Escape from Poverty Helps Explain Diabetes Epidemic in the American South

Study: Rapid Economic Growth Can Strain Bodies Developed for a Lean World


The study tests the “thrifty phenotype” hypothesis, which suggests that if economic conditions present during fetal development improve dramatically during a person’s childhood, the prospects of poor health in adulthood increase.


In the South, and particularly for African Americans, poverty was rampant for several generations until industrialization took hold in the 1950s and ’60s, leading to rapid economic growth. The benefits of prosperity and the South’s large African American population – also at higher risk than whites for diabetes – both help explain the region’s current poorer health.

“It’s a clash between anticipated lifestyle and the lifestyle that’s realized,” said Richard Steckel, distinguished university professor of economics,anthropology and history at The Ohio State University and author of the study. “If the thrifty phenotype hypothesis is correct, people with diabetes today should have had a socioeconomic history of moving from poverty to prosperity.”


If future rates of diabetes can be predicted based on income history, “this message is dire for historically poor countries undergoing rapid growth,” Steckel said. He also said the research has health-care implications, suggesting that doctors should collect data on patients’ socioeconomic background at the same time they take medical histories.



Steckel obtained state per-capita income data from the Bureau of Economic Analysis and diabetes figures from the CDC. He constructed a statistical model to investigate the consequences of income change on diabetes prevalence, analyzing the ratio of per-capita income in 1980 to that in 1950 and those ratios’ relationship to the proportion of each state reporting Type 2 diabetes in 2009.

The model suggested that two variables, the income ratio and the share of each state’s population that was African American in 2010, could explain more than half of the nation’s variance in the prevalence of Type 2 diabetes.






“This article does not contradict studies that show proximate causes of diabetes. I’m just trying to back up behind those proximate causes and say this is the underlying mechanism: a socioeconomic revolution, a nutrition revolution and a ‘derevolution’ of exercise and work,” Steckel said.


“You can probably identify the people most at risk for diabetes based on their socioeconomic history, and those are the ones clinicians should target.”


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