I finished my first year of medical school a couple of weeks ago. Needless to say, I learned A LOT. One disease that came up in multiple courses is diabetes. This is unsurprising considering it is a disease that affects over 25 million people in the United States and leads to various serious complications, including high blood pressure, blindness and heart disease. It is also the number one cause of kidney failure (National Diabetes Fact Sheet, 2011). I spent hours studying diabetes, learned how doctors help their patients manage the disease and saw the consequences of uncontrolled diabetes in the emergency room, including serious infections requiring amputations.
This month, the New York City Department of Health and Mental Hygiene released a report on diabetes-related deaths in New York City (Diabetes-Related Mortality in New York City). According to the report, diabetes-related deaths in New York City are rising. What is more upsetting, although not surprising, is the tremendous difference in numbers of deaths across neighborhoods. Less people in wealthier communities die of diabetes-related illnesses than low-income neighborhoods. For example, Murray Hill, a wealthy Manhattan neighborhood, had the lowest number of deaths (19 deaths per 100,000). Greenwich Village/SOHO, the Upper East Side and Chelsea, followed with deaths reaching 27 per 100,000. However, in Brownsville (Brooklyn) and Mott Haven (Bronx), two low-income neighborhoods, there were 150 deaths per 100,000 and 177 deaths per 100,000 respectively. Finally, diabetes-related deaths were highest among non-Hispanic blacks and Hispanics.
Despite coming across diabetes several times in my school curriculum, there wasn’t any discussion about disparities in diabetes. In fact, health disparities didn’t make it into the general curriculum at all. I only learned about health disparities through involvement in electives and clubs. I am now happy to be working with Bronx Health REACH and Physicians for a National Health Program this summer and am looking forward to exploring the many initiatives throughout NYC that are highlighting and addressing health disparities.
Managing a chronic disease like diabetes is a challenge. For individuals in lower income neighborhoods, the challenges may be far greater. Access to healthy food, quality healthcare and a safe environment for exercise determines who is more likely to get diabetes and impacts the ability of an individual who has diabetes, to manage it.
Last week, as part of the Bronx Community Conversations for Change initiative, I co-facilitated a meeting with parents at the Mid Bronx Early Childhood Center in the Highbridge community of the Bronx about healthy eating. When asked about challenges to eating healthy in their neighborhood, parents noted that fast food and liquor stores are everywhere, but fruits and vegetables are hard to find, expensive and usually not fresh. Also, they expressed frustration over the disappearance of an affordable fruit stand that sold fresh fruits and expressed disappointment over the options available at their local bodegas. One parent commented, “At BJs people buy fruits and vegetables even if they weren’t planning on it, because it looks good.” Finally, some parents agreed that even if the bodegas in the area did begin to sell produce they would be hesitant to purchase the items, because of the conditions of the stores, i.e. lots of cats, rodents, and pests.
That being said, the parents had plenty of great ideas for changes that would promote healthy eating in their neighborhood, including: selling fruit platters, ready to eat meals, prepared salads and fresher fruits at bodegas; providing more cooking demonstrations using culturally sensitive specific foods; creating a mandate for stores to serve healthy options; and making existing fruit and vegetable sections more attractive. I am excited to work with these parents this summer to bring about some of these changes.
Addressing health disparities is going to take a collaborative effort by health providers, community members, food distributors, public policy decision makers, educators and EVERYONE ELSE. Join in the conversation.
To learn more about the initiatives to get healthier food into your neighborhood, please contact Hannah Moreira at firstname.lastname@example.org
This blogpost was written by Hannah Moreira, a second year medical student at Albert Einstein College of Medicine and intern at Bronx Health REACH.