Diabetes: Sugar‐coated Crisis: Who gets it, Who profits and How to Stop it

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 24 July 2007

185

Citation

Bowerman, J. (2007), "Diabetes: Sugar‐coated Crisis: Who gets it, Who profits and How to Stop it", Leadership in Health Services, Vol. 20 No. 3, pp. 213-216. https://doi.org/10.1108/lhs.2007.20.3.213.1

Publisher

:

Emerald Group Publishing Limited

Copyright © 2007, Emerald Group Publishing Limited


Could there be something about diabetes that people are not talking about? After all, it appears that just about everyone I know has it or is getting it, particularly the type 2 (T2D). Someone recently told me that the diabetes education clinic where her husband had been directed to has a waiting list of more than 200 people – and this in a Canadian city and region where the largest employer is the health care system.

I am by nature suspicious which leads me to have a personal drive to examine possible underlying reasons for “issues” that appear to be rampant in our world and which are being treated as normative. The very title of this book suggests a new paradigm for looking at diabetes as something other than just a medical condition of organ failure in our individual human bodies. Could there be a leadership perspective beyond a medical and pharmaceutical protocol that may help us to transcend the traditional paradigm of a quick cure fix, and help us to gain control over our own lives as fully‐present players rather than as patients? Should we be looking for the “cure”? Or is this a social issue – something that can be explored beyond the boundaries of medicine and genetics?

This book, written by Spero, has started me on a new journey of research and exploration as I continue to mull on the information that is provided here. This is a book that contains far more than just information on diabetes and its prevention. In simple language and a straight forward format, it crosses political, sociological, anthropological, medical and economic boundaries, and places Type 2 diabetes in context as a “social pandemic”, a product of our times.

Just what are the facts of diabetes? Spero places Type 2 diabetes (T2D) in full context calling it a tidal wave seeping over the world. “It afflicts 200 million people, an increase of almost 400 per cent in the last 30 years. It cripples communities, it bankrupts healthcare systems. About 10 million people die from it (more than AIDS). [And] It's getting worse: about 400 million more are pre‐diabetic, on their way to full blown illness” (p. 15). Spero notes the traditional medical view of this pandemic – that this is simply genetic, that our dietary practices are at fault, and/or that our life style practices are too sedentary. “We are either doing something wrong or else something is wrong with us” – either way we feel the shame, the shame that makes this an intensely personal condition. This is exacerbated because so often in affluent nations, T2D is associated with excess weight. Thus, in a culture of blame where we are made to feel personally responsible for carrying excess weight, then all too often it is our lack of will power that causes us to fall prey to this condition. We simply lack will power. Or our culture or our ethnicity is to blame. Either way, the result is guilt – a psychological condition that is both paralysing and crippling and stops us from connecting, communicating and sharing with others

Our economic system of capitalism and with it globalization in my opinion represent a paradox. At the same time as the opportunities they present to explore and mix and trade with people and cultures from far away, a major by‐product is a dehumanizing economic, and social situation that strips us of our power to become real leaders and actors in our own lives. The price of economic progress means that people are removed from their original cultures, and in their removal, we become increasingly the same – alienated from those who are dear to us, isolated from our traditional communities and sources of sustenance, highly stressed, powerless, and addicted to the sugars and fats of the fast food industry, as we compete to make a living in this fast paced global economy. In this new world, our bodies react – they don't like what we are doing to them and they make us sick.

The book describes how this happens and what we can do to combat it. As such, it is of value to medical practitioners who deal with diabetes on a daily basis, people at risk of diabetes, community health workers, researchers, scholars, teachers, indeed anyone and everyone in our society concerned with health and community issues. As a teacher of leadership and management cultures to international business students, I found myself quoting parts of it to my classes, and integrating some aspects into my curriculum. This book is, in my opinion, a treasure trove of information of interest to everyone.

David Spero himself is an interesting author. A nurse by trade, he has lived with multiple sclerosis for 25 years. His life experience has made him a nurse with a difference. His struggle to manage his own condition has led him to become an expert in self‐care – an expertise he works at transferring to others through his practice of counseling and coaching. However, in his own words, he has learned that “self care can only take you so far” (p. 3). He was fortunate to discover the works of “Michael Marmot, Leonard Syme, and Nancy Adler, medical sociologists who look at health from the perspective of communities, populations and countries,” and through their work he became aware of the huge gulf between clinical medicine and social medicine. This book is his attempt to bridge the gulf that unites social medicine, clinical medicine and community activism. Through his travels Spero has learned that “people get sick because their lives are hard, their environments are unhealthy, and they lack the power to respond effectively” (p. 4). He believes that connecting these movements may help us in our struggle against diabetes in a war that we are currently losing.

This book is plainly written and full of information and facts about the diabetes crisis and what we can do about it. Spero's main thesis is that to understand it, we need to recognize it, but once we know what it is, we need to look beyond the individual aspect of diabetes and our “genetic predisposition” to deep within our society where the real answers lie. Those most affected by diabetes are the disempowered. Originally a disease of the affluent who ate too much and who failed to exercise sufficiently, it is now a condition largely of the poor and the dispossessed. Take native Americans for example, and Inuit peoples. Before the Europeans came along, these people were unaffected by diabetes – there is not even a word for it in native languages. Now some of these native groups have some of the highest rates of diabetes in the world. Are they simply genetically predisposed to this condition or is it rather, as Spero suggests, that they have an intolerance for the Western way of life? Look at their recent history; they have lost their land and with it the means to make their own living in their own way. They have lost their freedom. In exchange they have received the calling cards to diabetes –welfare food in the form of high starch, high fat fast food in the form of burgers, fries and hotdogs, pop and candy bars, and access to television (p. 19). It is simply too easy to say that genes are at fault. Spero points out the logic of the argument, few people have genes strong enough to withstand the kind of injury these peoples have suffered. Small wonder high blood pressure, insulin resistance and full‐blown Diabetes Type 2 are the results.

If stress and trauma are built into our way of life, making us vulnerable to illness, then what can be done? Spero's book is in many ways an appreciative call to action using programs and initiatives from around the world but mostly North America that are working to positively impact people's lives. He does point out that the privatized medical system is failing us. In the USA, medical insurance all too often denies diabetics coverage for drugs and education. Diabetes is just too common. As long as surgery pays more than education and prevention, then the medical model will always attract our money. A heart or kidney transplant is much better evening news than 100 people managing their impaired blood sugar. The diabetes education programs in existence are often badly under‐funded, even when they work. The traditional medical model of physicians working one on one with patients does not address the social issues of diabetes. Furthermore, it tends to emphasise the powerlessness and the isolation of the patient. And if there is a waiting list of individuals for the educational programs that exist, and these individuals are already suffering high stress, then they surely will not hang around.

Spero documents the fact that so many educational and community‐based programs are successful at helping people manage their condition, often with limited medical staff. Such programs emphasise a strong element of self‐care, including proper nutrition and exercise, and include community partnerships and alliances with health care systems and medical providers. The most successful are those that empower people in the form of self‐management. Such community initiatives may include doctors, “but not necessarily as leaders”, as well as nurses, diabetes educators, and “promoters” who can go into the community and who understand what people are going through (p. 128) Paying attention to all the pieces in the form of clinics as organizing centres is still fairly uncommon, but Spero thinks (hopes) they will grow as the wellness movement grows.

There is much more I could say about this book. Although not specifically a self‐help book for diabetics, there is a very useful appendix providing information useful information on self‐care and resources, with information not necessarily available easily in other places. It gives examples of ways that communities can come together to help people change their environments and their eating habits, and provides examples of exercise programs that are sustainable. The appendices and footnotes are as interesting as the information included in the text. My own research suggests there are some interesting partnerships and initiatives outside of the medical mainstream that Spero does not mention. These include some the evidence‐based research emanating from the Canadian Centre for Functional Medicine. Perhaps an additional question, not addressed by Spero, is how we can start including these non‐medical and other breakthroughs into the mainstream of diabetes educational movement.

Diabetes is a huge issue we are already facing as a society. It is a chronic progressive disease where high levels of sugar lead to major medical complications including “heart attack, stroke, kidney failure, blindness, chronic pain, and loss of feet and legs to amputation. Diabetes in the US alone costs 132 billion dollars a year … (a low estimate according to some), and 80% of that money is spent on treating complications” (p. 9). Spero's book shows us that we can do something about this situation – if we have the will. His message is clear. Creating the conditions to “fix” diabetes will not only help us manage and perhaps control the condition; through the development of supportive and caring communities, we can also help build a better world.

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