Racial Disparities in Diabetes Outcomes

Jun 02, 2020

Yesterday I did a Facebook Live to talk a bit about issues of race in the U.S. from a Diabetes perspective. (Yes. There actually IS a Diabetes perspective. Go figure.)

Here’s a rough transcript of the notes I spoke from:

I don’t really even know where to start with this. So first I’m going to say this: There’s a deep wound and I am not the injured party. As a white person, it’s not my place to speak to the deep pain for a community that’s not my own or to center the conversation around me and my response. What I CAN do is talk about the facts that I know and refer you to more knowledgeable voices from the Black, Indigenous, and Persons of Color (BIPOC) communities.

Because Diabetes is my corner of the world I’m going to talk today about the intersection of racial trauma and health outcomes, specifically Diabetes. Before today’s Live, I looked up the statistics. I’ll not bore you with them here but will compile them for you to look at on a blog post later. [That’s THIS post, BTW. Here's an article with statistics.]

The summary of the stats is this: in the US, Non-Hispanic Whites not only have the lowest incidence of Diabetes (by far), they also have the best outcomes following diagnosis.

Why is this?

Like most things in health, it’s multi-factorial.

In general, when discussing health disparities, we look to two primary causes: socioeconomic status and medical bias. It actually goes deeper than that. But let’s look at those first.

Socioeconomic Status: Racial minorities statistically have more socioeconomic struggles, resulting in less access to healthy food, education, healthcare, transportation, etc. There’s often an argument to be made that people should just pull themselves up by their bootstraps and improve their socioeconomic status. Much easier said than done when the system is rigged against you due to things like generational wealth and institutional racism.

Medical Bias: No one likes to be accused of racial bias or think that they’re capable of implicit bias. But here’s the deal: we all are. Like it or not, it’s part of the training and it’s passed down from practitioner to practitioner. As a student and as a new nurse, I was taught that certain people weren’t to be believed about their pain because of “cultural differences” and not to expect adherence from people of certain ethnicities. I’m sure that no racism was intended in this informal teaching but racist ideas that I was taught, both explicitly and implicitly remain with me. Unlearning my ingrained biases is an ongoing process.

Medical bias results in patients of color being treated different than their white counterparts. This usually isn’t intentional but can have a detrimental effect. For example, a provider may make an assumption that a patient can’t afford a newer medication that is the better choice but is more expensive. Or assume that the person won’t be willing to change their dietary habits due to cultural expectations so doesn’t take the time to explain optimal food choices.

While Socioeconomic Status and Medical Bias, certainly play a part in Health Disparities, these are not the major drivers of the racial differences in Diabetes statistics because differences remain when the statistics are adjusted to control for these factors. I think that the bigger drivers are Chronic Trauma and Epigenetics (generational trauma).

Chronic Trauma. During this time of COVID-19, I’ve been taking a lot about the effects of ongoing stress on the body. Short term stress response is an adaptive response and is meant help our bodies live through an immediate stressor. Longer-term/chronic stress is maladaptive and causes health problems as sustained infusion of stress hormones causes problems, particularly related to increased insulin resistance. Now imagine living in a state of permanent trauma. This is quite literally the situation for Black people. Again, I won’t presume to speak for the Black community, of which I am not a member. So I will refer you these people who can speak of their own daily stress. The effects of chronic racial trauma are devastatingly detrimental to health.

Another huge contributor to racial disparity in health outcomes that is almost never talked about is Epigenetics. Epigenetics is the field of science that focuses on the inheritance of genetic expression. I find it a super complicated field but the general gist is this: things that happen to people in one generation can affect the way genes are expressed in the next generation. The example I usually give of this is about women who have babies during or shortly after a time of famine. Studies have shown that their babies are more likely to be insulin resistant and to develop obesity and other diseases related to insulin resistance as they age. Like the stress response, this is an adaptive response that is helpful if the baby is born into famine and continues to live in a situation of food scarcity. However, it becomes a problem when the child has easy access to food but remains forever able to easily store fat.

In the same way, people who are living in a state of chronic racial trauma pass along the physical effects of that trauma to their children. Imagine centuries of trauma from slavery, segregation, and racism, passed along through generations of detrimental genetic expression.  

So what’s the answer?

I don’t know. I don’t have the answers. But that doesn’t mean I’m going to give up. Here are a few things I WILL do:

  • I will listen. Listen to the voices of the people who are experiencing trauma firsthand.
  • I will support them in the ways they ask to be supported.
  • I will use my privilege as a shield to protect people of color. I will call out microaggressions when I see them.
  • I will examine my privilege and bias and continue learning.

Here’s what I WON’T do:

  • I won’t ask people who are personally affected by racism to teach me about it. To do so is to ask them to relive their pain and is lazy on my part. Many are offering information that I can find by looking.
  • I won’t ask for free labor. If someone charges a fee for teaching me, I will pay for their service. If they don’t charge a fee, I will offer to pay. If they refuse pay, I will make a donation and/or pay forward their goodwill.
  • I won’t speak over the voices of people of color. As a white woman, I know that my voice is likely to be listened to over that of a woman of color. I will use my voice to say, “Please listen to this Woman of Color who is trying to be heard.”
  • I won’t assume that I know how to help. I will donate to organizations run by Black people that support Black communities. Beyond that, I will seek out cues for ways that I may assist, but I will never assume my help is wanted. I will ask before inserting myself into a situation. I am not a white saviour.

Here are some resources I have found helpful.

Books to read: Most of these are out of stock at Amazon. Try your local independent book store or get an electronic copy.

  • White Fragility by Robin DiAngelo
  • So You Want to Talk About Race by Ijeoma Oluo
  • Why Are All the Black Kids Sitting Together in the Cafeteria? by Beverly Daniel Tatum
  • I'm Still Here by Austin Channing Brown
  • The New Jim Crow by Michelle Alexander

People I follow on Twitter:

Articles and Other Resources:

These lists are by no means exhaustive. Please email me with suggestions of things that I can add to my list to continue to educate myself about the important work of anti-racism.

For now, blessings to you all. Particularly those who are hurting and bearing the weight of oppressed. I see you. And I'm sorry.  

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