Health inequalities and diabetes

Abstract

Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives’, to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse.In diabetes care inequalities are widespread, impacting on prevention, treatment, access to technology, screening for complications, risk of complications, morbidity and mortality. Ethnicity is a major risk factor, starkly demonstrated by the increased COVID‐19 related mortality in people from minority ethnic groups with diabetes. Disadvantaged groups include, but are not limited to, those with social deprivation, intellectual and physical disabilities and severe mental illness.The decision to shelve the long‐awaited white paper on tackling health inequalities, taken recently by the last Secretary of State for Health amid protests from a coalition of medical organisations, makes it unlikely that the government will take the actions proposed by Marmot. In the absence of a national strategy, responsibility to recognise and address inequalities in diabetes care falls on health care professionals, in teams and as individuals. Copyright © 2023 John Wiley & Sons.

The impact of diabetes technology advances on quality of life: addressing the barriers to uptake

“…However, a recent Scottish survey which was designed to gauge local interest in HCL found that interest in acquiring technology was equal across all deprivation quintiles, even though only 6.3% of those from the most deprived socioeconomic quintile were using HCL, compared with 37.4% from the most affluent quintile 37 . Other factors such as age, ethnicity, intellectual disability, may also influence access to technology and clinicians must be alert to these inequalities 38 …”

“…37 Other factors such as age, ethnicity, intellectual disability, may also influence access to technology and clinicians must be alert to these inequalities. 38 While the majority of participants in studies of CSII, CGM and HCL were positive about the technology, studies were usually conducted with a level of technical and clinical support which may be difficult to replicate in routine care. In a study of closed loop insulin delivery during pregnancy, 9/16 women said they would have considered dropping out had they not had 24-hour support during the trial.…”