Is Being Māori a Risk Factor for Diabetes?

… Understanding What ‘Risk’ Really Means

If you’ve ever completed a diabetes risk assessment, you may have come across a question about ethnicity. For many people in Aotearoa, that moment can feel uncomfortable.

So why does being Māori or Pacific appear in a health questionnaire?
Does it mean something is inherently wrong?
Is diabetes somehow “in the genes”?

These are important questions — and the answers are not as simple as they might seem.

For a long time, I understood this increased risk in fairly straightforward terms. I associated it with ethnicity, and assumed genetics played a central role. It seemed like a logical explanation.

But as I’ve come to better understand the experiences of tangata whenua — the people of this land — and the broader context of health in Aotearoa, that explanation has felt increasingly incomplete.

There is a much bigger story behind these patterns.

What do we mean by “risk”?

In health, risk is about probability — the likelihood that something may happen over time.

When we say a group has a “higher risk” of type 2 diabetes, we are not making a statement about every individual in that group. We are describing a pattern observed across a population.

Some Māori will never develop diabetes.
Some non-Māori will.

Risk is not destiny.

Why does ethnicity appear in risk tools?

You’ll often see ethnicity included alongside factors like age, weight, and family history.

This is not because ethnicity directly causes diabetes.

Instead, ethnicity is used as a proxy — a stand-in for a range of underlying influences that are harder to measure quickly in a simple tool.

In Aotearoa, these influences include:

• Differences in access to healthcare
• Socioeconomic conditions
• Food environments
• Housing and neighbourhood factors
• The ongoing impacts of colonisation
• Experiences of racism and bias within systems

When these factors cluster within populations, patterns emerge. Risk tools pick up those patterns.

The problem with how this can be interpreted

While ethnicity improves the accuracy of risk prediction at a population level, it can easily be misunderstood.

It can sound like:

• “Māori are high risk”
• “Pacific people are more likely to get diabetes”

Without context, these statements can feel like they are describing something inherent or biological.

But that’s not what the data is telling us.

The risk is not located in identity itself — it is located in the conditions people are more likely to experience.

What about genetics?

Genetics can play a role in type 2 diabetes risk for all populations.

However, there is no single “Māori gene” or “Pacific gene” that explains the higher rates of diabetes seen in Aotearoa.

In fact, genetic variation within populations is often greater than between them.

Biological explanations alone cannot account for:

• The scale of inequities
• The rapid rise in diabetes over recent decades
• The clear links with social and environmental conditions

Emerging research in epigenetics suggests that long-term exposure to stress and disadvantage can influence how genes are expressed across generations. But again, this points back to environments — not fixed traits.

Population risk vs individual reality

This is where confusion often arises.

At a population level, ethnicity helps identify groups who are more likely to be affected.

At an individual level, your risk depends on your own circumstances — including:

• Your lifestyle
• Your environment
• Your access to care
• Your whānau history
• Your broader life context

Ethnicity is just one piece of a much larger picture.

Should ethnicity be used at all?

This is an ongoing conversation in health.

Including ethnicity in risk tools can:

• Help identify people earlier
• Improve prevention efforts
• Highlight inequities that need addressing

But it also carries risks:

• Reinforcing the idea of biological difference
• Oversimplifying complex issues
• Undermining trust if not explained well

A more balanced approach is to:

• Use ethnicity carefully and transparently
• Clearly explain what it represents
• Focus on the underlying drivers of risk

A more useful way to think about it

Rather than asking:

“Is being Māori a risk factor for diabetes?”

A more accurate question is:

“What conditions are Māori more likely to experience in Aotearoa — and how do those conditions influence diabetes risk?”

This shifts the focus:

• Away from identity
• Toward systems, environments, and opportunities

Why this matters

How we talk about risk shapes how people feel — and how systems respond.

If risk is seen as inherent:

• It can lead to blame, stigma, or resignation

If risk is understood as contextual:

• It opens the door to change

Because the conditions that drive diabetes risk are not fixed; they can be improved.

The bottom line

Ethnicity does not cause diabetes.

But in Aotearoa, it can signal who is more likely to be exposed to the conditions that increase risk.

Understanding this helps us move beyond simple labels — and toward more effective, fair, and compassionate approaches to prevention and care.

Because ultimately, the goal is not just to predict risk; it’s to reduce it — for everyone.

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Published 30th May 2026

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