Read time: 4 minutes

• The common narrative around type 2 diabetes is that the condition is a result of individual health habits (or lack thereof), rather than systemic dysfunction and targeted advertising that lays the groundwork for unhealthy behaviors in certain populations, especially communities of color.
• In reality, research shows that type 2 diabetes is a systemic issue—one that’s related to many other structures of discrimination that especially impact the health of Black, Latinx, and Pacific Islander communities.
• To help raise awareness about these complex contributing factors to type 2 diabetes, The Bigger Picture campaign combines diabetes education with artistic expression, hosting spoken-word poetry workshops that encourage young people to share their personal experiences with diabetes in creative, yet informative ways.

Gabriel Cortez says type 2 diabetes is as common in his family as “hard work, obedience, and discipline,” or the row of sodas lining his family’s refrigerator “like a vest of dynamite, an arsenal of ways to self-destruct.” He paints a picture of his personal experience with diabetes through spoken-word poetry that captures what so many conversations about chronic conditions lack: the role of social, environmental, and structural causes.

In a spoken-word poem titled “Perfect Soldiers,” Cortez details the impact of type 2 diabetes on his Latinx family and community, tracing it back to his Panamanian roots. He talks about how his grandfather, a military veteran who lives with type 2 diabetes, grew up in Panama, “a country as occupied by Coca-Cola as it is by the U.S. military,” where “soda is cheaper than clean water.”

Later in his poem, Cortez writes that the same people who colonized Panama are now “colonizing his body, his taste buds” through targeted sugar advertising in the U.S. “It isn’t a coincidence that the military and beverage companies call us their target audience, our Black and brown bodies marching to the center of their crosshairs,” he says.

Cortez wrote his poem as part of a workshop for The Bigger Picture, a campaign that encourages young people of color to change the conversation about type 2 diabetes by educating them about the structural social circumstances that can lead to the condition and make some communities more vulnerable than others. In addition to dealing with targeted sugar advertising, communities of color also disproportionately face problems with accessing clean water, fresh food, support from healthcare professionals, and even spaces to exercise, according to a recent article in Diabetes Care. 

In collaboration with the University of California at San Francisco (UCSF)’s Center for Vulnerable Populations and Youth Speaks, a nonprofit youth arts organization, The Bigger Picture hosts writing and educational workshops with young people in schools and county health departments across California. For the past decade, the campaign has taught thousands of people about type 2 diabetes as an issue of not just individual health habits, but also of societal, structural dysfunction that sets the stage for unhealthy behaviors.

“We’re trying to raise awareness about type 2 diabetes as a structural issue that’s related to other structures of violence that impact the health of Black, Latinx, and Pacific Islander communities,” says Cortez, who’s now the director of programs at Youth Speaks. “We want to shift the narrative around how we think about type 2 diabetes, from one that’s rooted in shame (e.g., whether you as an individual make ‘good’ or ‘bad’ choices) to one that considers the options available to you when it comes to healthy food, clean water, and safe places to exercise.”

The hope is that, by connecting education about type 2 diabetes to an artistic expression of personal experiences with the condition, young people will be more driven to dismantle these social structures and improve the health of their communities. It’s this “union of art and science” that can really move people to action, Dean Schillinger, MD, founder of the UCSF’s Center for Vulnerable Populations, said in an interview with the National Institute on Minority Health and Health Disparities (NIMHD).

”When young people learn they are being targeted by the food industry, it gets them angry and motivated,” explained Dr. Schillinger. “I have heard them speak in ways that transform a room. No matter how much science and data I were to present, I could never be heard in the same deeply connecting ways that these youths are being heard.”

Granted, it’s tough to measure just how effective these types of workshops are in dismantling the health disparities behind type 2 diabetes. So far, though, the results seem promising. In one report from the Journal of Health Communication that assessed the impact of The Bigger Picture campaign, researchers noted that, after a school participated in a workshop, the school’s Black Student Union “successfully advocated for healthier menu options at their annual banquet after learning about how food impacts type 2 diabetes risk.” In another paper from Health Promotion Practice, researchers wrote that, to date, The Bigger Picture project has “contributed to local policy changes related to sugary beverages,” including taxes on these types of products and warning labels on certain advertisements.

In fact, one month after Cortez read his poem at the Berkeley vs. Big Soda headquarters in 2014 to support a proposed tax on sugar-sweetened drinks, Berkeley passed the tax.

Sure, instituting soda taxes and warning labels on sugar products may be small steps in the grand scheme of dismantling disparities in type 2 diabetes. But each step gets us closer to achieving health equity for all communities, shares Cortez, who now helps other young poets access The Bigger Picture workshops so they can use their own voices to speak out about chronic health disparities.

“The duty of the poet is to notice what other people might not—to direct their gaze to something new,” says Cortez. “That’s what we’re trying to help young people do so they can raise a new kind of awareness about type 2 diabetes.”