Health inequalities in the UK remain a significant challenge. According to Public Health England’s Health profile for England for 2018, the problem is getting worse; males and females in the most disadvantaged parts of the country face a 9.3 and 7.3 year lower life expectancy than those from the 10% most affluent areas – with both men and women in the poorest areas spending almost 20 years longer in poor health.
Yet guidance on diet and nutrition offered to people living with diabetes may not take these inequalities into account. We’re sometimes seeing a one-size-fits-all approach to dietary guidance which, as a body of scientific evidence has shown, cannot account for the broad range of factors that contribute to a person’s day-to-day dietary habits. There can be all kinds of reasons why a person isn’t eating healthily: economic, social and cultural factors can all play a role.
Socio-economic challenges are perhaps the most significant. While we might deem, say, a Mediterranean diet rich in oily fish and fresh vegetables to be the most suitable for a person with Type 2 diabetes to better manage their condition, the reality is that for a substantial number of people in the UK, this simply isn’t affordable. One study by Cambridge University found a “healthy” diet costs on average three times as much as an “unhealthy” diet, and that gap is widening. With around 8.4 million people in the UK living in households in which adults report food insecurity – placing the UK among the least “food secure” nations in Europe – tripling expenditure on meals is a tall order for many.
Also problematic can be the issue of even accessing such healthy food in the first place; the UK’s high streets vary dramatically in terms of the quality of food on offer. Deprived areas such as Blackpool and parts of Manchester and Liverpool, for example, are home to five times as many takeaways as more affluent areas. This proliferation in HFSS (high fat, salt and sugar) foods in socio-economically challenged areas takes a serious toll on the local population; research shows that those who live closest to the largest number of fast food outlets are twice as likely to be obese.
So where does this leave us? We may not be able to provide people with diabetes with the food they need to better manage their condition and long term health – but we can, potentially, show them other ways they can lead healthier lives. Finding something more achievable and manageable for the individual, something that doesn’t feel like a chore, can make a world of difference and sustain their motivation to change over the long term. It may the case, for example, that when a person is addressing their health risks, it’s difficult for them to change their nutrition but more manageable to walk to work rather than taking the bus.
As the American Diabetes Association put it earlier this month: “As detailed by the latest evidence, there is no one, single nutrition plan to be recommended for every person with diabetes due to the broad variability of diabetes for each individual, as well as other life factors such as cultural backgrounds, personal preferences, other health conditions, access to healthy foods and socioeconomic status.”
We must therefore personalise recommendations on diet and diabetes insofar as is feasibly possible, and crucially, maintain a non-judgemental approach. Ultimately, it’s about remembering one thing: everybody is doing the best they can, with what they’ve got.