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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