March 23, 2021

The COVID-19 pandemic has shed light on the glaring health inequities facing people of color in our nation and in South Carolina. It is not the only health crisis, however, that affects people of color at a disproportionate – and alarmingly – higher rate.

The prevalence of diabetes is higher in Black South Carolinians than it is in white South Carolinians. More than 16 percent of Black residents are affected by the disease compared to about 11 percent of white residents. Not only is diabetes more prevalent in Black communities in South Carolina, it is also more deadly. Information from the South Carolina Department of Health and Environmental Control (DHEC) shows the death rate among Black residents with diabetes is twice as high as it is among white residents with diabetes.

“Cultural behaviors and bias can be barriers to preventing diabetes and having effective diabetes management once the disease is diagnosed,” said Shauna Hicks, director of the Division of Diabetes and Heart Disease Management at DHEC. “Black South Carolinians, particularly those in rural communities often lack access to or may not be able to afford health care, healthy foods or membership to places for physical activity.”

Social determinants and diabetes

While there are genetic factors at play when it comes to diabetes, they do not account for such a glaring health disparity among people of color, according to Diabetes Free SC (DFSC) Medical Director Timothy Lyons.

“It’s complicated and not completely understood. However, the weight of evidence suggests that if all communities could experience similar social, educational and economic conditions, the burden of diabetes would not differ greatly between them. There are known genetic risk factors for Type 2 diabetes, but no clear-cut differences in their prevalence between minority and majority communities in the US. Furthermore, diabetes has become much more common in all communities just in the past three decades: this rate of change cannot be attributed to genetic factors. One hundred years ago, Type 2 diabetes was a comparatively rare disease,” Lyons said.

Not only do racial inequities appear in the health data related to diabetes, but they also are evident in the social determinants of health that increase risk for diabetes and complications related to the disease. Access to affordable health care, healthy foods, stable housing, living wage jobs and a safe environment for physical activity all intersect and show similar inequitable trends. Black and Brown communities in South Carolina are often more likely to experience inequities in all these areas, according to Zack King, DFSC coordinator.

“We know that the inequities we’re facing in our state are not limited to just diabetes and related health outcomes but are prevalent in all of the ways that our environment, systems and opportunities impact our health,” King said. “That is why it is so critical to approach our work in an innovative and equity-centered way. The roots to this are deep and wide, and impact the ability for all South Carolinians, especially communities of color, to have an opportunity for a healthy life.”

Hicks adds that a lack of access to adequate, culturally appropriate healthcare, early diagnosis and effective treatment of diabetes, and lack of reimbursement for prediabetes creates an additional barrier to providing more equitable care to minorities with diabetes. 

“These barriers make it more difficult to have diabetes prevention programs across the state,” Hicks said. “More diabetes prevention program providers are needed to conduct interventions such as the National Diabetes Prevention programs.”

The path to health equity

DFSC, a long-term commitment to reduce health care disparities and improve the health status of all South Carolinians affected by diabetes, was launched in 2020 in part to provide greater access to health care and prevention programs. The first phase of the DFSC initiative included the development of maternity programs designed to improve pregnancy outcomes for women who have diabetes.

“Adverse social, educational and economic conditions result in high risks for diabetes that operate throughout life, and they begin before birth,” Lyons said. If the mother has compromised health at conception or during pregnancy, the baby is born with a (usually invisible) handicap – risk factors already established.”

DFSC also is focused on reducing the lifelong risk of diabetes in children. The program has funded the Boeing Center for Children’s Wellness and the Alliance for a Healthier Generation with the goal of developing school-based wellness programs that will prevent future onset of diabetes.

“Poor diet, lack of exercise, obesity, stress and undetected risks (high blood pressure, high cholesterol, high blood sugar) during childhood, adolescence and young adulthood set the scene for diabetes and other chronic disease later in life,” Lyons said.

The DFSC initiative is focused on preventing diabetes and its complications in adult South Carolinians as well by promoting programs like FoodShare South Carolina. The organization offers low-cost fresh produce boxes to resident who might not otherwise have access to healthy foods. 

DFSC has made huge strides on the path to health equality for people of color who have diabetes in South Carolina. There is still work to be done, however, to tackle the systemic issues at the root of disparities in diabetes diagnoses and of health inequalities that affect the lives and health of many South Carolinians. 

Data from the Centers for Disease Control and Prevention show Indigenous and Hispanic communities nationwide are disproportionately affected by diabetes. DFSC is committed to learning more about addressing health inequities in these communities as well, according to King. 

“The right thing to do is for DFSC and our partners to continue to listen, learn and commit ourselves to think, plan and act in a way that intentionally fights against racial inequities across all of our work,” King said. “We are committed to ensuring that our efforts not only address the widespread impact of diabetes in our state, but specifically address the systems and barriers disproportionately impacting Black and Brown communities across South Carolina.”

*The Centers for Disease Control and Prevention, South Carolina Department of Health and Environmental Control and FoodShare SC are independent organizations that provide health information you may find helpful.