Diabetes and Inequities Among Māori and Pacific Peoples in Aotearoa

Diabetes is not experienced equally in Aotearoa New Zealand. Māori and Pacific peoples are significantly more likely to develop type 2 diabetes, to be diagnosed at a younger age, and to experience serious complications.

These differences are often described as “health disparities.” But that language can soften what is, in reality, a pattern of inequity — differences that are systematic, avoidable, and unjust.

This matters, because how we describe the problem shapes how we respond to it.

Looking beyond individual risk

Māori are around twice as likely to live with type 2 diabetes compared with non-Māori, and prevalence among Pacific communities is higher still. Diagnosis often occurs earlier in life, increasing lifetime exposure to high blood glucose and the risk of complications.

Rates of renal failure, cardiovascular disease, amputations, and premature mortality are all disproportionately higher.

These patterns are sometimes framed in terms of individual behaviour or genetic susceptibility. But this framing is incomplete.

The conditions people live in — and the systems they interact with — play a far greater role.

The role of history and Systemic structure

The roots of diabetes inequities in Aotearoa are deeply tied to colonisation.

Land loss, disruption of traditional food systems, and restricted access to natural resources fundamentally altered how Māori communities lived, ate, and sustained wellbeing. Similar patterns of disruption and migration have shaped Pacific communities.

Over time, this has been compounded by:

• Higher exposure to socioeconomic deprivation
• Barriers to accessing affordable, healthy food
• Housing conditions that make health management more difficult
• Health systems that are not always culturally safe or accessible

These are not random factors. They are patterned and persistent.

Systems still matter today

Inequity is not only historical — it is ongoing.

Access to diabetes medications, technologies, and services is shaped by policy decisions. Criteria that appear neutral can still disadvantage those who are already underserved.

When access frameworks do not account for differences in need, the result is predictable: those at highest risk are often least likely to benefit.

Addressing inequity requires more than equal access. It requires equitable access — recognising that different groups may need different levels and types of support to achieve similar outcomes.

Moving carefully with biology

Biological explanations, such as the “thrifty gene” hypothesis, have been proposed in the past. However, these do not adequately explain the scale or pattern of inequities seen today.

Focusing too heavily on biological differences risks reinforcing the idea that these outcomes are inevitable.

They are not.

Emerging research in epigenetics suggests that long-term exposure to stress, disadvantage, and trauma can influence metabolic health across generations. Importantly, this points back to environments and systems — not fixed traits.

What makes a difference

There is strong evidence that approaches grounded in culture, community, and connection are more effective.

These include:

• Kaupapa Māori health services that centre whānau and holistic wellbeing
• Pacific-led initiatives that integrate cultural and spiritual values
• Marae-based and church-based programmes that build trust and engagement
• Food sovereignty initiatives that reconnect people with traditional practices

These approaches do more than deliver care — they restore agency and connection.

From understanding to action

Diabetes inequities in Aotearoa are not inevitable. They are the result of systems, environments, and decisions.

Which means they can be changed.

Progress requires:

• Investment in Māori and Pacific-led health solutions
• Policy that improves access to healthy food, housing, and care
• Health systems that actively eliminate racism and bias
• Recognition of Indigenous and Pacific knowledge as essential, not optional

Most importantly, it requires a shift in perspective.

From asking:
“What is wrong with this group?”

To asking:
“What conditions have been created — and how do we change them?”

Because equity is not about treating everyone the same.

It is about ensuring everyone has a fair opportunity to live well with, or without, diabetes.

 

A note on ethnicity and risk

Statistics are often presented in terms of ethnicity — for example, that Māori and Pacific peoples have higher rates of type 2 diabetes. It’s important to understand what this means, and what it doesn’t.

Ethnicity itself is not a direct cause of diabetes. Rather, it reflects patterns in lived conditions. In Aotearoa, people who identify as Māori or Pacific are, on average, more likely to be exposed to environments and experiences that increase diabetes risk — including barriers to healthcare, socioeconomic disadvantage, and the ongoing impacts of colonisation.

This means that while ethnicity can help identify patterns at a population level, it does not determine an individual’s future, nor does it imply that these outcomes are inevitable.

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This post was originally published 1st October 2025
Page updated 30th May 2026

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