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Minnesota 2020 Journal: Diabetes Makes Me My Brother’s Keeper

May 03, 2013 By John R. Van Hecke, Executive Director & Fellow

Diabetes makes the case for affordable healthcare reform in Minnesota. It’s a long-term, grinding, expensive problem that impoverishes families, isolates the afflicted and diminishes communities. Real policy change is required. Once we stop saying one thing and doing another, putting real resources behind reducing risk, Minnesota will move forward.

Diabetes is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. It is not caused by obesity. Obesity is a clearly identified risk-factor for developing diabetes. Obesity is a result of genetic factors, lifestyle and diet. Sugary snack cakes and soda pop don’t cause diabetes; avoiding them will decrease diabetes risk.

Individual diet and lifestyle choices affect diabetes risk profile but genetic factors are strongly determinant. If your parents, uncles, aunts and grandparents had diabetes, there’s an excellent chance that you’ll develop diabetes, too. You need a risk mitigation strategy.

The numbers are staggering. Almost half of all Minnesotans have or are at risk of developing diabetes or prediabetes. Even arresting diabetes’ forward progress would be an amazing gain, to say nothing of genuinely reversing the trend. Without change, diabetes’ related costs will compromise Minnesota’s health and productivity.

In the health clinic, diet modification is a clear concept. The data that mitigate risk factors translate clearly and unequivocally into food choices. On paper, it looks good; easy, even. Walking out the door, however, everything changes.

We live in a toxic food environment. We are surrounded by food choices that would astonish even early 20th century people. I marvel at food manufacturing’s capacity to create cheap, attractively presented calories. We have collectively overcome the life-determinative drive for food. Hunger and poverty remain challenges but very few people starve to death anymore. The knife that puts food on our tables, however, has now become the knife that risks slitting our throats.

The term “toxic food environment” was introduced by Yale epidemiologist Kelly Brownell, co-founder of the Yale Rudd Center for Food Policy and Obesity. Published in 2004, Brownell’s book, Food Fight: The Inside Story of the Food Industry, strongly makes the case for environmental factors contributing to increasingly poor personal health and to mounting associated healthcare costs. Brownell argues for greater legislative and regulatory intervention by government to responsibly address the problems.

The other side, which I characterize as conservative, asserts individual responsibility’s primacy as a public policy factor. No one, this argument goes, forces anyone to purchase and consume a one-pint, 175 calories bottle of cola. The public, conservatives like to insist, shouldn’t bear the cost of any individual’s poor diet choice. Your diabetes, in other words, is your problem.

It’s a seductive argument with a seemingly clear premise and conclusion. It’s also misleading and wrong.

Step back to the health clinic door. You’re leaving, diet plan in hand, prepared to actively reduce your diabetes risk factors through diet modification and increased exercise. The first thing you see? A snack-chip company truck rolls past, followed by the soft drink distributor’s truck. Those vehicles are part of a complex production and distribution system that creates food product ubiquity and omnipresence. High diabetes risk foods may be banished from the nutritionist’s desk but they’re waiting just outside the door.

I don’t believe this debate is as simple as more regulation versus personal responsibility. Complex processes require equally determined, ultimately complex responses. This is the logic driving affordable healthcare reform. It’s the conviction that what we’re doing is inadequate and isn’t working, compelling systemic change to create better and more affordable access to healthcare services and insurance. The Affordable Care Act does many things but fundamentally it’s trying to lower costs by increasing insurance pool size, spreading risk and cost among more people.

The key lies in collective effort, propelled by individual incentive. Diabetes care’s long term costs means that we have clear financial reasons to create better risk-mitigation and treatment protocols. But, this only works if we understand that better healthcare, yielding healthier lives, is a long-term play. Unraveling the toxic food environment will take time but it’s not an impossible task. It wasn’t so long ago that everyone smoked, tossed garbage from moving cars and discharged raw sewage into lakes and rivers. Tackling diabetes, like embracing affordable healthcare reform, gains speed when we collectively help each other overcome the organized effort that wants to keep us isolated, sick and alone.

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