Beyond Arm Chair Social Science: Diabetes and Food Insecurity
Social science deals with social behaviour, everyday experiences, institutions and social issues that feel familiar to the public. This leaves people with the impression that they can refute empirical social science findings using their subjective world-views and personal experience. I will demonstrate the problems of this "arm chair" social science through a case study of the sociology of diabetes.
With increased media attention on diabetes, there are many misconceptions about what causes diabetes and how this condition should be treated. With these misconceptions comes judgements about the people who get diabetes, and why this may be the case.
On my blog, I provide an overview of the social science research on diabetes, centred on the research of epidemiologist Hilary Seligman (MD). Her team recently published a longitudinal study, finding that Americans from low socio-economic backgrounds who have diabetes are more likely than other income groups to end up visiting a hospital due to hypoglycaemia (caused when blood glucose level is too low). There is a temporal influence, which is related to the end of their pay cycle. Seligman’s team argues that food insecurity
(not having access to nutritionally adequate food) is a key factor in these patterns. Simply put, economically disadvantaged people with diabetes run out of money to buy food towards the end of their pay cycle and other bills also take priority. This results in a spike of 27% of hospital visits due to hypoglycemia (http://goo.gl/fCQ1tB
This work was refuted by +Scientific American
blogger, +Stephen Macknik
who did not draw on empirical evidence. Instead, even though he is not a social scientist, he drew on his personal experience
and his subjective opinion
about poverty to argue that poor people are not
suffering from hypoglycaemia - even though this is what the hospital records used by Seligman's team show. Macknick says that these people are simply gorging on the "dollar menu" of fast food chains, which triggers hyperglycaemia and eventually leads to a drop in blood sugar which then results to hypoglycaemia. What evidence does he have for this? Nothing but his own experience as a relatively privileged person who also happens to suffer from diabetes. Macknick subsequently posted this critique to +Science on Google+
, a large multidisciplinary Community that I help moderate (http://goo.gl/fohkIE
). My blog post expands on the social science I used to refute Macknik's assertions in his post to our Community. I use this case study to make a broader point about the dangers of "arm chair" social science.
Macknick is not the only science blogger to evoke personal opinions as a form of science. Since his arguments ended up on a science forum I moderate, I have used the sociology of health to show why it's not just the public, but also scientists from other fields, who need to understand the damage that subjective ideas and "common sense" can do. Reproducing scientific fallacies and stereotypes are especially problematic for vulnerable and disadvantaged groups. Disadvantaged groups with diabetes are doubly disadvantaged due to their precarious economic position and due to their illness which is already stigmatised.
Blogs are an informal medium for the discussion of personal opinions. But as +Michael Verona
, one of our Community members pointed out, blogging for a widely-respected science publication like Scientific American lends further credibility to these opinions. This only serves to confuse the public when a scientist steps out of their area of expertise to speculate on social issues they are not trained to analyse.
Social science is not about using personal opinion. We present empirical evidence. We draw on established theories, concepts and methods to provide a broader social context to phenomena that the lay public takes for granted. In brief, below is some of the evidence I present on my blog, with a focus on the importance of social science empirical insights.Sociology of diabetes
While diabetes has a biological component that geneticists and other sciences address, diabetes research is a multidisciplinary field. Social science research focuses on how socio-economic status and social factors impact on the spread and management of diabetes for different social groups. This is the focus of my analysis.
Social science research on diabetes has firmly established that poverty significantly impacts on the risks and management of diabetes (http://goo.gl/jXO1sd
). The American Dietetic Association has identified that food insecurity is a contributing factor to diabetes (http://goo.gl/fjlWnO
). Low-income people who are diabetic are more likely to experience food insecurity and as a result they are more likely to require treatment by physicians relative to people with diabetes who do not experience food insecurity (http://goo.gl/JGPZFW
Other studies have identified that people with diabetes experience hypoglycemic reactions as a direct outcome of not being able to afford food (http://goo.gl/ayDVce
). Food insecurity and socio-economic factors influence how people with diabetes access quality care and their "ability to adhere to recommended medication, exercise, and dietary regimens, and treatment choices"
). The same conclusions on food insecurity and diabetes are supported in other nations like Australia (http://goo.gl/78aeA7
My blog also shows that social location matters, as people living in low-income urban areas (http://goo.gl/DM1hCl
) and those living in poor rural areas (http://goo.gl/I9a256
) are more likely to experience food insecurity which exacerbates chronic illnesses like diabetes. These effects are compounded for racial minorities from lower socio-economic backgrounds, specifically Hispanic and Black Americans. There are further problems for women and children within these sub-groups (http://goo.gl/WOMrqk
Various comprehensive studies show that when poor people make food choices, these decisions are weighted against everyday necessities, such as paying essential bills. Their food needs and personal health comes secondary to paying the rent and key utilities like electricity (http://goo.gl/DNSg2U
). The research I discuss shows clearly that poor people with diabetes are not simply making frivolous choices about eating junk food. They simply can't make ends meet. Feeding themselves unfortunately is a day-to-day survival choice. Maintaining shelter and basic utilities for their families takes precedence. This is a no-win situation resulting in a health crisis.Sociology of health
Sociologists see diseases like diabetes as a public health matter. This is very hard for the general public to accept because because it goes against “common sense.” For example, some may wonder: Why can't poor people simply find a way to better manage their finances? What could be more important than eating right especially when one has an illness like diabetes? Can't they just stop eating junk food and follow doctor's orders?
Diabetes is linked to poor nutrition but this is not always simply about eating too much of the wrong types of food. As I've shown, diabetes can be aggravated simply because people don't have enough food to eat.
Diabetes is linked to obesity, an idea Macknik evokes by positioning diabetes as being about “too many carbs rather than too few calories.” In my post, I use social science to establish that both diabetes and obesity are linked to poverty and food insecurity. A White, educated American man's ideas of diabetes do not speak to the full spectrum of sociological reasons explaining how and why diabetes manifests and is managed by Other groups.
Diabetes involves self-care, which means following nutritional and lifestyle changes. Following doctors’ orders is easier when an individual does not have to cope with additional financial stress. In a society where values of individualism are the norm, health is perceived as a private matter that individuals manage alone.
Health and illness are not always just about an individual choices. While people have agency to make decisions about what’s best for them, these decisions are prioritised according to material and social constraints. In the case of poor people experiencing diabetes, their personal health sometimes has to take secondary position to their financial reality.
What looks like “common sense” from a privileged social position is not so simple from the point of view of minorities, disadvantaged, and vulnerable groups. Relying on personal experience and personal opinion as evidence against social science evidence is what I call “arm chair” social science. It is damaging to public education to perpetuate stereotypes about poor people. It distracts from addressing the social causes underlying illness.
Not all scientists are adequately qualified to speak about other sciences. As I noted last week, cultural beliefs, values and attitudes influence how the public understands science, and scientists can also fall prey to these social influences (http://goo.gl/7Rfa20
My blopg post further explores the problems of viewing diabetes from an individual perspective and why it's important for social science discussions to be led by qualified social scientists.
Read more on my blog: http://othersociologist.com/2014/01/26/sociology-of-diabetes/ #sociology #socialscience #science #research #DebunkingJunkScience #diabetes #publicscience #publichealth #inequality #foodinsecurity