Just generations ago, diabetes was viewed as a relatively rare disease the middle-aged and elderly.  Now, it appears that an "epidemic" is raging in every industrialized country, afflicting every age group, with Northern America's largest cities, such as New York and Toronto, being hit most severely.  The rate of increase in the spread of diabetes in the Canadian province of Ontario and, in particular, the city of Toronto, is mirrored in the whole of Northern America.  This chronic illness is largely associated with poor nutrition, poverty, and obesity.  The incidence rate of cardio-vascular disease, blindness, kidney failure, amputations, and other devastating heath conditions in people with diabetes is many times more than that of people who do not have the disease.  In Ontario, one third of all strokes and heart attacks, as well as two thirds of non-traumatic amputations, occur in patients with diabetes.  The disease has the dubious distinction of being the fastest growing in the province, with about 60,000 new cases diagnosed annually.  Diabetes in Ontario is now the main cause of blindness among people under 65.

The modern epidemic of diabetes shortens the lives of many Torontonians and threatens to overwhelm the heath-care system as it costs billions of dollars nationwide.  On November 1, 2007, the results of a groundbreaking Institute for Clinical Evaluative Sciences (ICES) study were released by the Canadian press.  Disturbingly, it showed that socially disadvantaged groups that typically live in the urban ghettoes of Toronto - its poorest neighbourhoods - have a disproportionately high degree of diabetes compared to the rest of the population.  In fact, the incidence of diabetes here is three times higher than that of the general urban population.  These socially and economically marginalized residents of Toronto include many recent immigrants, visible minorities, First Nations' peoples, the disabled, the unemployed, drug and alcohol addicts, and other groups that mostly reside in the 140 poorest districts of the city.

Recent statistics show that more than 850,000 people have been diagnosed with diabetes in the province of Ontario.  About 225,000, or one in nine, live in Toronto.  Growth figures indicate that the current number of cases in the city has risen by 50,000, or a devastating 27 percent, since the year 2003, and continues to climb.  And if we consider diabetes statistics for local First Nations Canadians, those living at Ontario "Sandy Lake" aboriginal reserve, for example, we see that the incidence of diabetes there is as high as 25 percent, or one in four!  These statistics are especially sad if one takes into consideration that most cases of adult-onset, or Type 2, diabetes are completely preventable through proper dietary practices and moderate exercise.  The World Health Organization predicts that diabetes in Canada will jump by 23 percent by the year 2025, but the ICES study indicates that the rate of increase has already topped 69 percent in Ontario alone, since 1997.

According to Canadian national statistics on diabetes, two and a quarter million people in the country are afflicted by the disease and about a third of them are unaware of their condition.  To make matters worse, since almost half of all diabetic patients develop serious complications, such as heart disease, atherosclerosis, kidney failure, etc., 20,500 Canadians per annum lose their lives to the disease or related complications before reaching the age of 75.  Nationwide, over 60,000 new cases are diagnosed annually.  The Canadian Diabetes Association links the onset of diabetes to both unhealthy eating and physical inactivity which lead to obesity, the key reason for the development of the condition.  Senior citizens and the aboriginal population are the most susceptible groups.  More than 90% of all diabetes cases in Canada are composed of adult-onset, or Type 2, diabetes which can be prevented or substantially delayed.  The total annual health costs for treating the disease and its complications account for more than $9 billion.  Besides the costs, the human toll is reflected in reduced life expectancies, personal hardships, increased absences from work or school, elevated stress levels for individuals and their families, and career disruption.

The ICES research appears to show that diabetes in Toronto is a disease that is unquestionably connected with poor and lower classes of people, especially those living in downtown inner cities or "ghettoes", as in other big cities in the U.S. and Canada.  These people are often plagued with a number of threatening health conditions associated with poverty and obesity is one of the most obvious of these.  It is well known that diabetes is mostly caused by obesity, when the excess intake of dietary carbohydrates, especially those that come from processed sugars and grains, eventually damages the body’s system of carbohydrate metabolism.  This chronic illness impedes the secretion and proper utilization of insulin - a hormone manufactured in the pancreas in response to stress and digestion of carbohydrates.  Poor residents of Toronto often cannot afford fresh, healthy foods and end up buying cheap, processed junk, subsisting on it for years.  Their consumption of simple carbohydrates can reach 500 to 600 grams a day, which exceeds the norm several times.  Another contributing factor to the epidemic of both obesity and diabetes may be, controversially, that Canada’s health officials promote the USDA designed "Food Pyramid" to the Canadian population as the guideline of "healthy nutrition".  Many alternative dietary researchers, as well as conventional and naturopathic doctors, warn that the Pyramid, which emphasises carbohydrate-rich grains, juices and fruits and restricts meats and traditional animal fats, does not reflect the body’s real nutrition needs and sets the stage for the development of obesity, diabetes, and a whole host of related conditions.

In addition to the wrong dietary guidance, the prohibitive cost of fresh, natural meats and other traditional products, and the constant bombardment of TV ads promoting processed junk food, sweets, and fast-food restaurants, the residents of poor neighbourhoods of Toronto are even discouraged from walking, although unintentionally.  Regular exercise, such as daily walking, would be an effective preventive measure against diabetes.  Unfortunately, the designs of urban residential neighbourhoods are created for cars, but not really for pedestrians, and going to the grocery store to get wholesome food often means driving to a distant shopping center.  People who cannot afford a car, or have gas to fuel one, simply buy their foods from more convenient nearby doughnut shops or similar junk joints.  Few want to walk for an hour to a shopping center especially when sidewalks are absent, the lightning is insufficient and, in the winter, snowdrifts crowd the remaining pedestrian space.  “Walking culture" in the streets of Toronto is terribly absent because it has succumbed to the predominant "driving culture," a noisy feature of North American cities.  A high crime rate also discourages walking, especially at night and in inner cities with the ominous elements of alcohol and drug abuse, assault and theft.  And, while people with better incomes can afford gym memberships, participate in golf tournaments, or enjoy other organized recreational activities, the disadvantaged are denied such opportunities to exercise and, instead, may spend their leisure time in front of the TV.

To just recommend to poor Torontonians to "eat healthy" and exercise in order to prevent diabetes is definitely not enough.  Poverty, bad living conditions, and profit-focused corporations which manufacture and promote unhealthy processed foods are largely responsible for the current epidemic of diabetes in North America.  It is relevant to note that, in Toronto, the worst diabetes situations are observed in the northeast and northwest districts of the city which, coincidentally, have the most limited access to fresh food supplies and pedestrian-friendly routes.  These neighbourhoods are also the poorest and least desirable places to live in all of Toronto.  As the authors of the Toronto diabetes survey say, the results of their report should be a wake up call to city officials to invest in the immediate improvement of conditions in poverty-stricken urban areas where the “diabetes epidemic” is especially pronounced.