Changing the Narrative Around Diabetes

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Diabetes is a chronic disease. But people with diabetes also experience an equally chronic problem: stigma.

Underlying this stigma against diabetes are shared, deeply held assumptions about health that are embedded in American culture. The most common and problematic assumption is that health is primarily a matter of individual responsibility. In other words, health is shaped by personal choices about diet and lifestyle, and the primacy of these individual choices prevents people from thinking about other critical factors like access to healthcare and healthy environments. When people hear and think about health and illness the assumption that health is simply a matter of individual choice is usually the first to come to mind.

This focus on personal responsibility leads to a stigmatizing narrative that blames people with diabetes for making bad choices and for increasing healthcare costs. This narrative sets up “us vs. them” thinking and the assumption that people with diabetes are using more than their fair share of limited healthcare resources. Diabetes is also tightly linked to obesity, which is similarly stigmatized, meaning people with diabetes are doubly othered and shamed. As a result, people may feel a strong sense of fatalism about addressing this disease because they assume people with diabetes won’t make the right choices. Health equity, meanwhile, is almost entirely absent from the conversation.

If we are going to tackle stigma against diabetes we need to frame effectively. Framing means making choices about how we explain an issue or problem, what we emphasize, what we say – and what we don’t say. We’ve seen the power of framing in our own work on aging, addiction, childhood development, and obesity (in the UK). And we’ve all seen the power of framing in shifting the narrative in the civil rights movement, marriage equality, and teenage smoking.

Reframing diabetes means making careful, strategic, and evidence-based decisions about how we talk about diabetes that avoid the traps posed by individualism and fatalism. Instead we can use effective framing to direct people’s thinking along more positive, productive channels. We can create messages that avoid othering and instead recognize our universal experience; that don’t just assert but explain how stigma happens and why it is so damaging; and that pre-empt fatalism by demonstrating that solutions are possible, and we can achieve them together.

This brief contains five reframing recommendations that will help us change the narrative around diabetes. Each recommendation includes text drawn directly from influential, diabetes-focused websites, and a reframed version rooted in research that shows how to easily and effectively reframe it for greater success in shifting mindsets.

1. Show – don’t tell – what stigma is and explain implicit bias.

Stigma against people with diabetes is pervasive. Our research has shown simply saying that certain groups are stigmatized does little to help combat stigma and can even backfire.

When we are exposed to negative images and representations of different “types” or groups of people, we develop patterned, unconscious ways of thinking called implicit bias. These are thoughts and feelings about social categories that fall outside of our conscious awareness. Explaining what implicit bias is and how it is harmful helps people understand that diabetes and the stigma around it is a challenge we need to address together. Instead of telling people to change their attitudes, we pinpoint the underlying problem and prime them to think about solutions that work.

2. Start with what you want people to know about diabetes instead of repeating damaging myths.

A common method of communication in health and beyond is to present audiences with a “myth” and then refute the false information with the real facts. But this myth-fact structure actually backfires. We tend to remember the thing we hear or read first, so we are more likely to remember the myth as true. Not only that, but this backfire effect can get worse over time as people’s memories begin to fade, and even lead people to attribute the myth to the people trying to refute it. Always try to avoid repeating false information about diabetes, and if you have to refute false information, start with the facts.

3. Explain equity and always link it to clear solutions.

Racial inequities affect every aspect of our lives, including our health outcomes. Diabetes is no exception. Black, Latinx, and Indigenous Peoples are at higher risk of developing diabetes and less likely to receive the healthcare they need. But most people don’t understand what inequity means, or how inequities work. Instead they misunderstand the term or conflate equity with equality and have trouble linking the solutions you are advocating for to the underlying problem. Communications that lack a clear explanation of equity miss a critical opportunity to build understanding and support for equitable solutions.

4. Avoid crisis. Instead talk about how we can tackle diabetes, together.

Back in 2020, we learned that COVID-19 poses an acute threat to the health and wellbeing of people with diabetes. Raising support for development of new treatments and effective supports is therefore more important than ever. Talking about diabetes as a public health crisis makes sense – but may also be deeply problematic. “Crisis messaging” is often ineffective and counterproductive for several reasons. First, talking about social problems as crises, particularly in our current environment, leads to a sense of fatalism about addressing the problem. Crisis messaging often present problems as so big and overwhelming, they are just too difficult to solve. Second, when everything appears to be a crisis – and this is particularly the case now – crisis fatigue begins to set in. Rather than engage, people tune out. And third, crisis messaging may raise support in the short term, but the salience of the issue may quickly fade. If we want sustained attention and support for treating this diabetes, we need to keep people engaged over the long term.

The cure for fatalism and short-term support is conveying urgency while offering people concrete solutions that they see themselves, their communities, and our country as a whole as having a stake in. When people see clear and concrete solutions that have collective benefits they can recognize, it raises their support and increases their sense that addressing a problem is possible.

5. Talk about what we all need to be healthy, while still discussing people’s specific needs.

People with diabetes face significant challenges when it comes to health and wellbeing. Their challenges stem from not just to the diagnosis itself, but also because they are blamed for their own condition. In our society, people are thought to be solely responsible for our own health. If you are unhealthy, it must be because you failed. Failed to eat well, failed to exercise, failed to control the impulses that made you unhealthy. People living with diabetes are “othered,” blamed, and shamed as people with diabetes, even within the healthcare system. This in turn discourages people with diabetes from seeking health assistance that could help them treat and control the condition.

When we use messages that begin by emphasizing what we all need to have good health – like high quality preventative healthcare, access to safe and exercise-friendly outdoor spaces, and healthy affordable food choices – we divert thinking away from individual blame and toward our common experiences. This creates space for more productive conversations about how to treat diabetes by fixing systems, not just individuals.

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FrameWorks Institute. (2020). Education is at a Crossroads. Washington, DC: FrameWorks Institute.

© FrameWorks Institute 2020