Introduction
Both the American Diabetes Association (ADA), and the Center for Disease Control (CDC), list race and ethnicity as a risk factor for Type-2 Diabetes (T2D). However, this discrepancy is not due to any intrinsic quality, but the effect of our environments on our health. The conditions of the house someone grew up in, their neighborhood, their school, these are the ‘social determinants of health’. And these are the primary factors influencing our well-being.
Due to historical mistreatment, and its resulting poverty, racial minorities, such as African-Americans, are overly-exposed to chronic conditions, like diabetes. According to the CDC, the total percentage of diagnosed diabetes prevalence of minority groups, such as African-Americans, Hispanic, Asian, and Indigenous Americans are all higher than those of the White, non-Hispanic population. In fact, according to the ADA, Indigenous Americans develop diabetes at nearly twice the rate of Caucasian people.
The Racial Disparity of Diabetes
In a 2014 study looking at the rates of T2D between different racial and socioeconomic groups, it found that the disparity between African-Americans and White people disappeared when both lived in lower-income neighborhoods. These neighborhoods often lack access to nutritional foods or safe places for physical activity. Without these, the prevalence of chronic conditions are much higher, regardless of race or ethnicity. However, since African-Americans are overrepresented in poverty, it is clear that socioeconomic forces are responsible for this disparity.
This inequity not only pervades the development of diabetes, but its treatment and mortality rate, as well. According to a study by The Lancet, African-Americans are 19% less likely to receive new diabetes treatments. For Native Americans, they are 41% less likely. In our conversation with Dr. Joanna Buscemi of DePaul University, she told us her recent study shows that, in Washington D.C., Black Americans were seven times more likely to die from diabetes than White Americans.
The Regional Disparity of Diabetes
These social determinants are not only racial or ethnic, but regional as well. Nearly one quarter of the people in the Northern Mariana Islands have T2D, a percentage more than double the U.S. average. This is due to colonizing powers replacing staple foods, like yams and cassavas, with highly processed, starchy foods. These, along with food waste products, like turkey tails, went on to rapidly increase the prevalence of T2D. Other U.S. territories, like Guam, the Marshall Islands, Puerto Rico, all have higher rates of diabetes than the continental U.S.
Additionally, within the continental U.S. there is the ‘Diabetes belt‘. Stretching from Louisiana all the way West Virginia, this belt is a collection of counties with high rates of diabetes. Often without access to Medicaid, or financial resources, this belt, where a majority of African-Americans live, is unfairly exposed to this disease’s horrors.
Conclusion
Access to care and preventative programs must be simple and universal in order to close this disparity. The present conditions restrict the potential of entire communities and inhibit the pursuit of happiness. If you would like to learn more about this topic, please check out our podcast episodes with Dr. Joanna Buscemi and Dr. Margrethe Horlyck-Romanovsky.