diagnosed with diabetes of one kind or another increased Diabetes also represents a major threat to risk of developing diabetes than non- migrants. …
Diabetes in society
Migration and diabetes: the emerging challenge
y Manuel Carballo and Frederik Siem
Diabetes is affecting more and more people every year In the last decade, the number of people diagnosed with diabetes of one kind or another increased by almost 50 By the year 2025, more than 300 million people around the world could have been diagnosed with the condition Many others who have diabetes will not have been diagnosed Diabetes also represents a major threat to the health of the worlds millions of migrants, who appear to be at greater risk of developing diabetes than nonmigrants Manuel Carballo and Frederik Siem report
to get the care and treatment they need if they do develop diabetes
In the past, diabetes was considered a problem of developed countries; this is clearly no longer the case People in developing countries and countries in transition are also very much at risk of developing diabetes In 2003, 355 million were diagnosed with the condition in India more than twice as many as in the USA in the same year In China there were around 238 million people with diabetes1
For the hundreds of millions of people moving around the world every year, diabetes also
represents a major health threat In Australia, the Netherlands, Norway, the UK, and the USA, studies suggest that migrants may often be more likely to develop diabetes than non-migrants Why this should be so calls for more research; so do the questions as to whether and how migrants are able
Stress, sadness and immigration policies Whether it is the forced movement of refugees and internally displaced people, or the movement of people looking for work and a better way of life, migration is always stressful Some scientists believe that this is one of the key factors behind diabetes among migrants Migration involves uprooting, leaving behind family and friends, moving under conditions that are psychosocially and physically difficult, and facing the realities of re-settlement in surroundings that may seem unwelcoming Part of the problem faced by migrants and refugees today is that migration
Diabetes is a major health threat to people moving around the world
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Diabetes in society
It is essential that the training of healthcare practitioners take into account the health of migrants
used to may be tempted to spend this on cheap food Indeed, adapting
to new eating habits and foodstuffs is always a problem for migrants and a potential risk factor for diabetes
ICMH
policies are designed to make it difficult for couples and their children to move together In the case of economic migrants, countries often insist that the person seeking work must migrate alone This can oblige men to travel by themselves, leaving their partners and children behind In other cases, women may be forced to leave their families behind Not surprisingly, research finds that one of the most common problems faced by migrants and refugees is chronic homesickness and sadness2 Not only do they miss relatives and friends, but sometimes they are not even able to stay in contact with people in their home country Refugees often do not know what has become of their families Some studies report
that migrants and refugees often feel that their health has worsened after arriving in a new country3 Some scientists believe that stress is one of the key reasons for diabetes in migrants Coping with the stress of migration and resettlement can take many forms High consumption of alcohol and other addictive substances, such as tobacco, is one of the ways some people
worldwide deal with difficult situations migrants are no exception The over-consumption of food is also a way in which many people deal with stress, and migrants who find themselves with a little more money than they were previously
When migrants arrive in a country, they have to quickly become accustomed to new diets and new foods Sometimes, the foods that are available and affordable contain more fat and less fibre than migrants were used to in their home countries increasing the risk of obesity Another food-related problem is that when people move to other countries in search of work or safety from persecution, they often use food to prove to themselves and others that the 
y are succeeding This often means over-consuming poor quality food and over-feeding children In situations like these, the potential for problems of obesity and diabetes is high Language and beliefs No matter where people come from or where they go they take with them any inherited pre-disposing
New eating habits and foodstuffs represent a potential risk factor for diabetes in migrants
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disease factors In some cases, people might come from
backgrounds where the genetic risk of diabetes was high or where eating habits put people at risk of the condition Migrants also bring with them their traditional beliefs about health and disease They may come from cultures and countries where most people never had access to good healthcare and where over the years they became used to not seeking care when they felt unwell; or believing that illness and disease are products of fate and not something that could be or should be prevented or mitigated Language represents an added problem for migrants, especially when they have health problems People may have difficulty finding the words to express their symptoms and be unable to talk comfortably with healthcare providers This is especially true if migrants come from cultures in which people do not easily discuss personal problems and in the case of women are not used to being examined by someone with whom they are unfamiliar Language difficulties can lead to impatience on the part of healthcare personnel Language difficulties and embarrassment at not being able to communicate effectively can lead to migrants choosing to ignore their problems This can lead also to impatience on the
part of healthcare personnel faced with migrants they cannot understand and who appear not to pay attention to what they are being asked or told In such situations, health problems are easily overlooked or misdiagnosed When the health problems of migrants are correctly diagnosed, problems related to cultural background and beliefs may persist There may be different attitudes to chronic disorders and long-term care which can pose problems of adherence and effective follow-up Particularly in the case of diabetes, it is important that people with the condition, their family and friends, and the healthcare team share a common understanding of the nature of the condition and its effective management ICMH will begin a study of diabetes among migrants in 11 European countries and Canada The study should provide new insights that healthcare planners, healthcare practitioners, migrants and the general public will be able to use in fighting diabetes and ensuring quality of life for all
Planning, education and research Migration has become a key part of our collective social and economic development It is essential that the design of healthcare services and the training of healthcare
practitioners take into account the health of migrants and the challenges posed by conditions such as diabetes It is equally essential to work with migrants to ensure that they are aware of the types of care that are available and any other options open to them to protect their health Given the growing prevalence of diabetes worldwide, and the apparently high rate of diabetes in migrant populations, time should not be lost At the International Centre for Migration and Health ICMH we are taking up this theme This year,
Migration is a key part of our collective social and economic development
y Manuel Carballo and Frederik Siem
Manuel Carballo is Executive Director of the International Centre for Migration and Health Frederik Siem is a Health Research Associate at the International Centre for Migration and Health
References
1 International Diabetes Federation Diabetes Atlas, 2nd edition International Diabetes Federation Brussels, 2003 2 Carballo M, Divino JJ, Zeric D Analytic Review of Migration and Health as it Affects European Community Countries ICMH Geneva, 1998 3 Carballo M, et al The Process of Social Insertion of Migrants, Refugees and Asylum Seekers in the Context of
Access to and Use of Health and Social Services ICMH Geneva, 2003
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Source:chronicdisease.org
