Diabetes and Inequities Among Māori and Pacific Peoples in Aotearoa
Diabetes prevalence in Aotearoa New Zealand is significantly higher among Māori and Pacific peoples compared with non-Māori, non-Pacific populations. These inequities are not attributable solely to lifestyle factors or genetics, they are also strongly associated with the ongoing effects of colonisation, socioeconomic disadvantage, and systemic inequities in health and social systems.
Let’s take a closer look…
Epidemiology
Prevalence: Māori are approximately twice as likely to have type 2 diabetes as non-Māori. Among Pacific adults, prevalence is higher still, with some community surveys reporting rates of up to 25%.
Age of onset: Māori and Pacific peoples are more likely to develop type 2 diabetes at a younger age than Pākehā, increasing lifetime risk of complications.
Complications: Māori and Pacific peoples experience disproportionately higher rates of diabetes-related renal failure, cardiovascular disease, lower-limb amputations, and premature mortality. Pacific peoples in particular have some of the highest amputation rates internationally.
Historical and Structural Determinants
Colonisation: Traditional food systems, based on local cultivation, fishing, and gathering, were disrupted through land alienation and restrictions on access to natural resources. Diets shifted towards introduced, energy-dense but nutrient-poor foods (e.g. refined flour, sugar, processed meats).
Socioeconomic inequities: Māori and Pacific communities are more likely to live in areas of high deprivation, experience overcrowded housing, and face financial barriers to accessing healthy food and healthcare.
Systemic barriers: Experiences of racism and discrimination within the health system contribute to delayed diagnosis, reduced access to effective treatment, and poorer engagement with services.
Biological and Intergenerational Factors
Thrifty gene hypothesis: Some researchers suggest that populations historically exposed to feast–famine cycles may have a genetic predisposition towards efficient fat storage, which in modern environments increases susceptibility to type 2 diabetes.
Epigenetics and intergenerational trauma: Emerging evidence indicates that colonisation, systemic racism, and intergenerational stress can influence gene expression, potentially contributing to increased metabolic risk across generations.
Protective and Culturally Grounded Approaches
Evidence shows that interventions are more effective when they are culturally anchored and community-led. Examples include:
-
Marae-based programmes that integrate tikanga Māori with lifestyle and health promotion activities.
-
Church-based and community-driven initiatives in Pacific communities that combine health education with spiritual and cultural practices.
-
Food sovereignty projects such as māra kai and Pacific food production initiatives that reconnect communities with traditional practices and improve access to healthy food.
-
Kaupapa Māori and Pacific health providers, which deliver care in culturally safe, holistic ways that address both social and health needs.
The high prevalence of diabetes among Māori and Pacific peoples is the result of complex interactions between historical, socioeconomic, biological, and systemic factors. These inequities are not inevitable. Addressing them requires:
-
Investment in Indigenous and Pacific-led health services.
-
Policies that improve access to affordable, healthy food and safe housing.
-
Elimination of racism within the health system.
-
Recognition of Indigenous and Pacific knowledge systems as integral to effective diabetes prevention and management.
