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Paper short abstract:

We explore interconnections between biosocial health and caregiving over lifecourses in the context of youth-onset type 2 diabetes in northern Australian First Nations carescapes. We discuss implications for addressing structural and institutional inequalities and for models of care.

Paper long abstract:

An epidemic of youth-onset type 2 diabetes (T2D) is emerging in First Nations communities across northern Australia. Although often considered a condition of later life, fetal exposure to elevated glucose levels predisposes children to T2D at an early age, leading to a cascading effect in which diabetes begets diabetes. To inform co-designed models of care for youth T2D across northern Australia, we explored diabetes experiences and social contexts in a series of case studies. Clinical outcomes for First Nations youth (aged 10-25 years) with YT2D were triangulated with interviews undertaken with the youth, their families and health professionals and analysed using a meta-synthesis approach. All youth had at least one caregiver with T2D or kidney failure, a diabetes complication. We show interconnections between intergenerational experiences of T2D and related conditions, and social conditions of poverty, food insecurity, lack of employment, children in out-of-home care and incarceration in First Nations families. To further illuminate interactions between biosocial health and caregiving over the lifecourse, we place Mendenhall’s framework of syndemic suffering (2012) in conversation with constructs of caringscapes and carescapes (Bowlby & McKie 2019). We argue that youth T2D can be conceptualised as both a deeply individual experience and a collective condition extending beyond bodily boundaries, with consequences for how care needs and responsibilities are understood and enacted. We discuss the implications for addressing structural and institutional inequalities and for northern Australian models of care.