Five social and cultural factors that drive the rise of diabetes in cities

From citieschangingdiabetes.com

Cities are on the frontline of the global diabetes crisis. Recent research by the Cities Changing Diabetes coalition investigated how the epidemic is playing out in five cities across three continents and impacting the lives of millions of urban citizens globally.
Here we reveal some of the surprising social factors and cultural determinants driving the rise of urban diabetes worldwide.

1. Mexico City: Belief that negative emotions cause diabetes

In Mexico City, diabetes is the leading cause of death. The research uncovered a popularly held belief that diabetes is a psychological issue caused by negative emotions, such as anxiety or stress (‘susto’).

Iztac, a 44-year-old woman from Mexico City, personifies this finding. Her type 2 diabetes has led to and exacerbated her loss of vision. Yet she feels that her diabetes is much more a consequence of living with stress due to family and working problems, a fact that she believes is inherent living in the city and with the city dynamics.
The research found that the belief that diabetes is an emotional or psychological issue is a barrier to meeting the physical demands necessary for preventing and managing the disease.

2. Copenhagen: Living alone and lack of social support

In Copenhagen, the number of people with diabetes could nearly double by 2040. The research found that living alone was an indicator of vulnerability, with a number of participants experiencing difficulties with being on their own.
This is evident in the case of Karen, a 55 year old woman living alone in Tingbjerg. “I hear the same story every time I go to the GP: ‘Mind your diet’. I do think about what I’m supposed to eat and what I should avoid, but when I’m sitting alone and thinking about life, it doesn’t matter.’
The research found that living alone can influence people’s ability to take care of their health. Some explained how unsatisfied they were eating alone – consequently, many do not bother preparing a proper meal, and instead end up choosing easy solutions, increasing vulnerability to diabetes.

3.   Houston: Social blindness to being obese

In Houston, we get a glimpse into the future of cities in the developed world. Despite having an advanced health system, obesity is a significant public health challenge, with 32% of adults self-reporting as obese. By 2040, one in five Houstonians will have diabetes. Obesity seems to impact the normative body images, and when these change, so do the perceptions of what ‘a healthy body’ might look like. “I see some people come to my store and I just cringe and think to myself that I am skinny compared to these people”, one lady, overweight and at risk of type 2 diabetes, told researchers.

The study found that comparing your own body size and physical shape favourably to others creates a scenario where change can be perceived as un-necessary  This can ultimately have a detrimental effect on people’s management of their weight and health.

4. Shanghai: Social stigma and negative beliefs

In Shanghai, the increase in the prevalence of diabetes is fuelled by rising obesity, and increasing elderly population.
Researchers found that many participants experience negative beliefs around diabetes as well as significant societal disapproval. In part, this stigma seems linked to the perception that diabetes is a condition of the elderly and ‘weak’, especially when a diagnosis of diabetes is made at a young age.  “I got diabetes when I was about 30 years old, and my parents didn’t want anybody to know I had it, so we didn’t receive help from others” one man with type 2 diabetes told researchers.
The study found that negative beliefs impact the diagnosis, care provision, and physical and mental wellbeing of those affected by diabetes.

5. Tianjin: Wealth, memory of hunger, and miracle cures

In Tianjin, an industrial and fast-growing city, diabetes is an epidemic. The recent memory of hunger and resource shortage is contributing to an obesogenic environment.
Researchers encountered misconceptions surrounding the cause of diabetes. One person with type 2 diabetes reported:  “Once I met a person who suffered from diabetes. When he died, I was invited to dress him. When I lifted his quilt, a disgusting smell came up to me. Suddenly I realised that it was a curse from the dead man’s ghost. At that moment I thought that I might have diabetes as well. I was diagnosed with diabetes within a month!”
The study also detected similarly strong-held beliefs in ‘miracle cures’ among some in the population, which can create biological risks and psychological ill health.

http://citieschangingdiabetes.com/2016/08/02/five-social-and-cultural-factors-that-drive-the-rise-of-diabetes-in-cities/