The systemic causes behind a simple case of diabetes

A patient is in poor condition. Hours before, they had collapsed from a stroke. Initial diagnoses revealed that the patient is obese and has high cholestrol. As medical care continues to be administered to the patient, it is revealed that the cause of the cardiovascular complications is unmanaged diabetes. This untreated disease has manifested itself through damaged blood vessels and nerves that are essential to cardiovascular health. The stroke was the result of a blood clot as a result of the diabetes and high cholesterol.

On the individual level, this case could be handled routinely. The patient could be diagnosed with diabetes and prescribed medicine and lifestyle changes to handle the cardiovascular diseases. Post-stroke rehabilitation could be provided as necessary. However, this was preventable.

The right approach could have been to educate the patient about healthier lifestyles and the importance of checking in with doctors when they were younger. Early action is essential to preventing diabetes. After all, the National Institute of Diabetes and Digestive and Kidney Diseases states that the best way to prevent diabetes is “to make lifestyle changes that work for you long term” by losing weight, moving more, and eating healthier. All this would have either prevented obesity and diabetes altogether or allowed them to find out sooner before the disease manifested itself with a stroke.

However, it’s not that simple.

While a healthy lifestyle may seem to be a simple individual choice, it is often the greater social and systemic factors that shape the health of individuals. According to the U.S. Department of Health and Human Services, the conditions in the places where people live, learn, work and play affect a wide range of health outcomes. These conditions are known as the social determinants of health.

The patient is from the South Bronx, one of the poorest communities in New York City. One study found that “the mortality rate due to diabetes for women ages 18 to 64 is twenty times higher than in the predominantly White Upper East Side of Manhattan, a ten-minute subway ride away”. The common occurrence of obesity and diabetes is not just the result of individual choices, but it is also the result of unhealthy social and environmental conditions. For example, lack of access to healthy foods is correlated with obesity. And, the lack of healthy food options, especially in the South Bronx, have led to high prevalence rates of obesity in the region.

Another notable theme in terms of social determinants of health is the lack of trust in medical practitioners. A study in the Journal of Health Care for the Poor and Underserved utilized focus groups to determine that residents felt that they received second-class care and felt routinely disrespected by the medical system. This decreases the likelihood that residents will seek out medical care and attend checkups, which is critical for finding out risk factors for diseases such as diabetes. Additionally, if prediabetic conditions are discovered, lifestyle changes are often recommended. However, these recommendations such as eating healthier and exercising more could be unattainable when there is a lack of access to food education, healthy foods, and spaces to exercise.

The important thing to note is that these are all factors that extend beyond direct medical care and intervention. No amount of prescriptions or surgery can prevent the root causes of diabetes. Instead, it is crucial to examine how social determinants such as access to supermarkets, education, and urban planning play a role in the health of citizens.

Numerous projects have been created in order to improve access to parks and recreation, as well as supermarkets. These are important parts of the lived environment that could influence the health of many residents. An example of this is the Bronx River Alliance which seeks to restore the Bronx River corridor. They have advocated for and constructed new parks that provide a space for outdoor recreation, which is a crucial given the lack of parks scene in the zoning maps.

This and future projects are crucial to influencing the social determinants of health.