Tuesday, January 10, 2006

The Epidemic

I’ve been reading the New York Times’ series this week on the scourge of diabetes. It is hard for me to read anything the Times’ puts out anymore and accept it’s accuracy on faith, but if the articles are accurate we are facing a huge problem in this country.

The reporters are focusing on New York in particular and have concentrated on Type II Diabetes cases, which is the form of the disease that at one time was referred to as adult onset diabetes. The problem is that the word “adult” is no longer an accurate descriptor. Increasingly, cases of Type II are seen in teens, and at times even in pre-teens. Trend lines indicate that not only is the disease reaching down into a younger age group, but that higher percentages of all age groups seem to be afflicted with Type II.

Most troubling is the demographic “targeting” that seems to accompany what by all accounts is an epidemic in some segments of our society. If you’re poor, Black or Hispanic, your chances of contracting Type II are greatly increased.

Some of this problem is genetics, and it is not clear how much can be assigned to this cause. A larger, much more troubling cause is diet and lack of exercise. Indeed, most of the people that have been interviewed so far seemed to have been severely overweight at the time that they came down with the disease.

I have been waiting for the series to take a turn into demonizing fast food companies, but this has yet to happen. In fact, the Times so far has been remarkably restrained (for the Times) in even mentioning the prevalence of fast food in the diets of the victims. They have more or less focused not only on fast food, but cake and other goodies that seem to be consumed in enormous quantities. I hope this continues, although I do think it is important to point out that all of these victims would be better off with more healthy diets and that many would be saved from what is described as a gruesome decline.

The problem it seems to me has to do less with the growth of fast food options and more to do with the dissolution of the family structure. Taken in this view, the proportional growth of fast food in the diet of the poor is a symptom of a larger problem. It begins to answer the question of why, if we’ve always had an under class in our society is it only now that diabetes is showing up.

I think the answer for this is two-fold; first a smaller proportion of poor families today represent the traditional two parent home than did in past years. This is a profound problem because it means that where in the past parents could split some of the work of raising a family, now this all falls on one parent.

Admittedly, the domestic obligations of raising a family were divided somewhat unfairly along gender lines, but still there were two parents and therefore a little more time for mom to put some dinner on the table and of course, back then, mom’s knew the basics of cooking. Today, simple cooking knowledge beyond that act of boiling water is limited, and in one parent families it is simply much easier to stop at McDonalds on the way home.

The second part of the answer is that in poor families today which have remained two parent enterprises, both parents are probably more likely to be working full days than in the past, particularly in dense urban areas. As above, the siren song of the fast food joint on the way home is difficult to ignore when pressed for time.

Despite all of this, I’m struck at how our social safety net has not, and probably cannot address this problem. School breakfast and lunch programs haven’t seemed to help and neither have food stamps. In listening to the folks interviewed, they know that their bad habits are a big driver behind their problems, yet few are motivated to change even after diabetes begins to take hold.

At the end of the day it seems to all come down to behavior. Which speaking as a conservative isn’t a terrible surprise, yet also doesn’t offer much hope for a solution. As an affluent American I have witnessed appalling eating habits in my friends and neighbors. These are people that not only know better, but can also afford the best. Happily, in the case of these people, obesity is an unacceptable trait, so they either control their eating or spend thousands working the excess calories off.

The Times’ series leaves little hope for similar behavior modification in the poor. Indeed many see cheap, high calorie food as a kind of solace against the travails of being members of the urban poor. I wish I could think of an answer, but I have none and in the end I’m left wondering where this will all end.

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