The objective of the research proposal in this paper is to analyze the development of type two diabetes in Latinos born in the United States, and/ or living in the United States for 3-5 years, and how it compares to the development of type two diabetes in Latinos born/ living outside the United States. Type two diabetes is described by the American Diabetes Association as follows,
[when] your body does not use insulin properly. This is called insulin resistance.
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[T]he pancreas makes extra insulin to make up for it. But, over time your pancreas isnt able to keep up and cant make enough insulin to keep your blood glucose levels normal. Type 2 is treated with lifestyle changes, oral medications (pills), and insulin.
A solution will be proposed accordance with the findings of how lifestyle choices based on birthplace enable or prohibit the development of type two diabetes. The research methods used will be utilizing the Arizona State University Online Library Data-Base to find primary sources as well as other well credited online secondary resources, and research papers, to gather information needed for the analysis. The class text Health Issues in the Latino Community will also be used as a source for information research.
It is well known amongst many Latino families that diabetes, specifically type two diabetes, is a disease that afflicts many families, and the Center for Disease Control (The CDC) says that as much as up to 50% if Latinos are likely to die due to diabetes, when compared to a white person. The CDC has also noticed that it makes a difference if a Latino person was born in the United States, or outside of the United States. It can be hypothesized that the disease would be prevalent in America, where dietary habits/ nutrition issues are a known problem, and an academic journal/ review by Sim?n Barquera, et al. entitled, Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin makes this hypothesis one of the research points the article focuses on. A quote from the article that demonstrates this can be seen here:
Diverse factors have been hypothesized to underlie these vulnerabilities [to diabetes], including genetic susceptibility, perinatal conditions including malnutrition and breast-feeding practices, adverse dietary and lifestyle patterns related to acculturation (high consumption of sugar-sweetened beverages, processed foods and low physical activity), food insecurity and lower socioeconomic status, poor access to health services, receipt of poor quality healthcare services, communication barriers (such as limited literacy and limited English proficiency) [19, 20] and sub-optimal adherence to treatment recommendations.
The root of the diabetes epidemic in the United States seems to be theoretically based on acculturation and healthcare access barriers, the next hypothesis would be to test if these common factors affect those across the border as much as it does to us in the US?
Mexicans that originate from Mexico have statistically lower rates of documented diabetes in the US, however this is in part due to the state of public health in Mexico is drastically different from that of the United States. According to the CDC, in an online web page titled, Vital Signs/ Hispanic Health published May 2015, Compared with US-born Hispanics, foreign-born Hispanics have: About half as much heart disease; 48% less cancer; 29% less high blood pressure; 45% more high total cholesterol. Meanwhile a quote from the Sim?n Barquera journal review describes the state of health in Mexico as such, While age-standardized death rates per 100,000 inhabitants due to T2D and cardiovascular diseases are similar in the US and Mexico (248.7 vs 199.9 /100,000 inhabitants), T2D mortality is much higher in Mexico (69.2 vs 16.6 /100,000 inhabitants) .
T2D has been increasing in Mexico since the 1980s and has become the leading cause of all-age mortality since 2000 . Without having an average diet to examine for either group, it is be difficult to infer what specific lifestyle changes cause the increase in diabetes in Latinos. The affect of acculturation upon moving to the US has been mentioned in both the Barquera text, and the Health Issues in the Latino Community chapter written by Jose Alejandro Luchsinger, which is quoted as saying, Less acculturated Latinos were more likely to eat fruits, rice, beans, meat, fried foods, and whole milk than more acculturated Latinos.
This change in diet attributed to acculturation, can be possibly connected to the ever-rising cost of living overall in the United States which creates a healthcare barrier for Latinos to avoid type 2 diabetes. Latinos born in the United States are born into a world of cheap unhealthy food, and even more food that advertises itself as healthy, but in reality, is no more nutritional than the alternative. The United States has also made efforts to help their Latino population diagnose and treat their diabetes with the National Diabetes Surveillance System.
According to the United States Census Bureau official website, a population estimate for the year of 2017, published July 1st of that year, claimed that the total population of the United States was about 325,719,178 (about 325.7 million) people, and about 18.1% of the population are documented as Hispanic or Latino origin.[D] This 18.1% of Latinos are the population most likely to be acculturated into United States culture, and arguably the biggest contributor to diabetes in the United States culture is the Standard American Diet (SAD).
The Standard American Diet (also called the Western Pattern Diet (WPD)) is described in The American Journal of Clinical Nutrition as, a modern dietary pattern that is generally characterized by high intakes of red meat, processed meat, pre-packaged foods, butter, fried foods, high-fat dairy products, eggs, refined grains, potatoes, corn (and High-fructose corn syrup) and high-sugar drinks.[E] The consumption of these processed, fried, and prepackaged foods results in weight gain, especially during early childhood, to the point of obesity and pre-diabetes. Research journals which support this thesis, published by their respective individuals Kant (2004), Drewnowski (2007), and Yang (2012), state the following in relation to consumption of foods in the Standard American Diet: [F, G, H]
There is a positive correlation between a Western pattern diet and several plasma biomarkers that may be mediators of obesity, such as HDL cholesterol, fasting insulin, and leptin.[F] Relative to a diet high in fruits, vegetables, legumes, and fish, a Western diet is associated with increased risk of being overweight among adolescents.[H] Meta-analyses have also shown that, compared to a healthy diet, a Western pattern diet is linked to increased weight gain among females.[G]
This affects acculturated Latinos who may already have a genetic predisposition to diabetes, as processed foods exist everywhere, even in food insecure areas. Fast food is cheap and convenient, and many fast food restaurants even have a lower-budget menu to service those families that have lower incomes. Many prepackaged foods sold in grocery stores are processed to point that the original components of the food had to be re-fortified with nutrients in order to be considered healthy.
A healthy diet is no easier to attain; a healthy diet is defined by Lean (2015) and the World Health Organization (2004) as a diet that helps to maintain or improve overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients, micronutrients, and adequate calories.[L] and a healthy diet is not complicated and contains mostly fruits, vegetables, and whole grains, and includes little to no processed food and sweetened beverages.[K] So why arent Latinos buying these whole foods instead of processed foods? A possible explanation can be found in an online article written by Claypoole, in this article Claypoole explains that there is a price barrier that is at play:
Produce is perishable. In fact, about 20 percent of all apples, oranges, lettuce and other fresh fruits and vegetables must be thrown away before even reaching shelves, according to Daily Finance. As a result, produce markups average 50 to 75 percent. Markup on products such as berries, which are easily bruised and have a short shelf life, may range even higher.
And these price barriers to healthy food could be overcome, despite the markups many whole foods still remain affordable to those with even minimum wage paying jobs, however in the research journal published by Towers, there are also psychological barriers that have arisen
Though the Latino participants found diet to be an important determinant of their risk for diabetes, they found their own diet to be less changeable than did their European American counterparts.
The shared belief in the importance of diet accompanied by a difference in belief in the changeability of diet in their own lives suggests the presence of a perceived barrier to dietary changes specific to Latinos This effect can be magnified for Latinas, who have been cited as being less likely to make dietary changes to reduce diabetes risk in an effort not to inconvenience their families dietary habits (Carbone, Rosal, Torres, Goins, & Bermudez, 2007).
There is not as much immediately available information about the standard diet of Mexican people in Mexico, however the cost of living difference can allow one to infer that the majority of the immigrant population is most likely not making enough to eat take out every day. In an article written by Christopher Woody (2015), they explains that:
The gap in wealth and in wages is visible across Mexico’s economic strata. According to OECD figures, the country’s richest 10% earn more than 30 times what the poorest 10% make making it the most unequal of the organization’s 34 countries. Mexico’s bottom 20% doesn’t make enough to eat three meals a day. That same year, the bottom 20% of Mexicans nearly 25 million people were worth an average of $80.
Mexico has made multiple efforts on the national level to combat diabetes within the population, even giving its people who may not have healthcare opportunities as Barquera et al. (2018) explain,
A number of national prevention policies have been implemented to curb the T2D epidemic in Mexico. Some of the more notable ones are 1) the 5 Pasos (Five Steps) national program in the 2006“2012 administration 2) the national healthy hydration recommendations, 3) healthy nutrition guidelines for the school environment, 4) a national agreement for healthy nutrition (2010), which subsequently became a national policy (2013), 5) the Ch©cate, mdete, muvete (Check yourself, test yourself, and move) national program and 6) a national 10% excise tax on soda and sugar-sweetened beverages, which has been demonstrated to yield a substantial reduction in consumption and potential health benefits [8, 25“28].
The United States has also made efforts through to help Latinos overcome healthcare barriers and become more aware of diabetes and diagnosing those who may not know they already have the disease, as Barquera et al. (2018) go on to say:
While not solely intended as a policy-level intervention to reduce the burden of T2D among Mexican-Americans, the Affordable Care Act (ACA) of 2010 (Obamacare) has made early diagnosis and management of T2D more accessible for Mexican-Americans in California. The first five years of the program yielded a reduction in the uninsured Hispanic-Americans from 26 to 16%. By comparison, among non-Hispanic whites, rates fell from 14 to 10% over the same time period.
The diabetes epidemic affects people on both sides of the border of the US and Mexico. While in the US there are multiple causes that require further examination, and preventative action by the United States government, the causes of diabetes in Mexico are not as clear. The most likely explanation is diet, and the Mexican government has taken multiple steps in creating programs to help their people become aware of what dietary patterns might be contributors to diabetes. Latinos who have become acculturated in the United States may have fallen into a pattern of eating unhealth foods, while not having access to health care. In response the US has made programs directed at Latinos such as the affordable care act in order to erase this barrier.
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