Noah Seelam/AFP/Getty Images/The Guardian
In recent years, there has been a growing awareness of the fact that non-communicable diseases, or NCDs, are no longer just diseases of the wealthy. It had long been assumed that they were more a phenomenon of developed countries, but recent evidence is showing drastic increases in rates of NCDs in developing countries as well. In the case of diabetes, around 80% of people suffering from the disease live in developing countries.
However, while great leaps have been made towards bringing awareness of diabetes to developing countries and poorer regions, what is often overlooked is the affect of movement on Type 2 Diabetes. Migrants are a high-risk group for the disease, and are frequently forgotten in the discussion on how to approach diabetes care. Migrants tend to be more likely to develop diabetes for a variety of reasons. The stress of migration and adapting to a new place, often with little support, can be a major inducer of T2DM. Studies have shown links between high levels of stress and susceptibility to obesity and diabetes. In addition, many coping measures for stress, such as overeating or smoking, are unhealthy and make a person more at risk for diabetes. The change in environment also causes a change in diet and activity levels. A high percentage of migration is from rural to urban areas, where activity levels often drop and quality of food may be lower, with fatty and sugary foods becoming more common. It has also been found that it can be more harmful to experience a sudden shift to a worse diet and lower energy levels than to have always been exposed to them.
So what does this mean for diabetes care? The issue with the high prevalence of diabetes in migrant populations is that they have very specific needs and cannot be treated in the same way as non-migrant groups. Cultural and language barriers severely impair migrants’ abilities to prevent, diagnose, treat, and control diabetes. Lack of diabetes education makes it difficult for migrants to know how to prevent the disease, and fear or poor understanding of the health care system can lead to late diagnosis. Poor communication with and mistrust of health care providers also reduces the chances of migrants fully understanding the treatments and following them properly. This is not solely due to language barriers; cultural gaps also play a role. If someone’s cultural views make it difficult to take advice from a doctor or nurse of a certain gender, or cause them to feel uncomfortable with certain treatments, it may result in them ignoring very important instructions.
It is necessary not only to understand these cultural barriers, but also to train health care professionals in how to deal with them. Cultural sensitivity training would go a long way to ensure that treatment advice is communicated in such a way that both parties are understood clearly. Working with community leaders can also ensure that information is effectively shared. These simple strategies can help physicians with sufficiently reaching migrant communities and guaranteeing they are able to successfully manage their diabetes. However, unless national or regional policies on diabetes care begin to take the unique case of migrants into account, this problem will only get worse, and the number of migrants going undiagnosed or not getting sufficient treatment will continue to increase.