Ethnicity and place: the geography of diabetes inequalities under a strong welfare state

Abstract

The Nordic 'health paradox' designates the seemingly puzzling empirical reality in which, despite the presence of strong welfare policies targeting structural inequalities, distinct health disparities persist in Scandinavian societies. In Norway, previous research has shown that inequalities in diabetes prevalence are particularly salient, notably between ethnic groups. These have often been attributed to lifestyle, socioeconomic factors, or genetics. No previous research has sought to investigate the sociospatial mediation of diabetes inequities. In this article, we examine the social geography of diabetes in Oslo to examine whether the link between ethnicity and diabetes is confounded by place. We use data from the 2002 Oslo Health Study (n = 17 325) to fit logistic regression models, assessing whether contextual factors, such as the concentration of fast food outlets, predict self-reported diabetes outcomes after controlling for relevant individual level covariates. We also test for spatial autocorrelation in the geographical distribution of diabetes. The findings suggest that the organisation of urban space and the spatial distribution of health-related resources exert an independent effect on diabetes prevalence, controlling for ethnicity and other covariates. Living on the east side of Oslo increases the odds of suffering from diabetes by almost 60%, whilst living in a neighbourhood characterized by a relative concentration of fast food and relative absence of healthy food shops and physical exercise facilities increases the odds by 30%. Spatial context and toxic environments contribute to diabetes inequalities in Oslo, Norway. Future research and policy-making should take the geography of health disparities into account.