Let me take a crack at this one. Essentially, poverty itself does not translate into diabetes. BUT, almost as directly, it translates into a host of increased risk factors which, in turn, DO correlate with increased rates of diabetes. It'd not about the health care system...it's about the factors which engender diabetes.
For example, poverty reduces one's ability to access a nutritious basket of foods (ie, adequate fruits, vegetables, whole grains, etc). In fact, as has been very well documented in the US (and is often true in Canada) it is very difficult to find adequate produce and healthy food in the supermarkets, shops and other dispensers that are often found in lower-income neighbourhoods.
Secondly, when it comes to lifestyle related risk factors, poverty often brings with it a host of environmental and social factors which limit one's ability (and willingness) to take preventive action. For instance, regular exercize to counter weight gain is one important step. BUT, if one lives in any area where poor infrastructure, limited social services and the possibility of violence act to inhibit regular exercize, obesity and then diabetes can result. When I used to live in Chicago for instance (assuming you are writing from the US, Diana), I used to wonder how Chicago Public Health's approach to healthy living and regular exercize sounded to residents of the Cabrini Green projects. "Just get out and take a walk...then pick up some fresh fruit and have a picnic"...yeah, right!!! Well, we have many examples of these environmental/social impediments in Canada as well.
So, not that I speak for Dennis, but to just focus on obesity and the link to diabetes is to miss the 90% of the iceberg that's below the surface. Poverty, social exclusion and environmental factors are what are deserving of our attention if we truly want to combat diabetes (and other chronic diseases).
Does that help?
Scott
Scott A. Wolfe
Senior Policy Analyst/Analyste principal en politiques
Association of Ontario Health Centres (AOHC)/
l'Association des centres de santé de l'Ontario (l'ACSO)
1 Eva Rd. - Suite 220
Toronto, Ont. CANADA
M9C 4Z5
Tel: (416) 236-2539 x234
Fax/Téléc: (416) 236-0431
"Promoting Access to Primary Health Care in Ontario"
-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Diana Liw
Sent: Saturday, November 10, 2007 9:40 AM
To: [log in to unmask]
Subject: Re: [SDOH] diabetes epidemic?
Why are people dying in a country that has universal health care? Aren't they being care for? Isn't universal health care "universal" regardless of income? What's wrong with this picture?
Poor people die from diabetes, because they get diabetes. They don't die of something without getting them first. Everyone may get diabetes, regardless of income. If you are saying "poor people" are dying from the disease, what's your country's prevention efforts targeted toward the "poor people"? To prevent someone dying from diabetes (rich or poor), the disease needs to be managed. What's wrong with your Public Health and health care system? Getting poor person to be wealthy will not cure him/her. I fail to see your logic.
>>> Dennis Raphael <[log in to unmask]> 11/10/07 5:05 AM >>>
The Toronto Star has another "epidemic of diabetes" story complete with
obesity being the cause of it all.
http://www.thestar.com/News/article/275323
Dear Editor:
There is no "epidemic" of diabetes in Canada. The incidence rate for
diabetes -- new cases per year adjusted for age -- is not increasing. This
was documented by Drs. Ohinmaa, Jacobs, Simpson and colleagues in their
article "The projection of prevalence and cost of diabetes in Canada: 2000
to 2016" published in the Canadian Journal of Diabetes. 2004;28:116-123.
There is however an epidemic of poor people dying from diabetes in Canada.
This is documented by Dr. Wilkins and colleagues "Trends in mortality by
neighbourhood income in urban Canada from 1971 to 1996" in Health Reports
(Stats Can), 13(Supplement), 1-28. Perhaps this "epidemic of death" rather
than non-existent "epidemics of diabetes" should have more attention paid
to it.
Dennis Raphael, PhD
Professor and Undergraduate Program Director
School of Health Policy and Management
York University
4700 Keele Street
Toronto ON M3J 1P3
416-736-2100, ext. 22134
email: [log in to unmask]
http://www.atkinson.yorku.ca/draphael
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