In this guest article, Rebecca Barlow-Noone discusses the intersectionality between diabetes and poverty/homelessness, and how the challenges faced by individuals living with diabetes increase when you add in these extra challenges. Rebecca has an MSc in Population health from University College London, and currently works at the European Public Health Alliance. I first met Rebecca when we both attended the Youth Leadership Camp run by International Diabetes Federation Europe (IDF Europe) in Romania in 2017, where we both represented the United Kingdom. I am delighted to know, and be friends with, someone who advocates for such important issues.
Diabetes of any type is incredibly difficult to manage. Yet juggling diabetes with poverty or homelessness makes the condition ever more challenging to handle. Anyone with diabetes can testify to its unpredictability, and the importance of routine for our glucose levels; yet the unpredictability of homelessness impacts everything: from access to healthy food, to the ability to attend regular healthcare appointments.
While volunteering with a local Trussell Trust food bank in London, I saw how nutritious food was difficult to come by for people in poverty or homelessness. The food bank did an excellent job by asking if beneficiaries had any dietary requirements, however all special food requests were still dependent on donations and availability of healthy foods with a low glycaemic load. Additionally, people living in accommodation without cooking facilities, or people in temporary accommodation such as hotels, frequently could only rely on cold, instant foods, which can cause spikes in blood glucose levels. This was often the case for asylum seekers, who were often placed in poorly equipped temporary accommodation. On more than one occasion I spoke to people with diabetes, who were finding it very challenging to cope with the demands of their condition in their circumstances; not to mention accessing regular healthcare.
For rough sleepers, a plethora of additional challenges may make diabetes difficult to manage, which I studied during my masters degree. Though data is lacking, it is clear that people experiencing extreme poverty and homelessness have significant nutritional deficiencies, affecting health and mental health. Homeless shelters often place bans on needles, and lack secure refrigeration, presenting unique challenges for those who are insulin dependent, or who use other injectable medications. Walking on the streets without adequate footwear puts people at risk of foot problems. In terms of accessing care, the availability of good medical care varies inversely to the needs of the population, known as the ‘Inverse Care Law’. The lack of routine and no fixed address for appointment letters makes attending regular check-ups very difficult to maintain; meaning people are more likely to attend A&E and experience readmission. The list continues; though very little data exists on the experience of people with any type of diabetes and homelessness in the UK.
Evidently, we need more patient-centred approaches when it comes to diabetes care for people experiencing homelessness. There is an interesting project upcoming, led by the charity Pathway, looking at how to better support homeless people living with type 2 diabetes; a project which will surely have ripple effects for Type 1 and other forms of diabetes.
Thanks to Alyssa for the opportunity to write this guest article! I hope as a diabetes community, we can champion the needs of all with the condition. Follow me at @r_bnoone and on LinkedIn.