A day late, a dollar short

I’m not usually one for following “memes” and “let’s all do this today’s”, but yesterday’s subject of Allison Blass’s Lemonade Life blog struck home… though not in the way I suspect she had originally intended it.

Blog Action Day: Poverty and Diabetes

Allison is (rightly) concerned about the costs of managing autoimmune diabetes, and the complications and deaths caused by the lack of money to pay for even the most basic diabetes-management care. This is a serious issue, both in the United States and globally.

I see the effects of poverty and diabetes from a different perspective: that of obesity-related diabetes in low-income communities. In these communities, the development of diabetes is often a direct result of poverty. Not ethnic origin, not race, not age, but poverty. Sure, there may be an increased genetic propensity to develop diabetes among a number of the residents of these communities, but poor diet certainly plays its role. And many lower-income families are restricted to either poor diet, or no diet at all. Food stamps and Work Incentive Programs help these families pay for their staples – but the staples they pay for are milk, eggs, cheese, beans, and rice. Not fruits and veggies, not lean meats, not even whole grain breads. And the subsidized brands are a bit wild: expensive Goya (name brand) beans on the one hand, low-income-supermarket-brand milk and almost-expired eggs on the other hand. White rice is covered; brown rice is nowhere to be found. When bread is covered, it is white bread made with high-fructose corn syrup and hydrogenated vegetable oils – both ingredients known to increase triglycerides and insulin resistance. In some low-income areas, there aren’t even supermarkets – only high-priced local convenience stores. In others, the produce at supermarkets and greengrocers may be leftovers that did not sell at the higher-priced stores.

When these hard working people come home from their long working hours, or their second jobs, they may have little time to prepare food from scratch. In that case, their only choices are the convenience store or fast-food takeout. The folk at McDonald’s and Wendy’s may point to their salad menus and say “we offer healthy choices”, but the sad truth is, in many of these neighborhoods, the salads aren’t on the menu – or if they are, they appear to be the leftovers from the branch several miles away in a more affluent neighborhood. The “Chinese Take-Out” places in these areas have no “steamed” or “diet” menu; instead, they offer battered-and-fried chicken gizzards and other deep-fried delicacies. Even the local fish places only offer battered-and-deep-fried selections.

Well, how about the children? Many school meal programs cut corners by replacing fresh fruits and vegetables with canned – or with just enough condiment to reclassify the garnish as “a vegetable”. (Some years ago, the New York City school districts classified ketchup as a vegetable.) Some of this is not the fault of the school meals programs – they are strapped for funding, at least some of which comes from meals purchased by nonsubsidized schoolchildren. So they have to cater to the tastes of these children…

The diets to which poverty restricts our many of our low-rent districts may not in itself cause diabetes, but it certainly increases the likelihood that someone predisposed to developing diabetes will indeed develop it. And because many of our poorer folk do not have medical insurance, or sufficient medical insurance, they are often diagnosed much further along the route of beta cell destruction. The intertwined issues of poverty and diabetes further escalate each other, as diets remain unimproved and the suggestion of monitoring is met with the brick wall of insufficient funds.

If the solution to this issue were simply “money”, we would not be seeing epidemic increases in obesity-related diabetes in more affluent neighborhoods as well as among the impoverished. What is needed is a combination of education and community action. Community vegetable gardens in place of vacant lots, food and drug cooperatives that bring healthy foods and over-the-counter medications into the community at affordable prices, cooperative kitchens in which members prepare food for several families, and ways to encourage the local, standalone grocers and take-outs to offer healthier foods, as well as healthier versions of their current offerings.

While this will eradicate neither poverty nor diabetes, education and community action will help mitigate its grasp on communities of need. And that’s nothing to sneeze about.

This is a really important aspect of poverty and diabetes and I’m glad you brought it up. I will highlight this post on my blog tomorrow. I also agree that while poor food choices don’t cause a disease, it certainly exacerbates a pre-existing or propensity towards the disease. Plus, high-fat, high-sugar foods don’t make the disease any easier to control. When all you can afford is McDonalds and your doctor is telling you you’re at a high risk for a heart attack, what can you do? Also, the most at-risk for poverty are African Americans and Latinos, which are also the most at-risk for type 2 diabetes because of their genetics. Double whammy there. It’s frustrating, but I like that you are solutions-focused. That’s a good way to be.

With all the hoopla about the economic meltdown lately it’s interesting to think about ways an increase in smaller-scaled, local food production might contribute to a solution – not just saving transportation costs but creating jobs, improving local food security, and making more healthy, whole foods available to more people (improving health and saving health-care costs!). Corporate control of the food supply has not done much to improve the health of our nation, that’s for sure.

My colleagues mother-in-law has Type 2, no insurance, and probably doesn’t know a great deal about healthy eating. Traditional Xhosa food isn’t exactly the best for diabetes (lots of red meat, porridge, ground corn meal etc). She goes to the clinic once a month and stands in line to have her monthly BG test. If it’s high, the nurses make her wait all day and watch it to try to bring it down. By American standards, she is dirt poor (South African and American standards on poverty are pretty different!).