As diabetes educators, we talk a lot about diabetes self-management. But while it is important that people understand the disease and how to best manage it to stay healthy, good diabetes care goes beyond education. It goes beyond what any one person can control.
A key illustration of this can be seen in the link between poverty and diabetes. Multiple Canadian studies have shown that the risk for type 2 diabetes is significantly higher for those living in poverty. One study found diabetes was more than four times more prevalent in the lowest income groups than it was in the highest ones.
The more marginalized the person, the greater their risk. This is a major reason why people who are homeless, those who have a history of mental illness, and racialized and indigenous communities all have extremely high rates of diabetes.
In our practice, we hear firsthand that when you are living in poverty, the immediate crises take priority: paying for rent, food or transportation. In the short term, you can ignore the nagging symptoms of high sugar and forgo taking time off work to seek medical attention. You can delay paying for expensive healthy food, medications or blood sugar test strips when other needs feel more pressing.
The Canadian Diabetes Association reports that 57 percent of people do not comply with their prescribed diabetes therapy because of the expensive out-of-pocket costs for necessary medications, devices, and supplies, calling it “the greatest challenge for Canadians living with diabetes.”
However, the long-term health complications of unmanaged diabetes can be very serious, including stroke, heart attack, kidney failure, limb amputations, vision loss and premature death. It is no surprise to us then that the research shows people living in poverty suffer more from serious complications than their higher income counterparts. This is even after adjusting for differences in lifestyle like physical activity and weight.
Therefore, we propose a shift away from emphasizing individual responsibility for diabetes management and a move toward addressing the link between poverty and diabetes. It’s all of our responsibility to ensure the most marginalized in our communities do not suffer the most around diabetes.
As health and social service providers, a major way we can help is by screening our clients for poverty. This allows us to offer and advocate for appropriate care and services that help mitigate poverty-related barriers and make good diabetes management more accessible for these clients.
But that’s not enough.
We need to work with our communities to hold our governments accountable to address the root causes of poverty. Fortunately, much research and thought has already gone into what can be done to eliminate poverty. What we now need is all levels of government (municipal, provincial and federal) to take concrete actions to improve our collective health. This means taking action in four areas:
- income equity with policies, such as a basic income guarantee, that ensure everyone can afford their most basic needs;
- decent employment with policies that ensure people are not discriminated based on their chronic conditions and can take paid leave when they are sick;
- affordable housing, which includes a housing first policy, to ensure everyone’s right to shelter and eliminate the need to sacrifice other basic needs for rent;
- affordable medications and supplies with better policies, like pharmacare, that ensure people can afford necessary medications and supplies to better manage and prevent diabetes complications.
Almost one in three Canadians has diabetes or pre-diabetes, and a significant number of them cannot afford to manage their condition. This is unacceptable. To really take action on diabetes, we must acknowledge the significant role that poverty plays, create space in our own practices to mitigate its effects and then demand our government take responsibility to break that link.