“You must not confuse poverty with laziness”: A case study on the power of discourse to reproduce diabetes inequalities

The disproportionate impact of type 2 diabetes (T2DM) on poor persons and the social and biological processes linking poverty and T2DM inequalities are well documented. Moreover, millions of dollars are invested annually in programs aimed at reducing T2DM inequalities, yet these remain stubbornly high. Our paper explores how public discourses reproduce T2DM and related health inequalities in a low-income neighborhood in Northern California, through a thematic analysis of interviews and focus groups of staff and clients at a non-governmental organization. We probe participants' beliefs vis-à-vis the causes of, and solutions to, T2DM inequalities and explore whether and how the discourses normalizing them are challenged. We find that staff identify the ultimate source of T2DM inequalities within health sufferers, i.e., in their lifestyle choices, psychological makeup, or cultural preferences, even as they acknowledge the widespread poverty and multiple other social determinants that present serious barriers to their health. Notably, we find this normalizing discourse among clients themselves. While our study is empirical, its goal is primarily conceptual: to add to the evolving understanding of discourse as a social practice that may contribute both to status quo reproduction and to social change and resistance.