Daniel  Zoughbie

This conversation is closed.

In what way is diabetes a communicable disease?

In what way is diabetes a communicable disease? If diseases can categorized as biologically infectious or non-infectious, why can't we start thinking about the behaviors that drive major disease epidemics as being socially infectious or socially contagious?

Closing Statement from Daniel Zoughbie

I want to thank you all for your very important contributions to this conversation. I think what we tried to do today was to explore some creative ways of thinking about a devastating disease epidemic and how public health systems could be more effective in preventing it's societal spread. Today, we are facing a global diabetes epidemic that is driven by a variety of factors, including social behaviors. While we cannot address all the factors that contribute to this epidemic, my team and I at Microclinic International are working to develop new ways of preventing death, disability, and the spread of the disease by focusing on social behaviors. We hope you'll join us. I look forward to talking again soon and thanks again for your comments.

  • Sep 28 2011: Diabetes isn't strictly a lifestyle disease. It's important to note that there is Type I and Type II and that the risk factors attributing to developing each type of diabetes are different.
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      Sep 28 2011: you said exactly what I wanted to say in less words.
      • Sep 28 2011: Type I has the stronger genetic component while Type II has the stronger lifestyle component.
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          Sep 28 2011: James, thanks for reminding us of the important distinctions between Type I and Type II. And the development of Type II actually also involves family history, etc. The genetics of diabetes are what we are calling "nature." But the explosion of diabetes in the Middle East, for example, cannot simply be explained by genetics and family history, i.e. nature. The way people live, work, eat, and play (i.e. nurture) greatly influences a person's health. And these social activities are things we can change through evidence-based social interventions.
    • Sep 28 2011: There are many type 1 diabetics on both sides of my family for three generations. All of us had led a very healthy lifestyle. In fact we were called "different" because we ate much more healthy than what was known at the time. In my home dessert was only available at celebrations and I didn't really think about it much. Contagious or a more prone to this disease because of familial genes?
  • Sep 28 2011: change in wording for me... type 1 diabetes has the stronger genetic component, type 2 diabetes has the stronger ENVIRONMENTAL component. I sort of cringe when I here folks calling type 2 diabetes a "lifestyle" disease... which implies that its one's own fault for suffering from it. Issues of healthy eating habits and active living are usually acquired from one's environment. some have the power and resources to change their environment, but most simply cannot make a move to a different social circle/neighborhood/city/global region. This is an important component i think people are overlooking and needs to be discussed as well.
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    Sep 28 2011: Recently I've been researching the American South, the Diabetes Belt, the Stroke Belt, etc. A colleague and I keep referring to what we see there as a shift from "Food Culture" ---> "Disease Culture." Kitchen conversation might've previously revered food as "comforting" "warming" "welcoming" "positivity" and "hospitality. Now, as more and more Southern Americans are diagnosed with diabetes we've seen food becoming an enemy to them. Their disease requires stricter daily choices in diet; guidelines and rules never existed here before. As a result, what was once good and simple is now unsettlingly evil and complicated.

    A cultural pillar of the South, food is more than just for sustenance or energy. Anecdotally, I've begun to see some in the South more vehemently defend their food choices and Southern food culture. My fear is that many diagnosed with diabetes will continue to make less-than-deal choices for their health as they seek to preserve traditions and the positive feelings they've come to associate with food.
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    Sep 28 2011: At Microclinic International (microclinics.org), we have been working for many years now on the microclinic model. Based on this idea of "contagious health" our microclinics are groups of people (e.g. friends, family, neighbors) who come together and share access to education, simple technologies, activities, and group support. The point of these microclinic groups is to spread healthy behaviors through their networks. For example, if a Jordanian mother and father join our program together, they can apply what they learn in their household of 10. The kids, and other extended family members, may start eating different meals as a result.
  • Sep 28 2011: Diabetes can be classified as a communicable disease because most cases are related to individual/behavioral choices. As Corvida mentioned, diet and lifestyle contribute to health. As we begin to address diabetes as a socially infectious, and socially contagious disease, we become educated thus making making healthier "choices". Such education is ideal for minority, urban, and rural communities.

    Thanks Daniel!
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    Sep 28 2011: if you surround yourself with other overweight inactive people you can be 'infected' by their lifestyle. even though i try very hard with my diet and exercise, i live with a non-diabetic and his food choices sometimes affect me and what/how i eat. it is difficult watching someone eat a bowl of ice cream, a big plate of pasta or a hand full of m&m's. and when these kinds of things are available in the home it's very difficult to constantly say no to myself.
    • Sep 28 2011: Couldn't the opposite be true as well? Could you not also spread ideas about eating healthier and exercising to your roommates? I know I picked up a lot of the organic and vegan food habits of my old roommates when I lived with them.
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    Sep 28 2011: While I find this idea to be quite interesting, I fail to see how thinking of diabetes as a contagious disease would help. The definition of an infectious disease is that it has a known pathogen and one can identify important factors such modes of transmission or incubation period. The point is, the cause of infectious disease can be relatively easily identified, while diabetes has a variety of factors that are far more complex and more interconnected than you would see in infectious diseases. The idea of analyzing diabetes as a contagious disease would suggest that we know exactly how a person gets diabetes. One usually gets an infectious disease from one encounter (sex, blood transfusion, mosquitoes...) while diabetes can be the combination of many factors (genetics, diet, lifestyle, exercise,) over the course of many years. Even believing that diabetes is socially contagious is to believe that people get diabetes solely due to their interaction with people who encourage bad habits. what about genetics, social class, education, access to healthy food..etc? How then can it be helpful to view diabetes as a contagious disease if does not behave like one?
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    Sep 28 2011: Diabetes is definitely a "lifestyle" disease in my experience and that's what makes it so communicable as a disease. The disease itself isn't contagious, but the habits that contribute to diabetes are very contagious! I guess this gets are you point of being socially infectious or socially contagious.

    This is something we should definitely examine, on many levels, but especially where health is concerned. Our diets and lifestyles are habits that can be tremendously hard to break and are socially contagious within our networks. I'm not sure why we don't think about diseases like this. Maybe the topic of disease is still very taboo to some and that cuts off open communications about prevention in the future. What do you think Daniel?
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      Sep 28 2011: Yes Corvida. I think what we are talking about is very intuitive for many people. Most of us would guess that if our friends/family around us eat junk food, we are more likely to eat junk food. If our friends/family are not active, we are probably less likely to exercise. Kids in school often feel "peer pressure" to smoke. Epidemics that are rooted in these behaviors are social epidemics.

      But if common sense tells us that unhealthy behaviors can be spread through social networks, then why can't public health professionals start thinking seriously about how to spread healthy behaviors? This is why Microclinic International is really trying to advance this notion of "contagious health." Global health professionals can start to think, not only in terms of the individual, but also in terms of the social networks in which individuals live, work, and play.
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        Sep 28 2011: It's a lot of work to get people to change their behavior (on both sides of the equation), especially when it comes to their diet and health.

        Plus, people will always throw out the good old "healthy food is expensive" answer, which I find to be true most of the time. How do you get around this type of thinking, that healthy food and a better diet is too expensive?
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    Sep 28 2011: The Culture, the information channels, the mono-agriculture, advertising sugar delivery systems
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    Sep 28 2011: As a caterer, I realise all to well how the choices we make are influenced by the media. There are too many fad diets telling people to cut out food groups, and people do more these days, leading to a rise in "fast food"

    Junk Food chains advertising as restaurants and presenting the image of the perfect family sitting under their golden arches and falsely promoting their food as healthy most certainly doesn't help
  • Sep 28 2011: I think it's a great idea to start thinking of Diabetes as a "communicable disease" purely because it get's people talking about it. The more people talk about diabetes, the more awareness is raised of the disease and it's problems, etc.
  • Sep 28 2011: I think it would be useful - specially when an open, intelligent discussion is attempted- to educate the world...there is no simply "diabetes" - there is Type I and Type II (and the other less common like gestational diabetes). But when people talk about it they are usually referring to either Type I or Type II - they are VERY different conditions - you can not/must not generalize it! Generalization is wrong, inaccurate and it defies the purpose of raising awareness and understanding of this condition.
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      Sep 28 2011: Agreed. In my previous comment, I was referring to Type II mostly. I work on research involving both Type I's and Type II's. And being born with the condition merits a completely different mindset and approach to disease management.

      When I think "communicable disease" or "diabetes epidemic", I believe we are mostly referencing the spike in Type II diagnosis.
  • Sep 28 2011: Almost all of my family has diabetes, my uncles, my dad, my aunts, my granma ... what i have learned from diabetes is that people ignore several things:
    1. What to do to avoid it diabetes? is not only about the sugar you consume but the carbs, alcohol, etc
    2. What are the the bad habits that increase your risk to have diabetes
    3. What are the effects of the diabetes? How bad is to have diabetes (and how people with diabetes should take care of their selves to avoid the worse effects-amputation, blindness,etc)
    4. How to identify your risk to have diabetes (familiy, diet, etc)
    5. Early identification of sympthoms
    I think that definitively diabetes is a social disease, the question is how to prevent society from unhealthy habits, how to educate mothers, fathers and schools to prevent children from un-healthy habits and foods
    Diabetes I think is one of the most avoidable disease that exists (most of the people with diabetes could avoid if they change their habits).
    The proposal is … how society can (without depends on governments) to start a Worldwide or at least local movement to improve the lifestyle of the people using social networks? Without being un respectful with cultures and people and socio economics groups ?
  • Sep 28 2011: If we take this seriously as a disease vector, then what do we know (what do we need to uncover) about effective ways of intervening in networks to slow/reverse the spread of these socially-reinforced conditions?
  • Sep 28 2011: I guess there is not much 'conversation' since everyone who might tap into this site probably thinks pretty similarly!

    But thanks for posting it and trying!
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    Sep 28 2011: An interesting article written by Christakis and Fowler on obesity: http://www.nejm.org/doi/full/10.1056/NEJMsa066082
  • Sep 28 2011: I think the issue becomes much larger when we look at the marketing of most fast food companies. And the way that we, as a larger culture live our lives "on the go". The SLOW FOOD movement is a great place to tap into the ideas of 'spreading health'.
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    Sep 28 2011: I think a few of you have pointed out that thinking about the diabetes epidemic as being socially "contagious" might be confusing. There are a variety of reasons an individual might develop diabetes, including genetics, etc. I mentioned in an early post that idea of nature v. nurture (and in some places this distinction becomes a bit fuzzy). Another way to think about this could be the difference between sociology and biology. If we simply focus on the biology of the disease, and we fail to address the ways in which a disease spreads socially through society, then we cannot really prevent the epidemic from getting more severe. Can we?
  • Sep 28 2011: Assuming you Type 2... I agree with your logic, but the difference that prevents this from being accepted in the mainstream is that biological drivers are tangible, whereas social factors are more implied... more decision based.

    The masses want something they can see... we see this in the general acceptance of disease drivers.

    - Biological... wide acceptance generally wasn't accepted until we had microscopes, etc... it then became tangible.

    - Psychological... wide acceptance generally wasn't achieved until "chemical imbalance" came into play... it then became tangible.

    So the problem really becomes, how can we prove social drivers in a tangible format that removes free will / decision making from the process?
  • Sep 28 2011: Without a doubt a disease particular to ones lifestyle...i see it in my country every day...i live in Barbados, which they claim to be the diabetes capital of the World...or more to the point the amputation capital...the disease on island is of epidemic proportions and its easy to see why...a simple glimpse into the average person's diet will reveal the source of the problem....the doctors know it, the people know it but amazingly there is little interest in the lifestyle change that would be required to arrest the problem. I invite you to visit - the numbers will shock you.
  • Sep 28 2011: in a culture of fast food and sugar..........and where people 'get together' to eat so often...........it becomes a communicable disease
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    Sep 28 2011: IMHO, This is socially contagious in terms of a family circle. Whether it consists of a nuclear family, single parent, siblings, even extended ones like roommates, what is socially acceptable, fostered, taught in these social spheres sets the stage for the behavioral patterns and choices that lead to health or harm. How often do you see a heavyset father and/or mother with overweight children? The epidemic of diabetes in children is appalling. Unfortunately, I feel this is one of many symptoms of a deeper and broader societal and cultural disease. It would be interesting to see your thoughts extend from the local social sphere/environment and extend to these foundational societal and cultural drivers.
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    Sep 28 2011: Fascinating work Daniel and it has the potential to be really helpful to many people. If you could make one first step to contain this contagion, what would it be?
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      Sep 28 2011: Thanks for your question Debra. I suppose we must really start at the beginning and ask, what are the roots of the social contagion? I think that we would have to say that it is partly "nature" and partly "nurture." The nature aspect of it may be a bit more complicated to deal with, but the nurture part is relatively simple. So to answer your question more specifically, we are essentially asking how do we change human behaviors (e.g. like diet and exercise patterns). Right?
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        Sep 28 2011: Right. I work for a company whose business is infection prevention. There are standard ideas of what we do on this scale. You are speaking about a societal contagion and I am sure you have ideas of how we can get a handle on this. If I gave you carte blanche what would you do?