During the pandemic, Black Americans have died of COVID-19 at than other racial and ethnic groups in the U.S. One of the many drivers of this inequity is a killer that has been disproportionately affecting the Black community for years: diabetes.
In , my team and I looked at diabetes mortality inequities in cities across the U.S., dating back to 2008. The results were striking: than rates among whites across the entire country and in each of the 30 largest U.S. cities. These differences are especially pronounced in Washington, D.C., where Black residents are almost seven times more likely to die of diabetes than whites, and in Chicago, Los Angeles, and Oklahoma City, where the disparities are getting worse instead of better.
The unequal burden of diabetes on Black Americans highlights the need for both federal and local policy changes to mitigate risk factors contributing to diabetes deaths: , , and and . Taking insulin as prescribed, going to the doctor regularly and eating fruits and vegetables may seem simple on the surface, but overarching societal issues like can manifest insidiously, making "simple" solutions anything but for some communities. While broadly addressing entrenched systemic issues is complex, the case of racial inequities in diabetes mortality shows how analysis of a specific manifestation of the larger problem can lead to clear, targeted, and effective policy recommendations.
First and foremost, we need to cap the cost of insulin. It's -- particularly for those with high deductibles, Medicare beneficiaries in the dreaded "," or young adults who are no longer on their parents' insurance plans. The Endocrine Society released a in January with several recommendations for making insulin affordable for all, including a $100 per month cap on insulin costs. And at this very moment, the a Trump-era executive order on insulin pricing; they should integrate expert recommendations aimed at lowering costs into the final order.
Second, we need to guarantee affordable quality healthcare coverage, as Black Americans are still insured at than whites. These differences are largely attributable to and , which influence access to and ability to afford adequate healthcare. Expanding Medicaid programs through the Affordable Care Act has for patients with diabetes, but more work needs to be done. in addition to local programs that will ensure more equitable access to care for Black Americans.
Finally, we need to expand programs like the that improve access to nutritious food and propose legislation aligned with for promoting physical activity. Eating a nutritious diet and regular exercise are , but many Black Americans experience substantial barriers to both. For example, Black Americans are by food insecurity or insufficient access to nutritious foods. Federal nutrition assistance programs can reduce food insecurity, but we need more resources to expand these programs, . Similarly, many Black communities have . Building infrastructure, including parks, sidewalks, and active transit, is imperative to for more people.
Beyond these key policies recommendations, our research suggests that there may be more to learn from cities that are doing better. For example, in Dallas, Boston, and Denver, . And in Louisville, where rates of diabetes mortality and inequity are both improving, they are targeting including employment, income, food systems, and the built environment. Policymakers in other areas should collaborate with community members to adapt and adopt similar approaches.
Diabetes mortality is only one example of how systemic issues have an impact on Black lives, but parallel factors contribute to inequities in other leading causes of death like . We need policy actions to address systemic causes of chronic disease, especially in areas of high inequity like Wards 7 and 8 in Washington, D.C., where are prominent, , and 90% of residents are Black. Making medication more affordable, providing equitable healthcare, and giving Black Americans fair access to healthy foods and exercise will not only address the problem of unequal diabetes mortality, but will also have a positive ripple effect on improving general health and preventing death in Black communities.
is a clinical psychologist and assistant professor in the Department of Psychology at DePaul University in Chicago.