What does it take for a person to properly manage their diabetes? When we think about this question, we tend to think about it in terms of personal responsibility: eating right, exercising, taking medications, and visiting with a medical team regularly. Indeed, these are all important variables for proper health management.
But viewing diabetes management solely in this light might obscure a larger reality: patients often have to fight for access to these basic needs. In a recent study published by JAMA Internal Medicine, researchers explored some of the implications behind these challenges.
From among 411 participants, those who struggled to pay for basics like rent and heat, and who suffered from food insecurity, were about 97% more likely to have uncontrolled cholesterol levels, glucose levels, etc. For each additional struggle – the odds of having poor diabetes control rose by 39%! This, in spite of most participants having access to health care (the study took place in Massachusetts, a state that has afforded universal healthcare to its residents for quite some time.)
It seems obvious – if a person cannot pay or have access to basic diabetes management tools, then how well could they meet management goals? But while researchers might point out how ‘a doctor is held accountable for their patients’ success,’ the reality of patient blame is lost in translation. Patients are regularly blamed for these issues, and labeled as non-compliant.
A patient is simply told to achieve goals – but seldom how to go about achieving them, especially when life is hard.
When I was diagnosed with type 2 diabetes, I suffered through a similar scenario – it was 2009, I was unemployed, lacked health insurance, and suffered from great food insecurity. My husband and I struggled to pay for basic necessities, such as heating and electricity, so things like medications and doctors’ visits were nowhere near our radar of priorities. Relying on food pantries often meant relying on trying to make the most of processed and prepackaged foods as well as a lack of fresh produce. Our quest for managing diabetes meant being frugal and digging long and hard for resources within our small community. This was not impossible – but it was certainly challenging: most pantries were far, and beyond our transportation means, and only open during what would be considered weekly ‘working hours’ for most poor; the local free clinic was only open once a week, and entailed a 4-6 hour waiting period. If a childless couple struggled meeting these challenges, how could a family with children achieve theirs? We were lucky enough to have connections with the diabetic online community, so we could have friends help with testing strips, but even with insurance a person with diabetes may be regularly denied an acceptable amount of testing strips and access to beneficial medications like insulin.
It takes a village…
Successfully controlling chronic illnesses within populations will require more than just pointing fingers at individuals – it will require a deep introspection by the state upon challenges which burden communities as a whole – such as a lack of education, employment, betterment opportunities, access to resources, medicine and food security, class disparity, crime, and of course, taking social responsibility for the public narrative that is broadcast in mass product marketing.