Diabetes Self-Management Blog

The less money you have, the more likely you are to have diabetes and other conditions. Studies find that giving people money improves their health. Why is that, and what can we do with that information?

A Canadian study found that living in poverty can double or even triple the chances of developing diabetes.

Professor Dennis Raphael of York University reported,

We know…low-income and poor people [are] more likely to get [diabetes], but they’re also the ones that, once they get it, are much more likely to suffer complications.

His study controlled for education, body-mass index, and physical activity levels. And still poor people had much higher risk.

The website Diabetes in Control asked, “What is it exactly about living in poverty that contributes to Type 2 diabetes?” The study found that stress was one of the main causes. Increased levels of the stress hormone cortisol raise blood sugar. Poverty is stressful. Poor people also find it more difficult to find healthful food and ways to exercise safely.

Lack of money also makes it much harder to manage diabetes and prevent complications. The York University team found that “insufficient income, inadequate or insecure housing, and food insecurity were key barriers to managing the disease.” The study was published in Health Policy, November 2010.

In interviews with patients, “Many [people with diabetes] said they had to choose between paying rent and feeding their children and managing their disease.”

Don’t forget, this study is from Canada. Even the poorest people there get medical care and their prescriptions paid for. So how much worse is it in the U.S., where diabetes care itself can be an expense greater than housing and food?

It’s a lot worse here. Diabetes is not only caused by poverty; it can put you into poverty once you get it. Read the comments on a blog entry I wrote in 2011 called “Paying for Diabetes.” The stories are heartbreaking and enraging. People write of losing their homes, their savings, going bankrupt, even getting divorced because of diabetes expenses.

You can almost feel the stress pouring off those comments. One veteran with Type 1 commented, “The cheapest insurance we could find was $3,000 a month for me and $950 a month for my wife.” That’s more than many people’s monthly income! No wonder diabetes is stressful, and no wonder people with money problems have more diabetes complications!

Would having more money improve your health? Studies seem to indicate that it would. One analysis of Cherokee Indians in North Carolina found that rates of mental illness, substance abuse, and crime all declined sharply after the tribe opened a successful casino and distributed profits to the members.

Researchers credited the improvements to reduced financial stress. Parents had more energy to “be better parents” when they could relax even a little from constant worry about money, according to The New York Times.

Those were mental health outcomes, but combined with the research from Canada on low income and diabetes, it’s a strong hint that money matters.

Professor Michael Marmot, head of the department of Epidemiology and Public Health at at University College London, says money helps in two major ways. Writing in the journal Health Affairs, he says money allows people to get the resources they need to be healthy, and it enables them more control over their lives and ways to participate in society. These reduce stress and improve quality of life.

“The fewer goods and services are provided publicly by the community,” Marmot writes, “the more important individual income is for health.” In the U.S., he says, not much is publicly provided, so income is extremely important. (He cautions, though, that “We should not view individual incomes in isolation from the community in which people are located.” Things like high crime rates and poor availability of healthful food or clean water affect people’s health, too.)

So science says money matters a lot for health. But how does that work for you in practice? Most Diabetes Self-Management readers don’t live in poverty, hopefully, but I’ll bet some are pretty close. And a lot of us have money worries. Is money stress or lack of financial resources affecting your diabetes or your self-management? How would more money help you?

Let’s imagine government or Bill Gates started a Cherokee-type plan and gave you $6,000 a year. What difference would it make for you? How do you think it would affect your health?

At Diabetes Self-Management, we have known for years that money is a big issue in diabetes. Here are some articles on saving money and living a healthier life for less with diabetes.

And please notice from everything in this article how single-payer health care would improve life for people with diabetes and millions of other people.

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Comments
  1. Some provincial health plans may routinely pay for medication, but I know that mine in Alberta does not. People who are low income or disabled can qualify for free supplemental insurance that will cover medication, but people who do not fit in those categories either pay for medication themselves or get it through supplemental insurance through employment.

    Posted by Vicki Smith |
  2. David this article sounds reasonable to me.

    Posted by CalgaryDiabetic |
  3. I can believe this. I know when I’m feeling stressed -about anything- my glucose readings go up despite anything else I’m doing to control my condition.

    Posted by Joe |
  4. I’m sad to hear that even in Canada diabetes medications may not be covered for people. I believe if a person needs insulin, it should be covered somehow. If not by private insurance then by a public program, no matter how much money they have. Some people are property rich, but cash poor and choose to keep their big house but skip their insulin. In the long run that is going to be more costly for everyone. And there may be no buyer for that big house anyway even if they did want to downsize in order to afford their medicine.

    Posted by BK |
  5. I would suggest that the food available to poor people is a major contributor to your chances of developing diabetes. It is a diet of cheap (junk) food that is really high in carbohydrates and low in nutrients. May I suggest KD and grain based products in a box.

    And Health Care costs in Canada are really not that great — depends on what Province you live in. For example in Ontario if you don’t use insulin, you can get less than 2 test strips a day paid for. Of course that would probably mean you’ll end up up on insulin sooner… and they’ll give you 3,000 a year.
    Certainly not perfect reasoning, but hey when you get really bad the province will spend a boat load of money trying to treat you. I live in BC and my income is large enough I have to buy my own strips. I purchase them on the Internet for a fraction of drug store prices.

    It is really a shame that too many doctors know so little about preventing or treating diabetes and that diabetics don’t have the education to treat it better. It’s not like the information isn’t there!

    Posted by JohnC |
  6. David, I can tell you from experience that it makes ALL the difference.

    At nearly 60 years of age, and almost 20 years with type II, I’ve been through it. I’ve never had a significant income and often had no insurance. At present, if it were not for the expanded Medicaid we now get in Ohio due to the Affordable Care Act (first of the year), I would not have any professional medical care. Even the local medical center (Federally Qualified Health Center) requires a minimum payment on a sliding scale, and since I have not had employment for quite some time, and no income as of the first of 2014, I have no monies to pay even the minimum to get medical treatment. If it were not for this new Medicaid, I could not pay for medications or supplies, like syringes and test strips. As of last July I now have diab. Retinopathy and have suffered some vision loss. Without the laser treatments for the retinopathy I would most likely be considered blind now. This expanded coverage has allowed me to get medical attention that was not available to me before, and address a number of issues that were causing problems. However, the attention you get is minimal, and often I have to “beg” and press to get what I need. It comes with the territory.

    But the ins. coverage in no way addresses the other problems of being without income. I have to depend on the limited generosity of family, even for the basics. And after too many years of it, the stress and anxiety take their toll. I sometimes feel like giving up, but that solves no problems. Even trying to write about it now is taking it’s toll. There’s so much to tell, and getting it out is difficult.

    What your article does not address, and I imagine the studies don’t either, is the social aspects of a culture driven by monetary gain, and the extreme standards held by those who determine whether you sink or swim. If you don’t “measure up” you don’t get to participate; it leaves many people like me who are affected by their diseases sitting on the sidelines. And if you are among the aging population, forget it; after five years of unemployment, NO POTENTIAL EMPLOYERS CONTACT ME, no matter how many applications I submit. It’s hardly what we would consider equitable, but it’s the code we live by as well as a socio-political structure. I think we will eventually come around and make the needed changes, but not in my lifetime. Thanks for listening.

    Posted by Tom |
  7. Yes, is my answer. My insulin runs my over $200.00 a month. On top of everything else it really adds up. Test strips are high. I’m switching to a store brand. Hope they work ok.

    Posted by C. Hickey |
  8. It’s a shame that even with the progress with medications, testing and treatment for diabetes, what you get is all controlled by your insurance carrier’s willingness to provide it for you. The affordable is frequently not the best available. I still hope to be Type None in my lifetime, but I’m beginning to wonder.

    Posted by Ruth Moore |
  9. Funny this came up. I was looking at my ins EOB and ins sent my metformin cost to my copay but paid a little on my singulair. Go figure

    Posted by lisa |
  10. money is without a doubt a issue with me :( most times i don’t take the meds like i am suppose to cause well i just can’t afford to take it. the other issues well most of the food that i should be eaten is just way to expensive. i live on a very strict budget and bread is cheap pasty is cheap and so are hotdogs. i can get a package of hotdogs for 99c and that is 2 or 3 meals depending on how hungry u just might be. anyway not sure as to why i am writting this on here cause it sure doesn’t do any good.

    Posted by robert quigg |
  11. Yes money stress definitely affects my diabetes management because it is difficult to get good quality food with the rising costs of food. Quality food definitely costs more than cheap processed foods.

    Posted by Patricia Pursel |

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