Diabetes, Obesity and Disparities
Increasing Rates of Diabetes
Nearly 1.5 million California adults —5.9 percent of the population— have been diagnosed with diabetes. African Americans, Latinos, Native Americans and Alaska Natives face far higher rates than whites. Children with a family history of diabetes also experience an increased risk of the disease.
The last decade has seen a dramatic rise in the rate of Type 2 diabetes (previously referred to as "adult onset" diabetes) among children in the United States. Before 1992, Type 2 diabetes accounted for 2-4 percent of childhood diabetes cases. Since then, recent numbers estimate that up to 45 percent of all new childhood diabetes diagnoses are Type 2. Experts now predict that one in every four Latino and African-American babies born in California will develop diabetes in their lifetime.
Diabetes is just one of several chronic diseases that now dominate the health landscape in the US. Chronic diseases are now responsible for 70% of US health care costs, and contribute 7 out of the 10 leading causes of death. Among these, poor nutrition and physical inactivity is the second leading cause of preventable death.
Nutrition and Physical Activity Disparities Framework
It has now been well established that the high prevalence of poor nutrition and physical inactivity that lead to obesity, diabetes, heart disease, and a host of other chronic diseases is caused by numerous environmental factors, in addition to any individual factors. Historically, strategies to reduce diabetes and obesity (which correlates closely with Type 2 diabetes) have focused exclusively on a traditional medical model of treatment and individual behavior change. These approaches have failed because they do not change the context in which individual behavior occurs. Recent studies have linked the obesity epidemic to environmental conditions including, but not limited to, the following:
- Increasing portion sizes
- Increasing exposure to fast food and soft drinks
- Availability of soda and junk food on school campuses, including preschools and after school programs
- Lack of physical activity opportunities in schools and communities
- Limited compliance with physical education requirements in many schools
- Too much exposure to television or playing video games
- Limited access to healthy foods in low-income neighborhoods
- Aggressive advertising of junk food to children and their families
- Lack of preventive strategies, training and preventive tools in the health care arena
Disparities in Community Environments
The social, economic and physical environments in which people live create the context for decision-making and behavior regarding nutrition and physical activity. Immense disparities exist between the environments for communities of color and low-income populations, compared with those of higher income whites. Many low-income communities lack supermarkets that sell an array of healthy foods, or they have a far higher proportion of fast food outlets and corner stores selling unhealthy snacks than supermarkets or farmers' markets. Many of these same communities lack parks or sufficient safety for residents to participate in physical activity in their neighborhood. These disparities in community resources contribute to high levels of disease related to poor nutrition and physical inactivity.
The Costs of Unhealthy Environments
Unhealthy food and physical activity environments, and the diseases and disabilities they promote, cost society. As the number of children who grow up in unhealthy environments rises, California will face growing costs for medical care and lost productivity. In 2000, the estimated national costs attributable to obesity amounted to $118 billion. Preventing such diseases by creating healthier community environments could save $5.60 for every $1 invested, or a total of $16 billion annually within as quickly as five years.
Supporting Community Change
In order to address the health disparities related to nutrition and physical activity, it is essential that programs and policies focus on the community environment in which individuals live, work, go to school and play. Members of the community need the resources and support to address the disparities in their neighborhood or area, particularly in low-income communities and communities of color. Programs that provide support to communities to change their food and physical activity environments are beginning to show that such changes can be accomplished, across multiple sectors within a community. Programs that support changing policies and institutional practices are accomplishing fundamental, long term change in community food and physical activity environments, creating healthier communities for the families that live there.
For more information about the full complement of work that The California Endowment is doing on Health Disparities, go to: http://www.calendow.org/Category.aspx?id=308&ItemID=308
