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Story Publication logo April 20, 2023

Diabetes a Major Factor Behind Declining Life Expectancy in Rural Areas

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Rural Rx

When it comes to health care, the gap is widening between rural America and the country’s urban and...

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Multiple Authors
Video courtesy of PBS NewsHour. United States, 2023.

Over the past two decades, life expectancy in rural areas has declined. One major reason is the prevalence of diabetes. With support from the Pulitzer Center and in collaboration with the Global Health Reporting Center, special correspondent Dr. Alok Patel reports from the Rio Grande Valley in Texas for our series Rural RX.

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Amna Nawaz: Over the past two decades, life expectancy in rural areas has declined. One reason is the prevalence of diabetes.

With support from the Pulitzer Center and in collaboration with the Global Health Reporting Center, special correspondent, Dr. Alok Patel reports from the Rio Grande Valley in Texas.

It's part of our ongoing series Rural Rx.

Dr. Alok Patel: It's dinnertime in Edinburg, Texas,

Zierra Guajardo, age 11, is helping to lay out the plates.

Destiny Rivera, Mother of Zierra: She's drinking lemonade, but the lemonade, where is it? It is sugar-free.

Dr. Alok Patel: They're watching the sugar because Zierra has diabetes, diagnosed last fall.

Destiny Rivera: At first, she had gotten strep throat. Then she had gotten scarlet fever. And she just kept picking up every single virus. I just told my doctor: I can't do this anymore. You need to find out what's wrong with my daughter.

Zierra Guajardo, 11 Years Old: I was getting, like, sick, like super sick. I had specks all over me.

Dr. Alok Patel: She ended up in the hospital.

Destiny Rivera: It was about the third day. They came back. They did a history in her blood and found that three months before that her body had stopped producing insulin.

And now, looking back and thinking all the signs, like, where she was always thirsty, she peed a lot, so much. She'd get up so much in the middle of the night. And I'm like, you need your full night's rest. And I would have never thought that this could happen to her.

Zierra Guajardo: This one is the testing strip to test what my blood is.

Like, I'm scared that it's going to go too high or like too low — 128.

Dr. Alok Patel: Eleven percent, or 37 million Americans, have diabetes. And it's an even bigger problem for rural areas.

In places like South Texas, the percentage of people with diabetes ranges from 15 to 21 percent.

Dr. Ivan Melendez is a family medicine specialist and the top public health official in Hidalgo County.

Can you give me an example of some of the big public health needs in this community that you look after?

Dr. Ivan Melendez, Hidalgo County Health Authority: Oh, my God, the examples are too numerous to count. You imagine, if you will, if you lived in a county where you were one or two always of the most poverty-stricken counties in the entire country.

So we are the most obese, the most diabetic, most hypertensive, the poorest, and an average education level of eighth grade.

Dr. Alok Patel: Of diabetes patients, about 6 percent, including Zierra, have type 1, an autoimmune disorder. The vast majority have type 2 diabetes, which is closely linked to diet and lack of activity, which Zierra's as doctor says are both common here.

Dr. Jose Gomez, DHR Health: Well, remember that type 2 diabetes goes hand by hand with the incidence of obesity.

Dr. Alok Patel: Across the country, rural children are 26 percent more likely to be obese.

Dr. Jose Gomez: And you can add to that the fact that, here in South Texas, there is not too much exercise, either for the weather, even for because the distance is too long, and we don't are used to walk like the people in New York, for example.

Dr. Alok Patel: Hispanic Americans are especially vulnerable, far more likely to have type 2 diabetes compared to non-Hispanic whites.

Dr. Ivan Melendez: So we have all the factors, obesity, a very poor diet, financial reasons and cultural reasons.

Here, if you're not at least 20 percent overweight, you're considered skinny. We have a high carbohydrate. We have 70 to 80 percent carbohydrate — carbohydrate diets and then the access of quality food. And so it's a — if you will, I hate to use this cliche, but it's a perfect storm.

Dr. Alok Patel: Silvia Garcia is a nurse making home visits for a program run by UTHealth Houston.

Silvia Garcia, UTHealth Houston (through translator): The biggest problem sometimes is poverty because they don't have the money to buy their medicines.

Dr. Alok Patel: Before Gloria Cortez was connected with this program, just getting to the doctor was an ordeal.

Gloria Cortez, Diabetes Patient (through translator): To go to the doctor, it took about an hour, sometimes all day.

Dr. Ivan Melendez: This is a part of the country that, if you do not have a vehicle, then it's extremely difficult for you to get about. The public bus system is — it's murderous. It's just nonexistent.

Dr. Alok Patel: Diabetes requires constant management.

Dr. Ivan Melendez: How do you get to the pharmacy? How do you get to your doctor? How do you get the follow-up?

Dr. Alok Patel: Visiting nurses are one solution. Another comes from U.T. Rio Grande Valley which sends a mobile unit to locations around the region.

Woman (through translator): Once a person has it under control, we need to think about the long term.

Xavier Duran, U.T. Rio Grande Valley: We try to make it to areas where they're a little bit further out, a little bit more rural clinics, rural areas.

Dr. Alok Patel: But transportation isn't the only challenge.

Dr. Linda Nelson, UTHealth Rio Grande Valley: I think that we're deeper in poverty here than in many places.

Dr. Alok Patel: Linda Nelson is senior director of clinical operations for UTHealth Rio Grande Valley. She oversees the mobile unit, as well as a network of 30 clinics.

Dr. Linda Nelson: If we don't have a low-cost health system for them, they don't come. A lot of our patients are day laborers. If they don't go to work, they don't get paid.

Dr. Alok Patel: So do you commonly run into patients who are having to pick between sustaining life with their family or work versus their own health?

Dr. Linda Nelson: Sure. Sure. Every day.

Dr. Alok Patel: Census data says a third of area residents are uninsured. However, a research project at U.T. Houston found the true proportion is even higher.

Silvia Garcia (through translator): Here in the Rio Grande, more than 50 percent of the community does not have access to health insurance; 50 percent is a very high number.

Dr. Alok Patel: Immigration status can be another barrier to care. Many medical providers here don't even ask, so they don't scare patients away.

Silvia Garcia (through translator): There were people who didn't go to the clinic to pick up their medication because they were afraid of being detained. We struggle a lot to get people to go to their appointments, to get people to go pick up their medications.

Dr. Alok Patel: For some families with children, it's a complicated dance, says Debra Franco. who runs the South Texas Juvenile Diabetes Association.

Debra Franco, President, South Texas Juvenile Diabetes Association: The children may not be undocumented. They may be born here in the United States. But the parents are undocumented. And so that creates this crazy distrust of the system.

Dr. Alok Patel: Undocumented or not, treating chronic illness puts a premium on lifestyle changes.

Silvia Garcia (through translator): Healthy vegetables are also a bit more expensive. Places are far away.

Dr. Alok Patel: Despite being surrounded by farmland, for people here, fresh fruit and vegetables are hard to come by.

Debra Franco: So we started a specialized food pantry. And we have a community garden so that we can also educate our families on how to have a healthier lifestyle.

Dr. Ivan Melendez: Prevention is the key.

Dr. Alok Patel: Ivan Melendez says that, for most people, it also takes a big change in mind-set.

Dr. Ivan Melendez: And how do you convince a 42-year-old man with a family of three, all five of them who make $500 a week, to go get their diabetes check or get their obesity check? How do you feed someone who has eggs and beans and bacon in the morning and a fajita platter at lunch and a hamburger in the evening? It's a lifestyle.

So it's a tremendous hurdle.

Dr. Alok Patel: Diet may not cause type one diabetes, but certain foods can lead to a dangerous spike in blood sugar.

So, like, when you look around the cafeteria and you see Takis and candy, like, what do you think?

Zierra Guajardo: Trouble, trouble, trouble and trouble.

Dr. Alok Patel: You look — you literally look around and in your mind, you think?

Zierra Guajardo: Sugar up.

Dr. Alok Patel: Do your friends know what you're going through?

Zierra Guajardo: Yes. They're like: We support you and we love you.

Dr. Alok Patel: Nearly half the patients with Zierra's form of diabetes go on to develop serious complications. But by catching and treating it early, she has a much better chance of beating the odds.

For the "PBS NewsHour," I'm Dr. Alok Patel in Edinburg, Texas.





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