Geographic inequity in healthy food environment and type 2 diabetes: can we please turn off the tap?

One problem is that the complexity of sustaining the prevention effort has not been captured well by randomised trials, which veer towards individual-level (sometimes referred to as “high-risk”) strategies rather than evaluations of structural interventions at the population level. General practitioners have a very valuable role to play, but placing the burden of prevention squarely on them will not work. The determinants of T2DM risk are intergenerational, relational, multifaceted and inequitably distributed. Legions of scientists have engaged with the idea that wherewe live andwork, andwhere our children growup and attend school, all have some influence on our life chances — for better and for worse. Pollution, green space, sidewalks, vandalism and so on — these “social determinants” accumulate, support, insult, provide resilience, wear us down and conspire in no small way to shape themanifestation of geographic inequities in health that our best efforts appear unable to budge. In fact, there is increasing appreciation that some health interventions actually widen health inequities.