Health Equity Approach to Diabetes Care

Diabetes is a leading cause of disease in the United States. It is also a major cause of death annually. However, rates of disease or death due to diabetes vary substantially across population groups. For this reason, it is important to consider taking a health equity approach to diabetes care. Read on to learn what a health equity approach would look like.

What is diabetes?

Diabetes is a condition where insulin in the body is insufficient to maintain safe blood sugar levels. When blood sugars rise due to insufficient insulin response for prolonged periods, serious consequences can include vision loss, kidney disease, and circulatory conditions.

Two main types of diabetes exist in the population:

• Type 1. It's the type where the body does not make enough insulin.
• Type 2. It's the type where the body becomes desensitized to the insulin being made.

The majority of diabetes cases in the population are caused by type 2 diabetes.

Diabetes prevalence is uneven

The prevalence of type 2 diabetes is higher among some population subgroups than others. The prevalence of disease refers to the proportion of individuals in a population who have a disease at a given time.

In the case of type 2 diabetes, many factors increase the likelihood of disease. According to the CDC, the overall prevalence of diabetes in the USA is 11.3%. However, the prevalence of diabetes is higher among American Indian or Alaska Native, Asian, Black, and Hispanic population groups than among White Americans.

Additionally, the prevalence of diabetes is higher among individuals with less than a high school or high school education than those with more than a high school education. Similarly, individuals at or below the federal poverty level in the USA have a multiple times higher prevalence of diabetes than the highest income brackets in the USA.

Diabetes and health equity

Health equity refers to the idea or goal that all individuals have the ability or potential for full health. Specifically, health equity involves identifying barriers to accessing health and health resources and how they vary across the population, to support all population groups in eliminating the unique barriers they face.

In contrast to equality, where a one-size fits all approach is typically applied, equity aims to provide what is uniquely needed to help all groups or individuals achieve the health goal or outcome.

For example, in the case of diabetes, equality-based approaches may see a policy that decreases the cost of insulin or other medical diabetes management supplies by 10%. However, an equity-based approach would look at redistributing the available resources for supporting costs of diabetes management and focus on individuals in the lowest income brackets or without medical insurance, where cost is preventing them from accessing necessary treatments.

Equity-based healthcare approaches can also include targeted information and education for population groups at higher risk of disease. Education campaigns with an equity lens may promote culturally appropriate disease prevention, such as healthy recipes that still reflect cultural values and flavors.

Health equity and diabetes outcomes

Social determinants of health, like education, income, or ethnicity, can impact prevalence of diseases like diabetes, but also the outcomes of disease. In many cases, factors that increase the likelihood of disease are also associated with more severe outcomes.

According to the CDC, in 2017, the average excess medical cost for a diabetes patient was $9,601. For a patient living at or below the poverty level, these costs are insurmountable. Without medical insurance or a well-paying job, a patient with diabetes may be forced to leave their diabetes untreated for long periods of time. Untreated diabetes can increase the risks of serious outcomes, such as kidney disease and nerve damage.

Why health equity for diabetes matters

Health equity is more than a “pie-in-the-sky” goal to achieve health for all. Health equity is an essential target that improves the lives of individuals and the population. Of course, the individual impacts of health equity leading to better health for individuals of all demographics is crucially important. However, health equity also helps to protect a strained healthcare system as serious outcomes are brought under control for those previously unable to take preventative or disease-controlling measures. Moreover, health equity also contributes to equity in other sectors, as healthy individuals are more able to participate fully in society, both contributing to and reaping the benefits of engagement in the community.

Diabetes is an important health condition and must be treated to prevent serious outcomes in patients. But for some population groups where the risk of diabetes or serious outcomes is higher, a health equity approach is crucial. Health equity approaches consider what specific needs are and target supports to meet those unique needs, aiming to provide the ability to reach full health for all.