ORIGINAL PAPER The Twin Epidemics of Poverty and Diabetes: Understanding Diabetes Disparities in a Low-Income Latino and Immigrant Neighborhood Claudia Chaufan • Meagan Davis • Sophia Constantino Ó Springer Science+Business Media, LLC 2011 Abstract In the United States, low-income immigrant groups experience greater health disparities and worse health-related outcomes than Whites, including but not limited to higher rates of type 2 diabetes (T2DM). The prevention and adequate management of T2DM are, to a great extent, contingent on access to healthy food envi- ronments. This exploratory study examines ‘‘upstream’’ antecedent factors contributing to ‘‘downstream’’ health disparities, with a focus on disparities in the structural sources of T2DM risk, especially food environments. Our target group is Latino immigrants receiving services from a non-profit organization (NGO) in Northern California. Methods are mixed and data include focus groups and surveys of our target group, interviews to NGO staff members, and estimation of the thrifty food market basket in local grocery stores. We find that while participants identify T2DM as the greatest health problem in the community, access to healthy foods is severely restricted, geographically, culturally, and economically, with 100% of participants relying on formal or informal food assistance and local food stores offering limited variety of healthy foods and at unaffordable prices. While this article is empirical, its goal is primarily conceptual—to integrate empirical findings with the growing literature underscoring the sociopolitical context of the social determinants of health in general and of T2DM disparities in particular. We propose that interventions to reduce T2DM and compara- ble health disparities must incorporate a social justice perspective that guarantees a right to adequate food and other health-relevant environments, and concomitantly, a right to health. Keywords Type 2 diabetes Á Poverty Á Social determinants of health Á Food environments Á Right to health Introduction Type 2 diabetes mellitus (T2DM) afflicts over 23 million children and adults individuals living in the United States, with annual costs exceeding $174 billion [1]. Major clinical trials have demonstrated that diabetes risk can be signifi- cantly reduced through lifestyle changes [2]. However, and despite some successes with culturally competent T2DM prevention or treatment programs geared to achieving those changes [3], rates of T2DM and its complications remain stubbornly high among people living in poverty [1]. Pov- erty imposes multiple barriers to health [4], including limited access to healthy nutrition [5], and is a strong predictor of diabetes [6]. The relationship between poverty and T2DM is mediated through a variety of biological/ behavioral pathways, such as fetal exposure to the mother’s risk factors (e.g. pre-diabetes) [7] and restricted access to adequate amounts and quality of food, i.e. food insecurity [8], the latter leading to stunting in early childhood or overconsumption of calorie-dense, cheap food over the life course [9]. However, our work in the field of poverty and T2DM has shown that poverty is rarely targeted for investigation or intervention, even as it is continuously acknowledged as a modifiable risk factor [10]. Thus, and despite the millions of dollars spend annually in attempts to reduce the societal burden of T2DM [11], the Healthy People 2010 goal of eliminating health disparities [12], C. Chaufan (&) Á M. Davis Á S. Constantino Institute for Health & Aging/School of Nursing, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA 94118, USA e-mail: claudia.chaufan@ucsf.edu 123 J Community Health DOI 10.1007/s10900-011-9406-2