12. Diabetes in Ethnic Minorities and Immigrant Populations in Western Europe
Authors: Oliver Razum, MD Helmut Steinberg
Publisher: Springer International Publishing
All Western European countries have ethnic minorities and immigrant populations. The origin of these populations is largely due to resettlement from former colonies, due to need for labor, and, to a lesser degree, due to policies regulating the settlement of political refugees. Most research comes from local and regional studies with varying definitions of ethnicity and diabetes, and, therefore, cross-European comparisons are rare. Diabetes prevalence appears to be approximately twofold higher in ethnic minorities as compared to native populations; in addition, females are at higher risk to develop diabetes than their ethnic male counterparts. Most evidence points toward lifestyle, increased caloric intake, and decreased exercise, as the main driver of diabetes in these populations; there may be differences in metabolism and genetic susceptibility and the results of currently ongoing studies will shed more light into these issues. Earlier studies reported higher rates of microvascular complications in ethnic minorities, but more recent studies suggest that these between-population differences are becoming smaller. Access to health care is almost universal in Western European countries. Data for health-care delivery and utilization, however, are scarce mainly due to lack of recording ethnicity in the primary care setting. While available studies show similar access for health-care services between populations, they demonstrate lesser improvement in glucose control in ethnic minorities; language barriers, low health literacy, and cultural and religious norms are some factors that may explain the lesser success in treating diabetes. Development of culturally competent health-care systems, based on studies designed to identify successful interventions, is needed to reduce ethnic health disparities and improve outcomes.