According to the Centers for Disease Control (CDC), Native Americans have more than double the rate of diabetes of white Americans (15.1% versus 7.4%, respectively). More than 12% of Black and Hispanic Americans have diabetes. Minority groups also have higher rates of diabetes complications.
Causes of racial disparities in diabetes
What are the causes of these racial disparities, as they’re called? Many of the causes affect people of all races to different degrees. So, understanding them will help us all prevent and manage diabetes better.
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Many of the causes are economic. Psychologist Ashley Butler, PhD, of Baylor University says that, “African American and Latino families face serious roadblocks to diabetes management. They are more likely to have food insecurity, financial insecurity, employment challenges and school challenges.”
There are non-economic causes also. Prejudice among healthcare providers toward Black, Hispanic, and Native people may lead to worse care. Some oppressed people may lack safe places to exercise in their neighborhoods. They may also have had fewer educational opportunities. Lack of exercise and lack of education make diabetes more likely and more difficult to manage.
Like racism itself, economic and social difficulties often cause stress, and stress is known to worsen diabetes. All these difficulties can interfere with self-management.
Eating healthy food on a regular schedule is a big part of diabetes care. But how do you eat regularly when food is hard to get? Not being able to find or afford healthy food is called food insecurity. It is more common among minority groups, although it can happen to all working-class people. The U.S. Department of Agriculture (USDA) found that 40 million Americans — including 12 million children — experienced food insecurity in 2018. Food insecure people are twice as likely to develop diabetes as those with reliable access to food. In 2020, with the COVID-19 shutdowns, more people struggle with putting food on the table.
What can people with diabetes do if they are food insecure? They can apply for all possible food benefits, such as SNAP (Supplemental Nutrition Assistance Program). If there are small children or pregnant women in the house, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) can provide money for food. During COVID-19, some people can pick up food at local schools, or even have it delivered. Beyond that, there are food banks and pantries in most communities. Don’t be shy about using them. Unfortunately, pantry food is often heavy on carbohydrates, which must be used with care in diabetes. Find some good recipes here.
Food bank food may not match the diets of some people, especially immigrants. But people can grow healthy food themselves if they have a vegetable garden. They may also be able to get affordable food at farmers’ markets, especially late in the day when prices are lower. Discount groceries often sell healthy food at reduced prices.
People of color often have lower incomes, and low-income people are more likely to get diabetes. Lack of money can make living with diabetes much harder. It can be hard to find good medical care or to pay for it. Diabetes medicines and supplies can add thousands of dollars of expense to already-tight budgets. This article gives wonderful money-saving tips that can make diabetes finances much easier to handle.
Many people of color may have longer experience dealing with less money. Some have strong community and family connections, and everyone should be looking to strengthen their connections now, especially with COVID-19 economic stress.
Racism in the medical system
Research shows that most healthcare providers try to treat all patients equally. But some providers may have stereotypes about patients from different groups. They may assume that Black, Hispanic, Native and poor people are less able to understand or pay for diabetes treatment. A study from the University of Pennsylvania found that Black children with type 1 diabetes are less than half as likely as white children to be prescribed insulin pumps, even among those who had good insurance. Lead researcher Terri Lipman, PhD, said that “Provider bias has been shown to play a critical role in the prescribing of diabetes technologies. The provider perceptions of a family’s ability to pay the costs of new therapies, and of family competence, are important factors in determining the prescribed treatment regimens.”
Studies have found some doctors are more skeptical of patient self-reports when those patients are from nonwhite groups. There may not be medical staff who look like the patients or speak their language.
Shivani Agarwal MD, MPH, advises doctors about these barriers: “Encourage patient involvement in decision-making,” she says, “especially with regard to technology.” She says to make sure that communication is done in ways patients can understand, for example, “using show-and-tell techniques as opposed to written materials.”
Patients may have to ask firmly for this kind of support. They may want to shop around for doctors who communicate well.
Stress of being Black in America
Because of racism, being Black in America is stressful. Native Americans and Hispanic immigrants also live with high levels of stress, as do many working-class white people. Diabetes itself adds layers of stress to people’s lives.
What can people do about stress? You can read self-help methods for relaxing in this article or many others on our site and other sites.
Often, though, self-help is not enough. People need to reach out to others who share their problems, both for support and to change stressful situations. Support groups, community organizations, coworkers and unions, congregations and political movements can all help in reducing stress and changing unhealthy conditions.
Social network effects
Peers and family have a major impact on people’s diabetes management. In her studies of low-income African Americans with uncontrolled type 2 diabetes, Elizabeth Lynch, PhD, at Rush Medical College found that the eating norms of a social network often made it hard for participants as they tried to change their diets.
It’s very hard to eat differently than your peers. For example, many people’s traditional food is healthier than modern packaged or fast food, but if everyone you know guzzles soda pop, you probably will, too.
Changing a group’s food habits may be a path to changing individual eating. This is why the national Diabetes Prevention Program says they “support wellness and diabetes awareness among Native Americans by collecting and retelling stories about tribal efforts to reclaim traditional foods.”
Awareness is the first step
In the end, racial disparities cannot be eliminated by self-help or even community-level support. But, taking care of self is necessary for social change. As Lynch says, “I don’t know the solutions to disparities, but being aware of the problems can help.”
For those interested in the social dimensions of diabetes, I wrote a whole book about it called Diabetes: Sugar-Coated Crisis. Learn more about it here.