There is a regrettable lack of understanding about the complex causes of type 2 diabetes, says Dr. Jan Hux, chief scientific advisor for the Canadian Diabetes Association. “There's a significant genetic component to this illness – people who are young, athletic and who eat well can still get type 2 diabetes.”
But even when socioeconomic conditions play a major factor in an individual’s condition, that may not be a matter of choice, she stresses.
An example is a single mother with two children, struggling to make ends meet financially, who is told by her doctor that she needs to exercise more. “She can’t afford a gym membership or even proper athletic shoes to go the gym,” Dr. Hux explains. “She might not feel safe walking in her neighbourhood, particularly at night, and she can’t afford babysitting for her children.”
The relationship between diabetes and the environment we live in is underscored by the Toronto Diabetes Atlas, released in 2007, which analyzes more than 100 data sources to identify significant disparities in diabetes prevalence between Toronto neighbourhoods.
Areas with high rates of diabetes were generally found to be in the suburbs, with reduced access to fruit and vegetable stores, fewer amenities within walking distance, poorer access to public transit and greater car dependency.
“When those maps were shown to economists, it was clear to them that diabetes was an economic illness, because the most affluent neighbourhoods had low rates and the poorer suburbs had higher rates,” says Dr. Hux. Urban planners saw it as a disease of planning, because the highest rates are in the post-war neighbourhoods, where reliance on a car is assumed, resources for healthy living such as fresh fruits and vegetables and health services are less available and neighbourhoods are not walkable. These findings have been reconfirmed in a more recent study by Institute for Clinical Evaluative Services (September 2012), which noted a higher risk of diabetes in neighbourhoods that aren’t pedestrian friendly.
“These insights can really help us think about how we can then design solutions,” she notes.
One encouraging finding from this project is an area on the east side of downtown Toronto where, despite high levels of poverty, the rates of diabetes are surprisingly low. “It reinforces the concept that if you have a walkable neighbourhood, if you can access fresh fruits and vegetables and if you have access to good free or subsidized recreation programs and health-care resources, some of the risk from non-modifiable factors can be significantly mitigated,” adds Dr. Hux.
57% of Canadians with diabetes cannot afford their medication and supplies