We need a dif­fer­ent ap­proach to tack­ling di­a­betes

The Province - - EDITORIAL - HEATHER GAINFORTH, MARY JUNG, JONATHAN LIT­TLE AND ALI MCMANUS

As we mark World Di­a­betes Day on Nov. 14, the mount­ing toll of this dis­ease is stag­ger­ing. One out of three Cana­di­ans has Type 2 di­a­betes or pre-di­a­betes.

In all like­li­hood, some­one you know or love is af­fected. If left un­treated or im­prop­erly man­aged, it can have dev­as­tat­ing con­se­quences, rang­ing from heart at­tack to stroke or even blind­ness. It touches many and its erad­i­ca­tion re­quires us all to be united.

How­ever, tra­di­tional pub­lic pol­icy and pro­fes­sional guid­ance on healthy liv­ing has sug­gested that man­age­ment and avoid­ance of di­a­betes and pre-di­a­betes is as ob­vi­ous as it is easy. The mantra of “eat right and ex­er­cise” has been re­peated for decades, of­ten with the weight of large pub­lic health cam­paigns be­hind it.

The strat­egy un­til now has the ef­fect of point­ing the finger at the in­di­vid­ual and the choices they make as both the so­lu­tion and the source of the prob­lem.

But it’s not that sim­ple. Nor is it work­ing.

Yes, ex­er­cise — just 20 high-in­ten­sity min­utes per day, three times a week — has a hugely ben­e­fi­cial im­pact. As does skip­ping the junk food. But our re­search also shows that adopt­ing healthy be­hav­iours is of­ten an up­hill bat­tle, where so­ci­etal, cul­tural and com­mer­cial pres­sures make it in­creas­ingly dif­fi­cult to meet these “sim­ple” goals.

Take for ex­am­ple our teens, who have been urged to ex­er­cise at least 60 min­utes per day through in­di­vid­ual guide­lines and school-based pro­grams. Yet, with­out the ap­pro­pri­ate sup­port, this rec­om­men­da­tion has fallen flat. Only nine per cent of 16- to 17-year-olds achieve this goal. It’s a shock­ing trend that should have us all con­cerned.

So if the goals aren’t achiev­able, then maybe it’s time to rein­vent the game.

Rather than treat­ing Type 2 di­a­betes and pre-di­a­betes as an in­di­vid­ual fail­ing, we need to shift re­spon­si­bil­ity for this epi­demic to our com­mu­ni­ties and govern­ments and away from its suf­fer­ers. We need to de­sign bet­ter com­mu­nity pro­grams that lever­age the power of so­cial sup­port struc­tures and help gen­er­ate bet­ter ac­cess for all Cana­di­ans, re­gard­less of per­sonal cir­cum­stances, to health­ier foods and an ac­tive life­style.

Per­haps, most im­por­tantly, we need to ac­knowl­edge that the “sim­ple” so­lu­tion of eat­ing prop­erly and get­ting ex­er­cise is more of a strug­gle today than it ever has been. That the com­mon sense we’ve been taught for decades is, in truth, un­com­mon and non­sen­si­cal in a plugged-in, al­ways-on and con­sumer-driven mod­ern so­ci­ety.

Our labs at the Univer­sity of B.C.’s Okana­gan cam­pus are at the fore­front of re­search into com­mu­nity-based and com­mu­nity-driven health in­ter­ven­tions. Our own data and work in our com­mu­nity has shown that be­hav­iour change is in­cre­men­tal. It takes pa­tience and re­quires an enor­mous amount of sup­port on mul­ti­ple lev­els, from gov­ern­ment pro­grams to pub­lic pol­icy to fam­ily, friends and the com­mu­nity at large.

Through our re­search, we are be­gin­ning to un­der­stand the chal­lenges in­di­vid­u­als face liv­ing with Type 2 di­a­betes. We know that we need a new ap­proach to its treat­ment, where every­one in the com­mu­nity, from gov­ern­ment to academia to em­ploy­ers and the health care sys­tem it­self, move in unity to shift col­lec­tive be­hav­iours to­ward a health­ier and fuller life­style. We need an ap­proach where we ac­cept re­spon­si­bil­ity to­gether and avoid blam­ing suf­fer­ers.

In our ex­pe­ri­ence, the most pow­er­ful first step in help­ing those with Type 2 di­a­betes be­gins with a sim­ple phrase: It’s not your fault and we’re here to help. With this mind­set, we stand a bet­ter chance of win­ning this long bat­tle.

Heather Gainforth, Mary Jung, Jonathan Lit­tle and Ali McManus are health pro­mo­tion and di­a­betes re­searchers in the Fac­ulty of Health and So­cial De­vel­op­ment at UBC’s Okana­gan cam­pus.

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