Abstract
In the United States, low-income immigrant groups experience greater health disparities and worse health-related outcomes than Whites, including but not limited to higher rates of type 2 diabetes (T2DM). The prevention and adequate management of T2DM are, to a great extent, contingent on access to healthy food environments. This exploratory study examines “upstream” antecedent factors contributing to “downstream” health disparities, with a focus on disparities in the structural sources of T2DM risk, especially food environments. Our target group is Latino immigrants receiving services from a non-profit organization (NGO) in Northern California. Methods are mixed and data include focus groups and surveys of our target group, interviews to NGO staff members, and estimation of the thrifty food market basket in local grocery stores. We find that while participants identify T2DM as the greatest health problem in the community, access to healthy foods is severely restricted, geographically, culturally, and economically, with 100% of participants relying on formal or informal food assistance and local food stores offering limited variety of healthy foods and at unaffordable prices. While this article is empirical, its goal is primarily conceptual—to integrate empirical findings with the growing literature underscoring the sociopolitical context of the social determinants of health in general and of T2DM disparities in particular. We propose that interventions to reduce T2DM and comparable health disparities must incorporate a social justice perspective that guarantees a right to adequate food and other health-relevant environments, and concomitantly, a right to health.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Centers for Disease Control and Prevention (CDC). (2011). National diabetes fact sheet. Atlanta: Centers for Disease Control and Prevention. Accessed February 1, 2010, from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
Tuomilehto, J., & Lindstrom, J. (2003). The major diabetes prevention trials. Current Diabetes Reports, 3, 115–122.
Norris, S. L., et al. (2002). Increasing diabetes self-management education in community settings: A systematic review. American Journal of Preventive Medicine, 22(4, Supplement 1), 39–66.
Link, B., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94.
Chaufan, C. (2008). What does justice have to do with it? A bioethical and sociological perspective on the diabetes epidemic. In B. Katz Rothman & E. Armstrong (Eds.), Bioethical issues: Sociological perspectives—Advances in medical sociology. New York: Elsevier.
Dinca-Panaitescu, S., et al. (2011). Diabetes prevalence and income: Results of the Canadian community health survey. Health Policy, 99(2), 116–123.
Benyshek, D. C., Martin, J. F., & Johnston, C. S. (2001). A reconsideration of the origins of the type 2 diabetes epidemic among native Americans and the implications for intervention policy. Medical Anthropology, 20, 25–64.
Economic Research Service USDA. (2008, July). US household food security survey module: Three-stage design, with screeners. Current Population Survey. http://www.ers.usda.gov/briefing/foodsecurity/surveytools/hh2008.pdf.
Seligman, H., et al. (2007). Food insecurity is associated with diabetes mellitus: Results from the national health examination and nutrition examination survey (NHANES) 1999–2002. Journal of General Internal Medicine, 22(7), 1018–1023.
Chaufan, C., & Weitz, R. (2009). The elephant in the room: The invisibility of poverty in research on type 2 diabetes. Humanity & Society, 33, 74–98.
Peek, M. E., Cargill, A., & Huang, E. S. (2007). Diabetes health disparities. Medical Care Research and Review, 64(5 Suppl), 101S–156S.
US Department of health and Human Services. (2011). Healthy people 2010-what are its goals? Accessed March 18, 2011, from http://www.healthypeople.gov/2010/About/goals.htm.
US Department of Health and Human Services. (2011). HealthyPeople.gov-disparities. Accessed March 18, 2011, from http://www.healthypeople.gov/2020/about/DisparitiesAbout.aspx.
US Census Bureau. (2010). American FactFinder. http://factfinder2.census.gov/main.html.
Department of Health and Human Services (HHS). (2011). Poverty guidelines, research and measurement. Last accessed February 18, 2010, from http://www.aspe.hhs.gov/poverty/11poverty.shtml.
US Department of Commerce Economics and Statistics Administration US Census Bureau. (2010). Income, poverty, and health insurance coverage in the United States: 2009. http://www.census.gov/prod/2010pubs/p60-238.pdf.
US Bureau of Labor Statistics. (2011, January). The employment situation. http://www.bls.gov/news.release/pdf/empsit.pdf.
US Department of Labor Bureau of Labor Statistics. (2010). Local area unemployment statistics. http://www.bls.gov/lau/home.htm.
US Department of Education (2010). Trends in high school dropoutand completion rates in the United States: 1972–2008, compendium report. http://www.nces.ed.gov/pubs2011/2011012.pdf.
California Department of Education. (2010). Statewide graduation rates. http://dq.cde.ca.gov/dataquest/CompletionRate/comprate1.asp?cChoice=StGradRate&cYear=2008-09&level=State.
US Department of Education-National Center for Education Statistics. (2010). The condition of education-context of post-secondary education. http://www.nces.ed.gov/programs/coe/2010/section3/table-eda-1.asp.
Nord, M., Andrews, M., & Carlson, S. (2009). Household food security in the United States, 2008. US Department of Agriculture, Economic Research Service, ERR-83 (November). http://www.ers.usda.gov/Publications/ERR83/ERR83fm.pdf.
American Diabetes Association. (2001). Diabetes 2001 vital statistics. Alexandria: American Diabetes Association.
Chaufan, C. (2006). Sugar blues: Issues and controversies concerning the type 2 diabetes epidemic. In Sociology. Unpublished dissertation, University of California, Santa Cruz, 367 pp.
American-Diabetes-Association. (2000). Website of the American Diabetes Association. Available from http://www.diabetes.org.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health—Executive summary. Geneva: World Health Organization. http://www.whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf.
Isaacs, S., & Swartz, A. (2010). On the front lines of childhood obesity. American Journal of Public Health, 100(11), 2018.
Raphael, D. (2007). Poverty and policy in Canada. Toronto: Canadian Scholars’ Press.
Acknowledgments
This study was funded by the School of Nursing at the University of California-San Francisco. The authors wish to thank the staff and faculty at the Institute for Health & Aging, especially Professor Patrick Fox, without whose continuing support it would have been impossible to conduct this study.
Author information
Authors and Affiliations
Corresponding author
Appendix
Rights and permissions
About this article
Cite this article
Chaufan, C., Davis, M. & Constantino, S. The Twin Epidemics of Poverty and Diabetes: Understanding Diabetes Disparities in a Low-Income Latino and Immigrant Neighborhood. J Community Health 36, 1032–1043 (2011). https://doi.org/10.1007/s10900-011-9406-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-011-9406-2