Parks and safe walkways as cure for diabetes

Socio-economic status (SES) and its constituent elements are accepted as being determinants of health. There is considerable evidence to show that poverty is associated with shorter life expectancies and increased mortality, particularly cardiovascular mortality [1-3]. Significant socio-economic gradients have been shown in the prevalence of several cardiovascular disease risk factors, including diabetes. Diabetes may be up to two times more prevalent in low income populations compared to wealthy populations [4-6]. In patients with diabetes, low income is associated with an increased rate of hospitalization for acute diabetes related complications. Booth and Hux [7] demonstrated that, even within a universal health care system, the least affluent patients were admitted to hospital 43% more often than the wealthiest patients. They also identified lack of physician directed ambulatory care as a major determinant of hospitalization in patients with diabetes.

Little is known about how individuals with diabetes access ambulatory care. The influence of wealth on health care access and utilization of health care services, however, is an area of active research. Even within publicly funded and universally accessible systems, there is evidence that individuals from lower socio-economic groups have impaired access to care, reflected in longer wait times and fewer referrals for specialist care [8][9]. This might contribute to the observation of worse health outcomes, such as the increased rate of acute diabetic complications seen in the Booth study [7], in lower income populations.

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This socio-economic gradient in diabetes prevalence has been shown previously across studies and across cultures [3,4,6]. The link between income and diabetes risk is complex. It has been speculated that the increased diabetes risk seen in low income groups is related to the increased prevalence of obesity within this group. It has already been clearly shown that low SES is associated with a much higher prevalence of obesity, especially among women [12]. Obesity remains a potent risk factor for the development of diabetes; however, low income has been shown to be an independent risk factor for the development of diabetes among women – even after controlling for body mass index and physical activity level [3]. Alternatively, low SES could be a result of diabetes in so far as disability related to diabetes complications may limit work and educational opportunities.

Neighbourhood and community level factors also contribute to the increased diabetes risk seen in low income populations. The "built" environment has been shown to be a clear barrier to physical activity in poorer neighbourhoods. Low income communities have been shown to have less biomass and park-space compared to wealthier communities [13]. There may also be a perception that it is less safe to walk in a poorer neighbourhood – this not only deters physical activity but erodes the sense of community among residents [3,13,14]. This sense of community, along with established social networks, has been shown to be protective against certain negative health outcomes [3].

Doreen M Rabi, et. al., Association of socio-economic status with diabetes prevalence and utilization of diabetes care services - BioMed Central Ltd, BMC Health Services Research 2006, 6:124, WEB 2024