Beyond individualised approaches to diabetes type 2

Explanations for type 2 diabetes are broadened beyond the individual body and 'bad lifestyles' to include major institutions, the social and material contexts of food and eating, and employment. Precarious employment, a social determinant of health, encourages changes to food practices, lowers working conditions, worsens health, can bring poverty and increases shift work, a causal risk factor for diabetes. Scientists have played a part in revolutionising foods and technologies which minimise labour and movement. There are excess additives in processed food. Genetic explanations for the higher rates of diabetes in First Nations peoples give way to social explanations: colonial history, British/Euro-American cuisine, food insecurity, trauma and social conditions resulting in chronic stress. Self-management education takes a 'nutritionist' approach towards food and eating and tends to minimise the social context and skills of those with the condition particularly women workers in poorer social groups who have higher rates of diabetes (T2DM).