The causes of diabetes stigma are not hard to find – sadly, it’s all around us – and much of it currently seems to stem from the debate surrounding the Australian Parliamentary Inquiry into Diabetes.
Yes, I was very excited when I wrote about the recommendations and entailments in last week's report. Improved access to pumps and AID systems. That was fantastic news and it was great to see a community-led effort have produced such a positive outcome.
But the broader message isn't so great, which is very disappointing.
It's disappointing, but not really surprising. After all, this study was about diabetes and obesity. Last week, I said that people with type 2 diabetes should receive the same consideration as people with type 1 diabetes when it comes to advocacy and campaigns. And that goes for people living with obesity. I remember reading this study when it was first released and my heart sank. These are separate and equally important health issues that require focused attention. And within that, there are different types of diabetes itself. Again, all equally important and all requiring special attention.
But instead of giving diabetes the attention it deserves and doing research that is purely focused on identifying what needs to be done to improve outcomes for people with diabetes and improving our health care system to serve us better, we've been given research that conflates two separate and serious health conditions. Something's going to get lost in this. And it seems that's diabetes.
Since the report was released on Wednesday, much of the media coverage has focused on one particular recommendation – a sugar tax. It was featured on the front page of The Australian, in a project article and in a number of radio interviews. The coverage also covered the recommendation on advertising junk food to children. As you can imagine, the comments from the community have been extremely nasty and completely misinformed. If there was ever a time when you didn't need to read the comments, it's now.
I completely agree that a sugar tax is a good idea, and have been saying so for years. I also believe that junk food advertising should be banned across the board, especially advertising to children, starting with TV and online advertising, and ending with sponsorship of children's sports activities. Again, I've been involved in efforts around this for many years. One of the reasons these measures are important is because they make healthier options more accessible, which can reduce the risk of becoming obese. And certainly obesity is a risk factor for type 2 diabetes. But not everyone who is obese will have type 2 diabetes, and not everyone who has type 2 diabetes is obese. But this nuance is completely missed by the simplistic messaging and lumping it together with type 2 diabetes.
And this nuance is important, they point out, as obesity is also a risk factor for many other diseases, including some types of cancer, liver disease, heart attack and stroke, high blood pressure, high cholesterol, osteoarthritis, sleep apnea, mental illness, infertility and pregnancy problems, etc. Why is it included in the diabetes study, and not just type 2 diabetes?
While I shouldn't be surprised that the media completely missed the mark, that doesn't mean I'm not angry and upset, because we can make an effort to minimize the damage and stigma caused by misinformation. I was asked to collaborate on a media release about AID activities this week, but I made it clear that I would not engage with any messaging that could be deemed stigmatizing. I provided a copy of the language position statement and asked to see it before the release went out to ensure everything was consistent. I pointed out to the PR firm that if any media resulting from this release was stigmatizing of any type of diabetes, I would publicly condemn it. Sadly, I don't believe that level of care has been taken across the PR and media group. Without that care and sensitivity, stigmatizing language about diabetes, especially type 2 diabetes, will be overused.
But this isn't just a media issue. The report itself states that “People with type 2 diabetes place a significant strain on healthcare resources,” clearly placing the blame on people with type 2 diabetes who must navigate an underfunded, underresourced and understaffed healthcare system. There is no recognition of the unalterable reality of risk and social determinants of health. Stigma is further spread, misinformation is further spread, and people with type 2 diabetes are further victimized. And this affects all types of diabetes, whether we like it or not.
As we all rush to highlight this report, I sincerely hope that we also pause to think about the messages we are sending to the world about diabetes. So far, there is very little I have seen that I haven't found cringey. There is too much that is prejudicial and harmful. We all have a role to play in making sure we are not reinforcing diabetes stigma, especially if we participate in the commentary and media frenzy surrounding a shiny new report that has just been released.