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Critical medical ecological perspectives on diabetes in the Pacific Islands: colonialism, power, and balance in human-environment interaction over time
Open accessAbstract
Background Diabetes is endemic in Pacific Island jurisdictions where complex colonial relationships arose from the Spanish Empire, Japanese and German occupation in World Wars 1 and 2, and the Pacific Trust Territory era of the USA. Since diabetes reflects a cluster of ecological processes involving sociobehavioural, medical, and environmental constructs, interpretation of the diabetes epidemic requires both an ecological and intervention framework with an economic and political perspective that accounts for historical and contemporary power relations. Methods We conducted qualitative interviews with 272 local residents (totalling 3440 h) of seven Pacific Island communities (Majuro, Pohnpei, Palau, Kayangel Atoll, Saipan, Tinian, and Rota). Interviews were recorded and an inductive analytical plan implemented (analysed for themes within and across sites). An ecological interpretive framework that situates humans within their bodily and environmental context—combined with historical socioeconomic power dynamics (and agency)—informed the generation of findings and implications. Findings Communities attribute diabetes in their islands to the direct result of rapid shifts in lifestyle brought from the Japanese (World War 2) and US (Trust Territory) periods of colonial history. The replacement of local starches with rice during the Japanese period, combined with the replacement of local protein sources with US canned meats, fish, and instant foods, catalysed a diabetogenic diet. Shifts in food economies replaced local forms of trade, barter, and reciprocity. Local forms of physical activity—procurement of local food (fishing, gardening)—became devalued in the new food environment, further creating metabolic disease. Individuals from more remote locales are more likely to see their way of life as healthier than their counterparts in central population hubs, and attribute this asset to the slower reach of development, the subsequent lower processed food consumption, greater engagement with traditionally meaningful local activities, and a stronger reliance on local medicine, with less access to Western medicine. Interpretation Island communities are aware of the dynamics historically that led to their present food and health environment. Cultural and community assets—perceived as resilience by community members—could be promoted to support social norms that contribute to growing local pride, traditional thinking and behaviours, and a redefinition of "healthy". Funding US Centers for Disease Control and Prevention Research Center Program.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This qualitative study argues that diabetes in Pacific Island communities is understood by residents as the product of colonial-era dietary and economic shifts—Japanese and US periods replacing local starches and proteins—rather than as an individual behavioural failure. The authors propose an ecological interpretive framework linking historical power relations to contemporary food environments and suggest community-perceived resilience assets as a basis for redefining "healthy."
Key findings
- Communities attributed diabetes directly to rapid lifestyle shifts introduced during the Japanese (World War 2) and US (Trust Territory) colonial periods.
- Replacement of local starches with rice during the Japanese period, combined with replacement of local protein sources by US canned meats, fish, and instant foods, "catalysed a diabetogenic diet."
- Shifts in food economies displaced local trade, barter, and reciprocity, while local physical activities (fishing, gardening) became devalued in the new food environment.
- Residents of more remote locales were more likely to view their way of life as healthier than those in central population hubs, attributing this to slower reach of development, lower processed food consumption, greater engagement in traditionally meaningful local activities, and stronger reliance on local medicine with less access to Western medicine.
Methods
- Qualitative interviews with 272 local residents, totalling 3440 h, across seven Pacific Island communities: Majuro, Pohnpei, Palau, Kayangel Atoll, Saipan, Tinian, and Rota.
- Interviews were recorded and analysed inductively for themes within and across sites.
- An ecological interpretive framework situating humans within bodily and environmental context, combined with historical socioeconomic power dynamics and agency, informed generation of findings and implications.
Limitations
- Not stated in the paper (the abstract reports no limitations).
- Evident from the text: this is a conference abstract (Volume 6, Special Issue, S36) presenting only summary findings, with no detail on sampling strategy, participant characteristics, interview guide, coding procedures, or saturation; the 3440 h figure is reported without explanation of how it was derived.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
7 Own result · 4 Own interpretation · 1 Own method
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Local forms of physical activity—procurement of local food (fishing, gardening)—became devalued in the new food environment, further creating metabolic disease.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Shifts in food economies replaced local forms of trade, barter, and reciprocity.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The replacement of local starches with rice during the Japanese period, combined with the replacement of local protein sources with US canned meats, fish, and instant foods, catalysed a diabetogenic diet.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Communities attribute diabetes in their islands to the direct result of rapid shifts in lifestyle brought from the Japanese (World War 2) and US (Trust Territory) periods of colonial history.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The replacement of local starches with rice during the Japanese period, combined with the replacement of local protein sources with US canned meats, fish, and instant foods, catalysed a diabetogenic diet.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individuals from more remote locales are more likely to see their way of life as healthier than their counterparts in central population hubs, and attribute this asset to the slower reach of development, the subsequent lower processed food consumption, greater engagement with traditionally meaningful local activities, and a stronger reliance on local medicine, with less access to Western medicine.”
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Island communities are aware of the dynamics historically that led to their present food and health environment.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Local forms of physical activity—procurement of local food (fishing, gardening)—became devalued in the new food environment, further creating metabolic disease.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The replacement of local starches with rice during the Japanese period, combined with the replacement of local protein sources with US canned meats, fish, and instant foods, catalysed a diabetogenic diet.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 3
- Probably not a substantial claim. 2
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individuals from more remote locales are more likely to see their way of life as healthier than their counterparts in central population hubs, and attribute this asset to the slower reach of development, the subsequent lower processed food consumption, greater engagement with traditionally meaningful local activities, and a stronger reliance on local medicine, with less access to Western medicine.”
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A statement the paper makes itself — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Since diabetes reflects a cluster of ecological processes involving sociobehavioural, medical, and environmental constructs, interpretation of the diabetes epidemic requires both an ecological and intervention framework with an economic and political perspective that accounts for historical and contemporary power relations.”
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Interviews were recorded and an inductive analytical plan implemented (analysed for themes within and across sites).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper relies on this without support.
Diabetes is endemic in Pacific Island jurisdictions.
“Diabetes is endemic in Pacific Island jurisdictions where complex colonial relationships arose from the Spanish Empire, Japanese and German occupation in World Wars 1 and 2, and the Pacific Trust Territory era of the USA.”
Citations
Cited by
Sorted by citations
Colonial dynamics limit climate adaptation in Oceania: Perspectives from the Marshall Islands
Bordner, A. S., Ferguson, C. E., & Ortolano, L. (2020) · Global Environmental Change · doi:10.1016/j.gloenvcha.2020.102054 · Cited by 137
Dye, T., Muir, E., Farovitch, L., Siddiqi, S., & Sharma, S. (2020) · Infectious Diseases of Poverty · doi:10.1186/s40249-020-00694-3 · Cited by 28
“ical Ecology is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for the processes of evolution, context, unintended/unexpected consequences, stressors, homeostasis, adaptation, and power relationships — the main co…”
BackgroundSelf-citationExternal vulnerability, local resilience, and urban-rural heterogeneity in the Marshall Islands
Roland, H. B. (2023) · Environmental Science & Policy · doi:10.1016/j.envsci.2023.103643 · Cited by 14
“For example, Majuro residents attribute new obesity and diabetes epidemics to lifestyle and cultural changes that accompanied colonialism (Blankenship et al., 2020; Dye et al., 2018; Helble and Francisco, 2017; Passmore and Smith, 2019).”
BackgroundPerez-Ramos, J. G., McIntosh, S. E., Barrett, E. S., Vélez-Vega, C. M., & Dye, T. (2021) · Journal of Medical Internet Research · doi:10.2196/24671 · Cited by 14
Self-citationOcasio, D. V., Perez-Ramos, J. G., & Dye, T. (2020) · BMC Public Health · doi:10.1186/s12889-020-09735-w · Cited by 12
Self-citation
Metadata
- Authors
- Dye, T. D. V., Sy, A., Albert, P., Cash, H., Hadley, J., Tomeing, T., Muir, E., Robles, B., McIintosh, S., Ikerdeu, E., Farovich, L., & Buenconsejo-Lum, L.
- Affiliations
- University of Rochester (US)
- University of Hawaiʻi at Mānoa (US)
- University of Hawaii System (US)
- Whakatane Hospital (NZ)
- Republic of Palau Ministry of Health (PW)
- Corresponding author
- Dye, Timothy D V
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 6
- Pages
- S36
- ISSN
- 2214-109X (ISSN-L)
- OpenAlex
- W2789409655
- Semantic Scholar
- 0fdd7d9173d079ea98ca7f0913d05840ca0b309a
- Cited by
- 11
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2021: 3 · 2020: 3
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Geography, Planning and Development › Island Studies and Pacific Affairs
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Indigenous Health and Education
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Keywords
- diabetes mellitus, Pacific Islands, colonialism, human-nature relationship, food environment, traditional food systems, food economy, physical activity, community resilience, power relations, Japanese occupation
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- CoChat. (2026). Citation check: Critical medical ecological perspectives on diabetes in the Pacific Islands: colonialism, power, and balance in human-environment interaction over time. https://app.cochat.ai/papers/10.1016/s2214-109x(18)30165-7
- The paper
- Dye, T. D. V., Sy, A., Albert, P., Cash, H., Hadley, J., Tomeing, T., Muir, E., Robles, B., McIintosh, S., Ikerdeu, E., Farovich, L., & Buenconsejo-Lum, L. (2018). Critical medical ecological perspectives on diabetes in the Pacific Islands: colonialism, power, and balance in human-environment interaction over time. The Lancet Global Health. https://doi.org/10.1016/s2214-109x(18)30165-7
