Applying the Health Justice Framework to Diabetes as a Community-Managed Social Phenomenon

Traditionally, prevention and control of diabetes have been viewed primarily as a matter of personal responsibility. As scientific understanding of the social determinants of health has become more sophisticated, however, many experts have questioned the effectiveness of individualistic strategies that emphasize urging at-risk individuals to change their habits, rather than making changes at the community level to facilitate healthier lifestyles for everyone. Furthermore, as we shift toward a more collective approach to health care financing, interest in evidence-based approaches to disease prevention and management — in the clinical context, as well as in the community — is growing. The Affordable Care Act includes several provisions that directly address gaps in diabetes prevention, screening, care, and treatment, as well as more broadly applicable provisions aimed at promoting community-level prevention. This Article argues that health law and policy can and should support a nascent reorientation — consistent with the health justice framework I have developed in previous articles — of the health system’s response to diabetes, from understanding diabetes primarily as a self-managed medical disorder, to responding to it as part of a broader social phenomenon managed at the community level. Part I describes the challenges posed by particular characteristics of diabetes, with an emphasis on its chronic and progressive nature, the common understanding that it is primarily a self-managed disorder, and the insidious nature of its complications. Part II describes the existing legal and policy landscape for responding to diabetes, including with respect to prevention, medical management, health insurance coverage, and discrimination. Part III introduces health justice as a framework for eliminating disparities, and points to indications within the existing law and policy landscape of a reorientation toward understanding diabetes as a social phenomenon managed primarily at the community level. I argue that these developments can and should be reinforced through law reform, litigation, policy implementation, and scholarship consistent with the health justice framework.