Author: Sara Kemppainen

Asylum seekers in the Netherlands are twice as likely to be diagnosed with diabetes when compared to the native Dutch population (Goosen et. al. 2014a). In a study conducted in 2014 by Diabetic Medicine, the researchers found that with the increasing length of stay, asylum seekers are more prone than the reference population to be recorded with diabetes. The research concludes “the high diabetes prevalence among asylum shortly after arrival, and the likelihood of further increase in risk over time suggest that diabetes among asylum seekers is a problem of considerable public health importance” (Goosen et. al. 2014a). What causes the diabetes prevalence rates to be persistently so much higher among asylum seeking men and women in comparison to the Dutch population?

What is Diabetes?

Diabetes Mellitus, commonly referred to as Diabetes, is a condition characterized by hyperglycemia (i.e. excessive blood glucose) which is a result from the body’s inability to use blood glucose for energy (ADA 2013). There are two types of diabetes: Type 1 and Type 2. In Type 1 diabetes, the pancreas is no longer able to produce insulin and therefore blood glucose cannot either the cells to be used for energy (ADA 2013). In Type 2 diabetes, either the pancreas does not produce enough insulin or the body is unable to use insulin correctly (ADA 2013).

Diabetes is treatable chronic condition that requires medical attention. If not managed sufficiently, people with diabetes are likely to become progressively ill and debilitated (WHO 2018). Over long period of time, diabetes can also damage the heart, kidneys, blood vessels, eyes and nerves (ADA 2013).

Prevalence of Diabetes in the European Union / The Netherlands

The prevalence of diabetes is undergoing a rapid increase in the European Union. There are about 60 million people with diabetes in the European Region, and the number of people is estimated to rise rapidly in the future (WHO 2018). In 2011 alone, 89 billion of euros were spend on treating diabetes within Europe, however many indirect costs are not accounted in this number such as productivity loss (OECD 2018). A major issue related to managing diabetes in the Europe is the varying degrees of health care provided in responding to the challenge early diagnosis of chronic diseases like the diabetes (OECD 2018). According to the European Standard, the Dutch health care system is among the best in the world.  

Common Risk Factors for Diabetes

• High blood pressure
• Overweight
• Low fruit & vegetable intake
• Tobacco use
• Alcohol consumption
• Cholesterol
• Physical Inactivity

Causes of high prevalence of diabetes among asylum population

The reasons for this high prevalence of diabetes among asylum seekers can be various but the Diabetic Medicine study mentions that that asylum population are likely to face an accumulation of diabetes risk factors either in their country of origin or during the asylum-seeking process.

The diabetes risk factors connecting to asylum seekers’ country of origin or childhood can be following: higher genetic susceptibility, an early life exposure to low birth weight, famine and sweeping socio-economic change (Goosen et. al. 2014a). While, the risk factors upon arrival can be related to lifestyle factors such as physical inactivity, low intake of fruits and vegetables, high intake of refined carbohydrates and saturated fat, which all contribute to weight gain, thereby increasing the risk of diabetes (WHO 2018).

Another reason that appears to make asylum seekers more vulnerable to diabetes is the acculturation stress related to the asylum context (Goosen et. al. 2014b). These two aspects are stated to be the main determinants of the high risk of diabetes in their new host country (Goosen et. al. 2014b). In particular, childhood obesity and being overweight has been identified to lead to higher rates of diabetes prevalence. The study on “Obesity in Asylum Seeker’s Children in the Netherlands” by European Public Health Association, found that the prevalence of overweight and obesity increased rapidly among asylum seekers’ children throughout their stay the Netherlands (Stellinga-Boelen et. al. 2007). The early childhood obesity and malnutrition are closely related with high risk of diabetes mellitus. This trend among asylum seeker children in the Netherlands does not stand alone, according to the World Health Organization (WHO) every third child aged 6-9 in the European Union is obese or overweight (Enough and Elanco 2015).

What can be done?

Diabetes is a disease prevalent among overweight and obese people, which can stem from eating habits associated with excessive sugar and fat (Stellinga-Boelen 2007). However, in the case of lower income families the main issue is the lack of good-quality proteins and inability to afford nutritious food sources (Enough and Elanco 2015). Obesity cannot be thus classified only as an individual problem of over-eating and too little exercise, but as stated by Enough and Elanco “it is a systematic problem linked at least in part to the availability and affordability of nutritious and wholesome food” (Enough and Elanco 2015).

Thus, when trying to combat the public health issue of high prevalence of diabetes among asylum seekers, the policy should not only focus in promoting development of healthy and active lifestyle among incoming asylum seekers but also in ensuring access and affordability to balanced diet. Conclusively, the state that currently provides medical care for the asylum seekers is recommended to take into account this heightened risk of diabetes in planning their medical services throughout the asylum procedure.

References:

ADA (2013). “Common Terms.” American Diabetes Association. At https://www.diabetes.org/resources/for-students/common-terms.

Enough and Elanco (2015). “Dimensions of Food Security in Europe.” Elanco Europe. At https://www.elancoeurope.com/pdfs/elanco_eu_enoughreport_2015_press.pdf

OECD (2018). “The Diabetes Epidemic and Its Impact on Europe”. OECD. At http://www.oecd.org/els/health-systems/50080632.pdf.

Goosen, S., B. Middelkoop, K. Stronks, C. Agyemang, and A. E. Kunst (2014a). “High Diabetes Risk among Asylum Seekers in the Netherlands.” Diabetic Medicine 31(12): 1532-1541.

Goosen, Simone, Karien Stronks, and Anton E Kunst (2014b). “Frequent Relocations between    Asylum-seeker Centres Are Associated with Mental Distress in Asylum-seeking Children: A Longitudinal Medical Record Study.” International Journal of Epidemiology 43(1): 94-104.

WHO (2018). “Data and Statistics.” World Health Organization. At http://www.euro.who.int/en/health-topics/noncommunicable-diseases/diabetes/data-and-statistics.

Stellinga-Boelen, Annette A.M., P. Auke Wiegersma, Charles M.A. Bijleveld, and Henkjan J.   Verkade (2007). “Obesity in Asylum Seekers’ Children in The Netherlands — the Use of   National Reference Charts.” European Journal of Public Health 17(6): 555-559.