A Problem of Diabetes

Low socioeconomic status has previously been associated with type 2 diabetes. Health is not only affected by individual risk factors and behaviors, but also a range of economic circumstances. Primarily, this issue is caused by the underuse or reduced access to recommended preventive care in individuals from low socioeconomic backgrounds. Economic issues inherent in diabetes stem from the fact that economically disadvantaged individuals do not have the support for healthy behaviors. Furthermore, economically disadvantaged individuals may lack access to clinical care. Lastly, economic and social factors influence the physical environment in which an individual lives.

Multiple research studies have incorporated a diabetic patient's socioeconomic status as a factor for the onset of diabetes. However, some researchers argue that childhood socioeconomic status is not the only determinant of diabetes onset. Preventive care should become more available for individuals from lower socioeconomic statuses.

Keywords: diabetes, healthy, preventive, socioeconomic
The Association of Low Socioeconomic Status and Diabetes

Low socioeconomic status has been associated with chronic conditions such as diabetes mellitus. It has persistently been reported that individuals from lower socioeconomic status groups are at greater risk for diabetes than patients from higher socioeconomic status groups. The socioeconomic status of an individual is based on community access to resources and includes a combination of economic, social, and work status. What are the economic issues involved? Health is affected not only by individual risk factors and behaviors but also a range of economic conditions. The circumstances under which people are born and grow up are shaped by a variety of economic and social forces. How do these economic issues trigger diabetes and complications in individuals who are economically and socially disadvantaged? Social and economic factors drive one's exposure to a healthy or unhealthy physical environment, which continues to form a cascade of complications for the diabetic patient, depending on the environment. Thus, certain risk factors implicated in the development of diabetes are known to be associated with socioeconomic status.

For example, obesity, physical inactivity, smoking, and low birth weight have all been defined as risk factors for type 2 diabetes. In addition, these factors are associated with low socioeconomic status in Western societies. Hence, there is an inverse relationship between the prevalence of type 2 diabetes and socioeconomic status. Primarily, this problem is caused by reduced access to and underuse of recommended preventive care and poor metabolic control in individuals from low socioeconomic backgrounds (Rabi et al., 2006). These factors contribute to poor health outcomes, and, as a result, diabetes is correlated with low SES. Reduced access to healthcare, such as regular diabetes screening checks, can have long-term effects on individuals diagnosed with diabetes mellitus as the disease may advance to more severe complications such as eye problems, foot and skin infections leading to amputations, nerve damage, pregnancy issues, and even depression (Rabi et al., 2006).

Economic issues inherent in diabetes stem from the fact that economically disadvantaged individuals lack support for healthy behaviors. First, such individuals lack support for healthy behaviors. They are often associated with low socioeconomic status and may not be able to incorporate a healthy diet into their lives or even provide one for their families, which in turn is a risk factor for the family members. These economic issues trigger diabetes in individuals from low socioeconomic backgrounds, as most individuals who are considered low SES live in neighborhoods where it may not be safe enough for their children to play outdoors, exercise, or even take walks. Other burdens, such as work, school, childcare, and commuting schedules, may also prevent enough time in the day to accommodate such healthy behaviors.
Furthermore, economically disadvantaged individuals may not have access to clinical care. Visiting a healthcare professional becomes difficult as these individuals may have work schedules that conflict with clinic hours, transportation issues, sick-leave policies at work, and childcare issues. In addition, there is abundant evidence showing that individuals from lower socioeconomic status (SES), including those with lower education attainment, lower incomes, and people of color, generally receive lower-quality healthcare.

Lastly, economic and social factors determine the physical environment in which an individual lives. As a result, factors such as education and employment choices influence one another and establish a lack of health-supporting physical environments for these individuals. For example, an individual's level of education essentially determines their employment choices and, consequently, their income level. Together, these factors greatly influence the likelihood of affording a health-supporting physical environment, such as a safe community.

An experimental study, part of the Moving to Opportunity (MTO) housing intervention, examined obesity and diabetes outcomes when households were given the chance to move from a high-poverty neighborhood to a low-poverty neighborhood. Individuals who had the opportunity to move to a low-poverty neighborhood were less likely to become obese or develop type 2 diabetes over the course of a 14-year cohort study. This study concludes that "place matters"—where people live can determine their health status. Thus, the place where a person lives can either be protective or detrimental to their health behavior and outcomes. (Steve, et al., 2016)

According to the article, "Socioeconomic Position and the Incidence of Type 2 Diabetes: The ELSA Study", the authors state that although many studies exist on the association between socioeconomic position and type 2 diabetes, understanding how SEP might be related to the onset of diabetes in older people remains limited. This is due to many studies using mixed-age samples that include both younger and older people that focus on the associations between incident diabetes and measures of SEP from earlier life stages, like education and occupational class. Current research rarely focuses on incident diabetes and measures of current SEP, like wealth or subjective social status. Wealth, a measure of accumulated assets and financial resources command over a lifespan, is a more appropriate SEP measure to use in studies of older people than education and occupational class because it refers to the current stage of the life-course, thus more appropriately characterizing an older person's current SEP.

As a result, researchers should broaden the variables they test to include more individuals' personal characteristics in order to accurately associate diabetes with socioeconomic status. In my opinion, although some scientists believe that including wealth helps us better understand this connection, an individual’s upbringing and childhood SES have a greater impact on the individual, even as they age, compared to their current SES. The living condition of an individual during childhood and adolescence shapes the individual and impacts their health. There should be more resources available in communities with lower socioeconomic status to provide preventive care for individuals who may not have the knowledge or resources for a healthful lifestyle.

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