Diabetes Education

A Guide to Understanding the Social Determinants of Health (SDoH) That Attribute to Type 2 Diabetes

Realizing DPP
October 26, 2022

As a lifestyle coach, it’s important not just to know what your client’s lifestyle habits are now, but where they came from and how that has contributed to their condition. 

Understanding social determinants of health will also help you identify areas where your clients are vulnerable and help them address them proactively.

To help you make sense of how diabetes arises, we’ll look at information from the U.S. Department of Health and Human Services Offices of Disease Prevention and Health Promotion, which designated a task force called the Healthy People Federal Interagency Workgroup (FIW) to tackle the health crisis. Their Healthy People 2030 program lays out five key ways that social circumstances contribute to health or lack of health, including type two diabetes. 

We’ll also view data from other researchers, including those at the American Diabetes Association, which published Social Determinants of Health and Diabetes: A Scientific Review

As you open your eyes to how economics, education, health access, environments, and social connections contribute to this disease, you may at first be shocked. But you’ll be that much more empowered to help your clients.

In this article, we’ll look at how five key areas contribute to type two diabetes, so you can help your clients most effectively.

How Economic Stability Affects the Risk of Diabetes

Economics plays a huge role in determining health and quality of life. 

There are so many ways that money factors into health, from preventing people from seeing a doctor to limiting healthy food options to lowering access to good education. And unfortunately, there is widespread economic instability in the U.S. According to the U.S. census, one in ten people live in poverty.

There’s no doubt that economic conditions affect rates of Type 2 diabetes. A 2011 study found that socioeconomic status (measured by educational level, occupation and income) is an accurate predictor of the rate of possible diabetes diagnosis, with low socioeconomic conditions leading to higher chances of developing it.

It all makes sense when you consider that staying healthy is expensive in the United States, which makes it that much harder for those with low-income. For example, maybe one of your clients didn’t grow up with much money, and grew accustomed to eating fast food on a regular basis. 

If a mom has to feed a family of five, it’s just more economical to get as much bang for your buck, and fifty-cent tacos from Del Taco or dollar quarter pounders from Burger King are definitely cheaper than buying a healthier option like a salad.. Plus, if she and her partner both work full-time jobs or even multiple jobs to make ends meet, there’s not exactly a ton of time left to cook healthy meals or teach the kids about healthy eating. When it’s a matter of survival, McDonalds just has to do the trick.

But even moderate financial struggles can keep families from being healthy. A for-profit medical system that gives little in the way of benefits means sometimes middle-class families have to make sacrifices. Maybe your client grew up going to public schools, which, until the past decade or so, could easily have served up school lunches consisting of tater tots and hot dogs. This would have set them up for a lifetime of bad habits. Or maybe their parents traded an expensive summer camp for a season at home sitting and watching T.V. 

Of course, exercise is free, and there are ways to eat more healthfully on a budget. Yet without outside support and guidance, making those changes can be challenging. This is especially true for participants whose lives are hectic and chaotic, which can happen more easily if they’re low-income. 

As a diabetes prevention lifestyle coach, you can be that outside motivation to inform and empower them to make life-changing choices that reduce thier Type 2 diabetes risk.

The Affect of Education Access and Quality on Diabetes Diagnoses

Much like economics, education is an accurate predictor of health. 

The American Diabetes Assocation found that the more education you have, the lower your chances of developing diabetes and vice versa. People with a college education or higher have the lowest risk for diabetes. Having less than high school education doubles the risk for diabetes compared to someone with a college degree. 

Additionally, The Healthy People 2030 Task Force has also found that higher education is associated with better health and increased life span. 

There are a number of reasons for this disparity. First, a higher level of education will likely result in better access to jobs, including high-paying jobs and those that provide health benefits. A higher level of education opens many more doors and opportunities to live a balanced lifestyle, while lack of education can lead to taking on low paying jobs and living in stressful, even violent environments, which can even impede brain development. 

Plus, the less education a person has, the less exposure they have to information that can help them make healthy choices, understand how their bodies work, understand the connection between nutrition and health, and learn about the social factors that contribute to health disparities. There’s also less emphasis on critical thinking skills, which are needed to make empowered choices that don’t take information at face value. 

Understanding that a lack of education may be behind a client’s health condition is important as you connect with your participants. You can focus on informing them while having compassion for the fact that it was likely circumstance, not negligence, that contributed to their condition. 

How Healthcare Access and Quality Influence Diabetes Risk

Access to quality healthcare is a major contributor to people’s risk of diabetes, and one of the biggest hurdles people have to overcome in the U.S. is a lack of insurance. 

The Healthy People 2030 task force states that one in ten people don’t have health insurance, which means even routine or preventative visits, like physicals, could be out of many people’s budgets. What’s more, the people who don’t have insurance are more likely to be only partially employed, which means their incomes are lower to begin with. 

For those who only go to a doctor in the even of an emergency, they may not ever stick with a primary care doctor. 

Primary care doctors keep patients informed about important tasks like getting cancer screenings, stay on top of information such as smoking, drinking, and other lifestyle choices, and staying up to date with vaccinations. Without these life saving reminders, it’s all too easy to have a preventable disease like Type 2 diabetes spiral out of control without the patient even knowing about it. 

The qualitiy of available healthcare is also highly varied throughout the nation. Quality care means culturally inclusive and compassionate treatment that establishes trust between provider and patient. When BIPOC individuals experience a less than supportive environment, they may become less trusting of healthcare systems and avoid getting treatment. 

Lastly, quality is also measured by the amount of time providers spend with patients, how well they listen to their questions, and how much they’re wiling to do besides handing the person a prescription. Most of us have seen this in action when we show up at a clinic or visit a hospital we realized is second rate. For some, those are the only options they have.

As a lifestyle coach, you have the potential to counteract these negative experiences and give your clients the compassionate care they deserve. You can take the time to get to know who they are, not just what their symptoms are. You can attend to the whole person and get to the root of their health habits. By asking questions and providing motivation, you can give them the personalized attention they need.

How Someone’s Neighborhood and Built Environment Contribute to Diabetes Risk

The places where people live, play, and spend their personal time has a big impact on their diabetes risk. 

A 2018 study is one of many that have found that neighborhood environments impact risk for diabetes. They found that access to parks and other green spaces and walkability are the neighborhood features most associated with lowered diabetes risk.

Other factors include availability of fitness centers like public pools, parks, and sports facilities, availability of healthy food options, and neighorhood safety all contribute to how healthy a person is capable of being in their environment. 

Chaotic or unsafe environments might make it less likely for people to walk to the store or work out in the park. Plus, the stress of living in impoverished or violent areas could also lead to depression, anxiety, stress, which can increase the risk for diabetes. If a person is surrounded by other people who aren’t making healthy choices, it’s common for them to follow in the same footsteps.

Neighborhoods with more chemicals in the water — which tend to be poorer communities — can also contribute to increased risk for diabetes. A 2013 study found that aresenic in particular is highly associated with the condition, but other studies have shown that persistent organic pollutants, phthalates, and possibly bisphenol can also put people at risk.

While most of these factors are beyond your control, you can do your part to educate clients about how their environment impacts their health and provide them with practical tools to make the most of their living situation.

Social and Community Context’s Affect on Diabetes Diagnoses

The Healthy People 2030 task force states that the people we associate with can have a major impact on our health, and isolation and ostracism are associated with higher rates of disease. 

Social support is associated with better mental and physical health, while a lack of social support can inrease morality risk at rates on par with alcohol abuse or obesity.

Families with lower rates of education and higher rates of poverty may struggle with social support. A kid who’s parents are working two jobs and who has to cook for herself at a young age won’t just be facing income and education disparities, but also isoltaton. Additionlly, immigrants who don’t have extended family nearby and may stand out from their communities can also lack connection or even experience ostracism. 

Luckily, you have an amazing opportunity as a lifestyle coach to provide support to people who may not have had it in the past. That’s why honing your people skills, showing compassion, and being gentle yet firm in your coaching can make a huge difference. 

Understanding Social Detriments of Health With Realizing DPP

Type 2 diabetes isn’t a simple disease to understand, and its risk factors go way beyond diet and motivation. Behind every individual are complex circumstances, including economic status, education, neighborhood, access to quality healthcare, and social support systems. While you can’t erase inequities or injustices, you can help your clients understand how their environment impacts their health and make empowering choices. 

As a diabetes prevention lifestyle coach, you can be an amazing support for your clients. And that means you need your own social support system to help lift you up, empower you, and help you be the best you can be!

Realizing DPP is an incredible resource for your coaching practice. You will tap into a network of like-minded lifestyle coaches and harness benefits like peer discussions, trainings, FAQs and discussions, and much more. 

Join the Realizing DPP community today!