Diabetes is the number one health challenge in Mexico City. Back in 1975, Mexico City was one of the world’s first megacities, and today we are one of the largest metropolitan areas in the world. Over the years we have tackled head on the challenges that come with being a city of our size, from air pollution to water security, crime to transport. Today, we must rise to the challenge of urban diabetes.
In Mexico City we have the building blocks to tackle urban diabetes: some 26,000 healthcare professionals; nearly 700 medical units;
formidable partnerships with important foundations and academic institutions; expertise in urban planning; and the collective recognition of the scale of the challenge that we face. For me, Cities Changing Diabetes is a catalyst to sharing and learning about the dynamics of urban diabetes, and is a spur to concerted action across all of us who can make a difference in my city and beyond.
I’m delighted to work alongside a new and broader set of partners, and am proud to be a part of the global fight against urban diabetes.
How individuals and communities engage with healthcare resources in Mexico City is influenced by their trust or mistrust in the quality of care, their perceived right of access to those services, and barriers to accessing them. Insufficient insurance or the absence of insurance altogether can either be a motivator to manage one’s own health to avoid a precarious situation, or a disheartening experience for those who feel theirs is a ‘helpless’ condition.
With an abundance of needs but limited resources, it is logical to prioritise certain needs over others. In the face of socioeconomic disadvantage, people in Mexico City find themselves having to make a choice between food and medication; paying the bills or paying for transport to their hospital appointment. Similarly, when confronted with more than one health concern at a given moment, people choose to focus their attention and energy on illness at the expense of other health concerns.
Gender is very relevant to the experience of illness. In a society that places the emphasis on traditional gender roles, women struggle to manage their health alongside their domestic obligations. Not wanting to be perceived as selfish, burdensome or vulnerable, women in Mexico City are prone to neglect the dietary and physical requirements necessary to care for their personal health.
Women’s perception of themselves as vulnerable to the violence of others impacts their willingness to leave the safety of their homes and thus represents a major barrier to health-seeking behaviours, such as attending informative classes or doctor’s appointments on their own, or engaging in physical exercise. On the other hand, many men still depend on the care provided by the women in their lives. If there is no one there to assist them, men in Mexico City often struggle to manage their own care.
The type of care and treatment utilised and sought after is dependent on availability of particular options and attitudes towards those options. For example, in the presence of wide-spread distrust in the quality of services offered at hospitals, people tend to seek out alternative forms of care, including homoeopathic treatments, or ask their local pharmacist for health advice.
Data from Mexico City reveals that the negative consequences and symptoms of diabetes (such as loss of sight, amputation and kidney failure) are often based on a lack of understanding of the disease. In turn, a poor understanding of the disease and its dangers is the result of barriers to access resources and information.
Conceptualised as a place of stress, exploitation, social insecurity and delinquency, Mexico City is often referred to as causative of disease. A popularly held belief is that diabetes is caused by fear and other negative emotions, such as anxiety or stress (‘susto’). The belief that diabetes is a mental issue poses a barrier to meet the physical demands necessary to prevent and manage the condition. Though many recognise the impact of stress (particularly from the urban setting) and high-sugar diets on the development and management of diabetes, few acknowledge the role of exercise. However, recognition of the importance of exercise is only one of several barriers, such as absence of safe and appropriate places to exercise and availability of time to devote to exercise.
“There is no question about it: diabetes is the number one health challenge in Mexico City. In July I set out a new strategy for obesity and diabetes. We have a lot to do, from encouraging healthy lifestyles, to supporting treatment which can avoid some of the tragic complications. diabetes is today the primary cause of death across the country.
I see Cities Changing Diabetes as an important contribution to tackling diabetes in Mexico City. For the first time, people leading some of the city’s most impactful initiatives are coming together to share and develop learning. That Dr Ahued Ortega, our city Minister of Health, travelled to help launch the programme in Copenhagen shows our desire to connect with others around the world on this issue. I’m proud that Mexico City helped launch this programme beside Novo Nordisk, and I look forward to working together to take on this significant challenge.“