Control of lifestyle is beyond individuals and depends on social and political factors

Industrialising societies are said to have undergone various epidemiological transition stages, in which the transition from stage two to stage three involves a change from receding pandemics to lifestyle diseases.1 The dynamics of this transition, which took thousands of years in Western countries, have been unprecedented and greatly compacted in time in most indigenous populations. Rather than a transition we see the rise of lifestyle non-communicable diseases at a time when the receding pandemics have not yet receded.2 The pattern seems to be similar in indigenous people in their traditional lands, such as the Pacific, and in newly adopted metropolitan centres, such as New Zealand. We consider here the different dynamics of the epidemiological transition in indigenous people and argue that these are linked to socioeconomic transitions beyond their power and their borders. Thus individual lifestyle interventions cannot be naively transferred to indigenous populations. Rather, what is required is appropriate national and international social and political commitment to health protection, …