Читать книгу The Social Causes of Health and Disease - William C. Cockerham - Страница 12

Diabetes is of growing importance in the United States and it is clear that race is a key variable in this development, despite claims that race is simply a social label that by itself should not have any effect on health. What makes race most important with respect to health in American society is its close association with being affluent or poor. Even though members of all races are in each socioeconomic category and many whites are poor, blacks and Hispanics are overrepresented among lower-income groups (Cosby et al. 2019). As for diabetes, both the Type 1 and Type 2 versions are diseases in which excess amounts of sugar (glucose) in the blood damage the body’s organs – promoting kidney failure, heart disease, stroke, blindness, amputations of limbs, and other problems. Type 1 typically appears in childhood when the pancreas quits producing insulin that controls blood sugar levels because the body’s immune system has destroyed the cells that make it. Type 2 or adult onset diabetes is the most common form of the disease and usually develops in people after the age of 40. Some 90 percent of all diabetics are Type 2. This type features the ability to make insulin but the inability of the cells to use it to control blood sugar levels. Type 2 diabetes is often controlled through diet and exercise, but if this fails then oral medications and/or insulin injections are required.

Centers for Disease Control and Prevention (CDC) figures for 2017 indicate that 30.3 million Americans nationwide had diabetes and 84.1 million more were in a prediabetic stage (CDC 2017). One in three children could expect to become diabetic; for Hispanics, it may be as high as one in every two children – thereby suggesting a future explosion in the numbers of diabetics in the United States.

Genetics plays a critical role in that diabetes is more prevalent in certain families and groups than others. A variant gene (TCF7L2) has been discovered that increases the risk of Type 2 diabetes and is carried by more than a third of the American population (Grant et al. 2005). Since people carry two copies of each gene, one inherited from each parent, the extent of the risk depends on whether one or two copies of it have been inherited. The estimated 38 percent of Americans with only one copy are 45 percent more likely than the unaffected population to come down with the disease, while the 7 percent who have inherited two copies are 141 percent more likely than those without the gene to develop diabetes. This gene has existed in the American gene pool for generations and its presence in the body does not guarantee its activation; rather, it enhances the risk. However, the rapid acceleration of new cases in recent years cannot be explained by genetics alone since the human gene pool does not change that fast.

Instead, the culprit appears to be social behavior and is inextricably linked to socioeconomic status and race. Low SES is significant because of what the combination of low income, education, and occupational status signify with respect to the greater likelihood of smoking, obesity, sugar and high-fat diets, and lack of exercise – all pointing toward a greater prevalence of unhealthy lifestyles more common in this population group. Race is important because blacks and Hispanics are twice as likely as whites to become diabetic. The overall prevalence of diabetes, according to the Centers for Disease Control and Prevention (2017), is higher among American Indians/ Alaska Natives (15.1 percent), non-Hispanic blacks (12.7 percent), and Hispanics (12.1 percent) than among Asians (8.0 percent) and non-Hispanic whites (7.4 percent). The relationship between SES and race with respect to diabetes is documented in research by Mario Sims and his colleagues (2011), who found diabetes among African Americans to be patterned along socioeconomic lines. Lower SES blacks had both a significantly higher prevalence and greater incidence of new cases of diabetes than blacks higher up the social scale. The lower the SES, the greater the diabetes; the higher the SES, the less the diabetes.