I just returned from Findlay, Ohio where I addressed 25 people with Type 2 diabetes. Most of them use insulin and most rely on Medicaid for their insurance.
Yet Medicaid doesn't cover the cost of enough test strips for them to use insulin responsibly -- so their blood sugar and their health suffer. It's harder for them to control their weight, and two had already had a heart attack.
Medicaid also, like many health insurance plans, doesn't cover a simple device that makes taking insulin much easier, more convenient and less frightening: an insulin pen. Insulin pens replaced vial and syringe years ago in Europe.
I mention Europe because I'm married to a European. That causes me to see America a little differently. While we both admire America's "can do" spirit and individualism, there is a downside.
Our cultural reverence for going it alone, making it on your own and pulling yourself up by your own bootstraps -- think that great iconic Madison Avenue figure the Marlboro Man -- often obstructs us from strength gained by working together.
Personal and social responsibility
It's no surprise our beloved self-determination is expressed in chronic illness. In diabetes, we repeatedly talk about "self-care," "self-management" and "self-efficacy." It is the patient's responsibility.
Certainly I believe people with any illness must take personal responsibility. But think how much stronger and capable we'd be if our environment supported our health.
What if in addition to "self-efficacy" there also existed "social-efficacy"?
That would cause healthy food to be widely available and affordable. Legislative policies would support big food manufacturers making a profit while making foods that actually nourish our kids.
You could walk and bicycle easily in towns and cities. People would gather in community squares, minimizing loneliness and increasing physical and mental well-being.
Health care providers would see their role as both expert and partner. Health insurance companies would see their mission as, and tie their financial targets to, keeping people well. Not earning their money charging customers exorbitant fees as their health erodes because they couldn't get what they needed to stay healthy in the first place.
Tony Schwartz, CEO of The Energy Project and management guru, helps companies institute work policies and processes that first and foremost address employees' needs and values. The result? Companies become more prosperous and workers become more productive, happier and able to consistently renew their energy.
Schwartz' recent article, "Why You Hate Work," is a business case for social-efficacy.
Getting back to the Marlboro Man
As I waited in the airport for my flight home from Ohio, I searched for something healthy for lunch. It didn't exist.
The mantra in public health, "People will make the healthy choice when the healthy choice is the easy choice" is a clear cry for social-efficacy. Personal responsibility has not turned the tide on obesity, nor will it turn the tide of diabetes.
So, as I scraped the unidentifiable cheese-like sauce off my chicken breast and after paying an extra 99 cents for broccoli instead of fries, sitting in the Port Columbus International Airport, I wondered if the Marlboro Man existed today, would he get diabetes? I decided he would.
Walmart and a high end investor would have bought up the range, so Mr. Man was now living in town. With no job skills, his minimum wages from flipping burgers would have him dining nightly on the strip: Taco Bell, Kentucky Fried Chicken, Popeyes and Krispy Kreme. A dinner and a man-size Coke, $4.99. The same cost for a head of cauliflower and broccoli.
His diabetes, not to mention his high blood pressure from his salt-laden meals, means he's twice as likely to get a heart attack or stroke as people without diabetes.
The final irony? Because of his heart attack risk, Mr. Man's physician takes away his cigarettes! Of course being a cynic he may have died years earlier from lung cancer.
What needs to happen
It took policy makers, agricultural people, big tobacco's own workers and media -- social efficacy -- to make smoking uncool. Now we need politicians, food manufacturers, lobbyists, urban planners, marketers, health care professionals, dietitians, farmers and philanthropists to support our health.
To prevent diabetes we need to be able to feed our families healthy food and create more ways to move, not less. To stay healthy with diabetes and minimize complications, patients need access to essential medicine and tools.
Over the last few years cities like Cleveland and New York and states like Colorado, Pennsylvania and Delaware have been adding walking and biking paths. They know the power of social efficacy to create change. For while we may be strong alone, we are often stronger together.
Riva's latest book, Diabetes Dos & How-Tos, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.