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 hmoeira@institute2000.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.
