The rate of diabetes among Latinos in Rhode Island has shot up faster than any other group. Why the disparity in health between this group and others? It’s a tangle of problems scientists don’t entirely understand.
Poverty is often the driving factor behind growing rates of diabetes among Latinos in Rhode Island.
It’s week two of diabetes prevention class at the free clinic in Providence. Participants in the Vida Sana, or healthy life, class are learning about eating healthier, exercising, and managing or preventing chronic diseases like diabetes.
Damaris Rosales runs Vida Sana. She says she’s happy to see every seat is taken in the small classroom.
“I’m so excited because today we have a big group. Looks like we have a lot of participants who are newly diagnosed with diabetes or high blood pressure or high cholesterol and they don’t even have an idea that they have that condition.”
As class gets started, the instructor takes a quick poll, “How many of you have high cholesterol? How many have high blood pressure? Diabetes?” Several raise their hands. This is what we’re going to be talking about in this class, she tells them.
Many of her students are undocumented Latino immigrants who can’t afford or don’t have access to health care elsewhere. They’re part of a group in Rhode Island that’s seen rates of diabetes spike faster over the past few years than any other. Rhode Island Department of Health epidemiologist Dora Dumont uncovered the data.
“These apparently rising rates among Hispanics might simply be the result of increased access to health care. That you have to have a diagnosis from a doctor before you know you have diabetes.”
But Dumont says that’s only part of the story.
“I think one of the most fundamental health stories in America is how much it’s determined by your socioeconomic status and the kinds of resources – it turns out it’s not cheap to stay healthy in America. You need access to social resources and material resources.
In other words –driven by your ability to afford healthy food, medicine, trips to the doctor, to find the time and the means to exercise.
You can even have health insurance, and still find yourself at higher risk for diabetes or unable to control diabetes if you already have it.
Dr. Lenny Lopez is associate professor of medicine at the University of California San Francisco. Lopez undertook a huge study of Latino health in Massachusetts. Lopez says about 40 to 50 percent of Latinos nationwide do not have health insurance. But setting the study in Massachusetts made things interesting.
“The environment is unique in Massachusetts because of the universal health care that has been in existence for quite some time. And with insurance comes greater access to health care.”
And yet diabetes rates among Latinos were still higher than in other groups. Lopez concluded that it probably wasn’t a lack of access to health care or health insurance that was leading to high rates of diabetes among Hispanics in Massachusetts. He thought maybe acculturation- the process of adopting a new culture’s habits, like Americans’ unhealthy diets and sedentary lifestyle – could account for those high rates.
“Over time as Latinos acculturate to American diets and other behaviors, they tend to become heavier in terms of their weight and that influences the prevalence of pre-diabetes and diabetes.”
But he found that acculturation, as it turns out, didn’t entirely account for the higher rates of diabetes either. There may be another explanation.
“Most of Latin America is in the grips of a severe obesity epidemic. So people are arriving in the U.S. much heavier at baseline than they were 10, 15, 20 years ago. So many of them are arriving already with high levels of overweightness and obesity and, likely, many times undiagnosed pre-diabetes or diabetes.”
When they arrive, says Lopez, if they already have diabetes, acculturation can exacerbate the condition. But he thinks it’s partly poverty that drives the disparity. In Rhode Island, Latinos have the lowest median income of any group.
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Back at the Vida Sana class at a free clinic, Dimaris Rosales can rattle off the names of a dozen patients who are struggling to eat healthy and manage their diabetes.
“For example there was a patient who was telling me I have three children at home, and my husband only makes this much money, so they have to go to the supermarket and buy the cheapest thing they can find.
Rosales says she feels sometimes that she wishes she could provide her patients with more than just an education in healthy eating. She wishes she could give them more–money to buy medication, or healthy, fresh food.
To get a sense of just how hard it is to access affordable, fresh food, I head to Central Falls, a place that’s majority Latino and poor, and one where diabetes is a huge problem. According to local health experts, it’s not even a food desert but a food swamp: plenty of food options, but few of them healthy, affordable, and easily accessible. I drive up and down the town’s main drag. Not a single grocery store in sight.
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So let’s take a step back. The rate of diabetes among Latinos in Rhode Island has shot up. No one is entirely sure why. But poverty is one reason- and that leads to a lack of access to health care, affordable, healthy food, and the means to exercise. The growing rate of obesity is another reason. What’s more, the rate of diabetes among Latinos may be even higher than we know.
Matthew O’Brien is a researcher and internal medicine doctor at Northwestern Memorial Hospital in Chicago. He says we may not be screening for diabetes early or often enough.
“We know that Latinos and other racial and ethnic minority groups are developing diabetes at younger ages and at lower weights than whites. And since the screening criteria are based on middle age, you know that is 40 – 70 years old, and being overweight or obese, the guideline would obviously miss those who are not overweight or obese and who are younger than 40 years old.”
O’Brien reviewed the records of thousands of patients of federally funded community health centers and found that if the federal guidelines for diabetes screening were followed, a huge percentage of Latinos would be missed. University of California San Francisco doctor Lenny Lopez agrees.
“The data nationally also shows a similar trend, especially in particular pockets of the country. And it appears many of these things are associated with worse health behaviors, especially with adolescents. So diabetes is developing at a younger age.”
Rhode Island Epidemiologist Dora Dumont also found that Latinos who already have diabetes aren’t getting the care they need. They were less likely to have had an annual eye exam. A foot exam. The necessary blood sugar tests. Those are some of the recommended exams for any diabetic, and without them, a patient might not know the disease is progressing. Dumont says some patients may not be able to afford the exams, or the equipment you need to manage diabetes. Blood sugar testing strips are expensive. You need a glucometer to read them. Sometimes a medication called insulin.
Dumont says you can tell people they need to get this care. But is that enough?
“I think for a long time the assumption in public health was all we have to do is educate people. Once we explain to them that smoking is bad for you, you need to eat your veggies, you need to get exercise, they will do it. The more recent generation of public health is really being driven by this understanding that the social and physical environment in which we live overwhelmingly determines the choices we can make.”
Still programs like the Vida Sana class are teaching patients how to make better choices about their health. They’re raising awareness, and screening more people for the disease. And that’s a start.
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Join us next week for the final story in our series about diabetes among Rhode Island Latinos. She’ll take a look at efforts to prevent and manage the disease – and what hope lies ahead for turning the epidemic around.
