Diabetes in Canada and Social Determinants
Diabetes continues to be one of the world’s fastest growing and most costly chronic illnesses, despite ongoing advancements in medical treatments, research, and emerging technologies such as artificial intelligence (AI). The global prevalence has reached an estimated 422 million people, while in Canada over eleven million people live with diabetes and prediabetes (Diabetes Canada, 2022). In Ontario alone, more than 1.6 million people live with diabetes and millions more are at high risk (Diabetes Canada, 2022). Although clinical innovation has accelerated, the rise in diabetes suggests that biomedical solutions alone are insufficient. Rather, the social determinants of health (SDoH), the social and structural conditions shaping daily life, play a substantial role in shaping diabetes risk, complications, and long-term outcomes. This is the lens that needs to be explored to emphasize inequities across socioeconomic groups, gender, and race with particular focus on indigenous communities and populations living in rural and remote regions.
Socioeconomic Inequities in Diabetes Prevalence
Socioeconomic disparities significantly influence the burden of diabetes in Canada. Browns and associates reported that diabetes prevalence has nearly doubled since 2000, and their analysis of national trends from 2004 to 2012 showed pronounced inequalities across social groups (Brown et. al., 2015). Individuals with lower educational attainment experienced markedly higher rates of type 2 diabetes compared to those with higher levels of education, and these disparities increased over time. For women, the absolute difference in prevalence between the highest and lowest education groups widened from approximately 2.5% to 4.5% for men, disparities grew from 1.4% to 2.3% (Brown et. al., 2015). These findings demonstrate that socioeconomic status is not merely correlated with diabetes risk. It fundamentally shapes a person’s exposure to risk factors such as food insecurity, chronic stress, and reduced access to preventative health care.
Indigenous Peoples, Colonization, and Structural Inequities
Indigenous communities disproportionately experience higher rates of diabetes due to the ongoing impacts of colonization, historic trauma, and systemic inequities embedded within the health and social systems. Diabetes prevalence among Indigenous peoples in Canada is estimated to be three to five times higher than in the non-Indigenous population, with earlier onset, faster progression and poorer outcomes (Jacklin et al., 2017). These inequities cannot be understood solely through individual behaviour or biology; they are rooted in social exclusion, political marginalization, and deeply entrenched disparities in social determinants of health (Jacklin et al., 2017).
Jacklin and associates (2017) found that Indigenous individuals’ interactions with the healthcare system are shaped by four key themes: the colonial legacy of health care; the perpetuation of inequalities; structural barriers to care; and the role of the health care relationship in mitigating harm. Many participants linked their avoidance or mistrust of the medical system to traumatic memories, including experiences from residential schools and past coercive government heath programs. Contemporary encounters often reinforced this mistrust, as participants reported racially motivated interactions, denial of acre and health policies unsupportive of cultural practices. These experiences directly influence diabetes management, contributing to what clinicians may mislabel as “non-compliance” with recognizing its roots in trauma and systemic racism. There was consistency across the diverse sites concerning the root causes of mistrust of health care systems (Jacklin et al., 2017).
The findings suggest that improving diabetes outcomes for Indigenous peoples requires more than clinical education. It demands culturally safe care, structural reform, and adherence to recommendations from the Truth and Reconciliation Commission. As Johnson (2022) notes, traditional medicine and cultural reconnection may foster empowerment and improve diabetes management by recognizing the cultural and historic context in which diabetes is experienced.
Rural and Remote Communities
People living in rural and remote communities in Northwestern Ontario face additional; layers of complexity in managing diabetes. Food insecurity, geographic isolation, limited access to healthcare services and inadequate local resources all contribute to worse health outcomes, including higher rates of hospitalization and emergency department use. Social determinants such as income, transportation, health literacy and social support strongly shape an individuals ability to manage diabetes effectively (Costa et al., 2023).
Despite the substantial burden of disease, there are limited published studies examining diabetes in Northwestern Ontario, particularly those exploring the intersection of gender, race/ethnicity, and SDoH in shaping complications and outcomes. Understanding the intersecting determinants is essential for improving both care and long-term outcomes in communities where systemic barriers are deeply felt and disproportionately harmful.
Provincial Comparisons: Ontario and Manitoba
Diabetes prevalence and impacts also vary across provinces. Ontario and Manitoba share similar overall diabetes rates – 15% prevalence, with 11% diagnosed, but their patterns vary in important ways. Manitobans projected prevalence is expected to reach 18% by 2034, surpassing Ontario’s 17%, while Ontario is anticipated to experience a faster growth rate in diagnosed cases (Diabetes Canada, 2024). Economic burden also differs, Manitobans face much higher out of pocket costs for diabetes management, particularly for those with type1 diabetes, which may exacerbate inequities for lower income families (Diabetes Canada, 2024).
Key Differences at a Glance (Diabetes Canada, 2024)
| Category | Ontario (2024) | Manitoba (2024) | Notes |
| Overall prevalence | 15% | 15% | Same % |
| Diagnosed prevalence | 11% | 11% | Same % |
| Diabetes + Prediabetes | 31% | 30% | Ontario slightly higher |
| 2034 projected prevalence | 17% | 18% | Manitoba projected higher |
| Increase (2024–2034) | +35% | +30% | Ontario faster rise |
| Direct system cost | $2.209B | $145M | Reflects population size |
| Out‑of‑pocket cost (Type 1) | Lower | Higher | Manitoba substantially higher |
| Complication burden | Same | Same | Both high impact |
| Policy focus | Provincial framework | Formal action plan | Manitoba’s is more structured |
Policy approaches also vary. Manitoba has implemented a structured Diabetes Action Plan, whereas Ontario currently focuses on broader framework development (Diabetes Canada, 2024). These differences indicate that targeted provincial policies can significantly influence both financial burden and accessibility to care.
Diabetes is not simply a clinical condition. It is a condition shaped by the social, political and cultural environments in which people live. Socioeconomic status, colonization, racial inequities, geographic location and health system structures all intersect to influence who develops diabetes, how early it is diagnosed, how effectively it is managed and what the long-term outcomes will be. Appropriately addressing diabetes requires a systemic approach that prioritizes hath equity, acknowledges the lived experiences of marginalized communities, and integrates culturally safe and community informed interventions. As the prevenance of diabetes continues to rise, the need for policies and practices that address the social determinants of health becomes more urgent.
References
Brown, K., Nevitte, A., Szeto, B., & Nandi, A. (2015). Growing social inequality in the prevalence of type 2 diabetes in Canada, 2004-2012. Canadian journal of public health = Revue canadienne de sante publique, 106(3), e132–e139. https://doi.org/10.17269/cjph.106.4769
Costa IG, McConnell K, Adduono K, Camargo-Plazas P, Koné A (2023) Exploring diabetes status and social determinants of health influencing diabetes-related complications in a Northwestern community, Ontario, Canada: A mixed method study protocol. PLOS ONE 18(9): e0273953. https://doi.org/10.1371/journal.pone.0273953.
Diabetes Canada. (2024). Diabetes in Ontario: Backgrounder (Publication No. b4f2add1-c56b-48e5-93cd-beb9feebb667). https://www.diabetes.ca/getmedia/b4f2add1-c56b-48e5-93cd-beb9feebb667/2024-Backgrounder-Ontario.pdf
Diabetes Canada. (2024). Diabetes in Manitoba: Backgrounder (Publication No. e065eead-3993-40e0-8aa8-fca4f925f66e). https://www.diabetes.ca/getmedia/e065eead-3993-40e0-8aa8-fca4f925f66e/2024-Backgrounder-Manitoba.pdf
Jacklin, K. M., Henderson, R. I., Green, M. E., Walker, L. M., Calam, B., & Crowshoe, L. J. (2017). Health care experiences of Indigenous people living with type 2 diabetes in Canada. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(3), E106–E112. https://doi.org/10.1503/cmaj.161098
Johnson, R., Fiddler, T., Pirozek, J., Gordon, J., Sodhi, S., Poirier, J., Kattini, R., & Kelly, L. (2022). Traditional Medicine and Type 2 Diabetes in First Nations Patients. Canadian journal of diabetes, 46(1), 53–59. https://doi.org/10.1016/j.jcjd.2021.05.007