal Diabetes Initiative has supported training for 300 community diabetes workers. Community diabetes prevention workers act as a focal point for diabetes prevention activities and work in partnership with healthcare professionals and other members of their community. Continuing education has also been supported for health professionals and para-professionals working in communities in areas such as diabetes education, health promotion, foot care, and cultural competency. Regional Multi-Disciplinary Teams provide subject matter expertise to communities in areas including diabetes, nutrition, and physical activity.
Research, Surveillance, Evaluation, Monitoring
Within this component of the Aboriginal Diabetes Initiative, there have been several priorities. These have included the following:
- establishing partnerships with appropriate research agencies and organizations to jointly fund priority research;
- supporting the Canadian First Nations Diabetes Clinical Management Epidemiologic (CIRCLE) Study to determine the quality of diabetes healthcare in 19 First Nation communities;
- supporting evaluation studies and monitoring of programming at the local, regional and national levels.
Primary Prevention for Métis, Off-reserve Aboriginal and Urban Inuit
The second phase of the ADI also supported a component for Métis, Off-reserve Aboriginal and Urban Inuit Promotion and Prevention (MOAUIPP), which has provided time-limited, proposal-based funding for culturally relevant diabetes prevention and health promotion projects for these Aboriginal populations. Sixty-six (66) projects were funded between 2006 and 2010.
In 1999, the Canadian Diabetes Strategy (CDS) was funded at $115 M over five years and included the Aboriginal Diabetes Initiative (ADI) as a key component. Given the magnitude of the problem among First Nations, the Aboriginal Diabetes Initiative was allocated $58 M of the total $115 M budget. This funding allowed a foundation of awareness to be built in order to implement prevention and health promotion programs in Aboriginal communities. As part of the CDS, the ADI intended to increase awareness of type 2 diabetes and reduce the incidence of its complications among Aboriginal people.
In summary, the Aboriginal Diabetes Initiative has encouraged communities to address their own needs, building on their strengths and drawing on their traditions, in order to help community members prevent diabetes where possible and offer support to help manage or delay the condition effectively when it occurs. First Nations and Inuit communities are innovative in their approaches to tackling diabetes, forming strong partnerships where needed, employing local knowledge, and working together to reduce the burden of type 2 diabetes.
For more information about the Aboriginal Diabetes Initiative, please contact the Inter-Professional Advisory and Program Support Directorate (IAPSD). You can also contact the Regional Program Offices for information on regional programming.
Please consult the Aboriginal Diabates Initiative Program Framework 2010–2015 for more information on the program elements.
For examples and best practices on how to delay and prevent the onset of type 2 diabetes in Aboriginal communities, consult the Communities in Action report.
To help you become more active in your every day life, consult the Public Health Agency of Canada Tips to Get Active for children, youth, adults and older adults, and to learn more about the new Canadian Physical Activity Guidelines, visit the Canadian Society of Exercise Physiology.
For information about eating well, check out Canada's Food Guide for First Nations, Inuit and Métis. You can also find general information on Health Canada's Food and Nutrition page.
For information about cessation of smoking and the effects of smoking on diabetes, visit the Quit 4 Life Program, and the Go Smoke Free Program.
The Reports and Publications section offers guides, fact sheets and reports on a variety of health-related topics. You can also use the online ordering system to explore and order printed material.
Request for Applications — Knowledge Development and Exchange Component of the Healthy Living Program.
The Public Health Agency of Canada, in partnership with Health Canada's First Nations and Inuit Health Branch (FNIHB), announced the launch of a solicitation to support the development of tools and resources to support intermediaries who work with First Nations, Inuit and Métis in promoting physical activity as a way to help Canadians lead healthier lives. This invitation to submit an application is now closed. Should you still want to know about it for information purposes, you may visit the Knowledge Development and Exchange Component of the Healthy Living Program web site.
- Diabetes in Canada: Facts and figures from a public health perspective
- Communities in Action — Aboriginal Diabetes Initiative
- Aboriginal Diabetes Initiative Program Framework 2010–2015