Question

type 2 diabetes: poverty, priorities andpolicy: the social determinants of the incidence and management of type 2 diabetes

Answer 1

sugar diabetes

management of type 2

diabetes mellitus

: are we

prepared to rethink our questions and redirect our





York University, Toronto, Ontario, Canada

Susan Anstice

Ryerson University, Toronto, Ontario, Canada

Kim Raine

University of Alberta, Edmonton, Alberta, Canada

Kerry R. McGannon

University of Iowa, Iowa City, Iowa, USA

Syed Kamil Rizvi

York University, Toronto, Ontario, Canada

Vanessa Yu

York University, Toronto, Ontario, Canada

An expanding literature is examining the

dimensions of health inequalities in

industrialized nations (Acheson, 1998;

Raphael, 2002a). Specific focus is on

dimensions of social exclusion that reflect

increasing income, housing, and food

insecurity associated with the weakening of

the welfare state (Canadian Council on Social

Development, 2001; Health Promotion

Atlantic, 2001; Raphael, in press). Diabetes

mellitus (diabetes) ± like cardiovascular

disease ± is an affliction more common

among the poor and excluded (Chaturvedi

et al., 1998; Hux et al., 2002). A few studies in

Canada have included income as a relevant

variable in the incidence of diabetes, but

these studies lack adequate

conceptualization of the role social

determinants of health play in diabetes

incidence (Raphael, 2002c). Also, conceptual

and empirical analyses have not been carried

out in a way that has income as a

determinant of the risk factors usually

associated with diabetes morbidity and

mortality.

This paper outlines what is known about

the social determinants of type 2 diabetes and

challenges health researchers and workers to

begin asking different questions as to the

causes of its incidence and the factors

affecting its management. It does not include

examination of the possible role that genes

play in the incidence of diabetes. McDermott

argues that the evidence for such a role is

limited as compared to issues of social and

material deprivation. She also considers how

an emphasis on biological determinism as an

explanation of the late twentieth century

epidemic of diabetes distracts from

consideration of the types of social and

economic issues we raise in this paper

(McDermott, 1998).

Diabetes: definition, incidence,

and management

Diabetes is a common chronic disease that

affects over two million Canadians. All forms

of diabetes are characterized by the presence

of high blood glucose (hyperglycemia) due to

defective insulin secretion, insulin action, or

both. During an acute episode, coma and

even death may result from blood sugar that

is very high or very low, due to medication

overdoses. Chronic hyperglycemia may lead

to serious complications including damage to

the heart, kidneys, eyes, nerves and blood

vessels (Canadian Medical Association and

Canadian Diabetes Association, 1998). The

treatment for diabetes rests on blood glucose

(glycemic) control to be achieved with diet,

exercise and (if necessary) medications ± the

``three pillars'' of the diabetes management

regimen (Canadian Medical Association and

Canadian Diabetes Association, 1998).

Health Canada reports that diabetes is the

seventh leading cause of death in Canada,

claiming 5,000 lives