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Racial Inequity of Diabetes, Authors Golden, Joseph, and Hill-Briggs…

- - - - However, what this theory does not account for is the heterogeneity of Africans and the diversity of Africa as a continent and the increased heterogeneity of African Americans. This means that the disparity could not be at the "hands" of one single gene and therefor the theory was debunked (Marshall, 2005).
        
        Regardless of the debunked genetic theory, genetic research for the racial disparity of diabetes continued. A 2012 study entitled African Ancestry and Its Correlation to Type 2 Diabetes in African Americans: A Genetic Admixture Analysis in Three U.S. Population Cohorts” by Cheng et al. found a positive correlation between African ancestry and type 2 diabetes. They determined that odds of developing type 2 diabetes had a 30-40% increase among those with African ancestry even while adjusting for other factors including body mass index and socioeconomic status (Cheng et al., 2012)
        
        Yet again, African ancestry is very vague and does not consider the vastness of heterogeneity and diversity among people from the continent.
    - - In the 2009 article, "Disparities in the prevalence of diabetes: is it race/ethnicity or socioeconomic status? Results from the Boston Area Community Health (BACH) survey", authors Link and McKinlay report that focusing on race/ethnicity as a primary determinant of diabetes puts too much focus on biomedical factors while taking away important attention from the upstream, aka structural determinants, such as social circumstances, adequate access to care, and social policies where socio-medical interventions can come be implemented.
        
        A more recent study published in 2017 in the Journal of the American Medical Association called “Association of Modifiable Risk Factors in Young Adulthood With Racial Disparity in Incident Type 2 Diabetes During Middle Adulthood” by Banks et al. discusses how modifiable biological factors are at the root of the disparity. Some of these factors include body mass index and central fat storage, both being characteristics of obesity that can be targeted for change-- hence being modifiable (Banks et al., 2017).
        
        Authors Banks et al. highlight that underlying the disparity of these modifiable biological factors are social determinants of health such as psychosocial factors, environmental factors, and access to specific resources such as health care (2017).
        
        Influencing the social determinants of health, the authors discuss how other factors such as socioeconomic status, neighborhoods, and behavioral aspects also contribute to the disparity of diabetes between Black and white communities (Banks et al., 2017).
- - - - As discussed In the TED talk by Dorothy Roberts, Medical research has used race, a social construct, as a variable instead of ancestry for genetic information. Although evidence based measures exist for medical tests, race is used categorically to treat patients differently, leaving patients of color more vulnerable than white counterparts for proper and quality treatment and care (Roberts, D., 2016).
        
        Highlighting this difference in quality of care, a study looking at the Racial Difference In Diabetes Preventative Care revealed that African Americans are less likely to receive the two A1C tests, a diabetic foot exam, and an eye exam compared to their white counterparts for diabetes prevention screening which contributes to the racial disparity of the disease (Pu & Chewning, 2013).
      - Partly due to implicit bias within the healthcare community, in the United States, People of color experience health disparities regarding access to care, quality of care and health outcomes compared to white counterparts (Hall et al., 2015).
        
        The article, "Self-reported racial/ethnic discrimination In healthcare and diabetes outcomes" by Peek et al. explains how racial/ethnic discrimination suggested greatest impacts on diabetes quality of care and complications at the responsibility of the healthcare providers, however self-care behaviors at the responsibility of the individuals experiencing the discrimination were not affected (2012).
    - - This created barriers between communities regarding language and communication which further impacts access to and the quality of healthcare, while also decreasing health literacy in African American communities (Golden et al., 2021)
        
        Further leading to an increase in physiological factors like stress, blood pressure, cholesterol, and blood glucose which then lead to disparate health outcomes including diabetes (Golden et al., 2021).
  - - - These policies lead to underfunding within urban neighborhoods and thus a lack of access to quality resources including education, jobs, recreational spaces, and supermarkets (Golden et al., 2021).
        
        Due to the neighborhoods being underfunded, disparities in socioeconomic status between Black and white communities further contributed to the health disparities between the communities (Popescu et al., 2018).
        
        The structural and institutional racism as a result of the policies further resulted in neighborhoods full of inadequacies regarding affordable housing, sidewalks, open spaces and parks, access to healthy food, proper security, and cleanliness-- all of which are social determinants of health that lead to adverse health outcomes including diabetes in African American communities (Golden et al., 2021).
        
        In relation to the disparities in SES, the wealth gap between white and Black Americans is astounding, with white families' net wealth being about 8 times greater that Black families. This causes many discrepancies regarding the opportunities available between the groups of people, including the opportunity for proper health care (California Newsreel And Regents Of The University Of California, 2019).
        
        A study looking at the factors of Insurance, Racial/Ethnic, SES-Related Disparities in Quality of Care Among US Adults with Diabetes, found that Insurance coverage makes the most difference compared to the other factors In making sure diabetes care meets the standards provided by the medical system (Hu et al., 2013).
        
        Highlighted in the healthcare report called Racism, Inequality, and Health Care for African Americans, there have been historical health care coverage disparities between minority groups and white counterparts. Even after the Affordable Care Act, which resulted In 2.8 million more African Americans gaining health coverage, the uninsured rate of African Americans was still higher at 9.7% compared to the 5.4% of white Americans (Taylor, 2019).
        
        So, since insurance coverage had a stronger association than SES and race/ethnicity, for proper healthcare regarding diabetes In the Hu et al (2013) study, the disparity of diabetes relates more to the institutional and structural racism than the biological/genetic factors of race itself.
      - In discussion of the Stress and Sugar Study (SASS), contributor Tiffany Green states that , "[...] some researchers have suggested that what appears to be a “race” effect—racial differences in diabetes risk—can be substantially explained by a “place effect.” That is, the stress of living in resource-poor neighborhoods is a primary driver of racial and socioeconomic differences in diabetes risk." Shifting the focus from a solely biological context regarding diabetes is important as risk factors are seen as a result of physical and social components, as well. Further, "race" is a social construct and therefore does not hold scientific weight, rather the social determinants that impact those categorized in "minority races" need more attention (Green, T., 2017).
        
        The SASS looks at the context of diabetes risk factors in developing type 2 diabetes among the Black community in Richmond, Virginia-- a racially segregated community. While analysis of the study is ongoing, the rationale and baseline results report findings revealing that both low SES and race have an impact on stress levels (Mezuk et al., 2020)
        
        Furthermore, preliminary findings indicate a strong relationship between stress and overeating foods that are high in fats and sugars to cope, and that dulled stress reactivity is related to the diabetes risk factor of HbA1C at higher levels (Green, 2017).
        
        Interestingly, the study also explains their findings comparing African Americans and their non-Hispanic white counterparts and the similarities of health characteristics between the groups when living in the same low-income, integrated neighborhood, as consistent with previous results referenced in the study (Mezuk et al., 2020)